Notes from the Dead Zone

Many in the African-American AIDS community were angered by an action taken several months ago by the City of Miami, which administers the $12 million federal Housing Opportunities for People With AIDS, or HOPWA, program for Miami-Dade County. The city unilaterally diverted $500,000 in HOPWA funds to three agencies -- the largest chunk, $187,000, to a for-profit Hispanic company, Saber Consulting and Management Corporation -- to conduct AIDS education programs. That is not forbidden by the HOPWA regulations, but it did appear inappropriate to the U.S. Department of Housing (HUD), which had received numerous complaints and subsequently ordered Miami officials to reinstate the housing money. The city and HUD are currently negotiating the reinstatement.

Nevertheless support for AIDS treatment, research, and prevention programs appears halfhearted in Washington. AIDS funding has remained flat and some existing programs and policies are under attack from conservative interests. "You've got more organizations and there are more [people with AIDS] coming into the medical care system, so you're actually looking at an overall decrease in monies," explains Petera Johnson-Hobson, executive director of Empower U and director of education and training for Florida AIDS Action, a statewide lobbying group. "It's gone past being a racism issue; it's a federal funding issue, and I don't know if there will ever be enough now to go around. We're going to have to look at other funding streams, like foundations, become innovative in how we do business."

Johnson-Hobson and Empower U may have to look with yet more urgency now that the Bush administration is questioning the legality of the Minority AIDS Initiative. In light of recent court rulings dismantling affirmative action policies, the qualifications for receiving MAI funds may be eased, thus potentially allowing nonminority organizations to compete. However, according to some AIDS experts familiar with the issue, nothing has yet been decided in Washington (officials with the U.S. Department of Health and Human Services, which administers the MAI, did not return numerous phone calls).

The administration has also ordered the U.S. Centers for Disease Control and Prevention to audit AIDS prevention programs in several states, while promoting sexual abstinence and, according to a dispatch last month by the Associated Press, deleting information about condoms and sex education from the CDC Website. The government scrutiny of prevention programs, which one San Francisco official called a "witch hunt," was spurred by revelations that AIDS aid was used by one organization for shopping sprees and tickets to Disney World. Some lawmakers have also questioned the use of CDC money for sexually explicit educational seminars and workshops.

Those laboring in Miami's inner-city trenches don't have to worry about conducting workshops for their clients -- it's hard enough just finding them to tell them the results of their HIV tests. The Florida Department of Health, with the support of the CDC, sends hundreds of outreach workers into the streets each month, often in large vans equipped with educational literature, condoms, oral HIV testing kits, nurses, and counselors. The HIV test is now usually performed in about five minutes with the subject standing right there at the street corner, market, or bus stop. The worker hands him a swab, sort of like a Q-tip, which he holds in his mouth and then pops into a plastic tube filled with a preservative solution. The sealed tube is sent to a lab. The results come back in two weeks, and the workers who administered the test go back out with the good or bad news. By then a lot of subjects, most of whom are also drug users with unstable home lives or no home, have disappeared.

In a matter of weeks, when a new instant-testing kit comes on the market, the result will come back in only about an hour, thus largely solving the problem of low "returns," in AIDS lingo, and revolutionizing the entire testing process.

For the past four years, despite -- perhaps because of -- aggressive testing, the number of new HIV or AIDS cases in Florida has remained at about 5000. That's almost an eighth of all new cases nationally, about 42,000, a number that has also stayed static. Last year Florida health department laboratories processed 271,000 HIV tests (officials don't know how many tests private labs accounted for but estimate roughly the same number). A fair portion, some 4300 state-funded tests, were performed out on the streets of Model City, Little Haiti, Allapattah, and Overtown by MOVERS outreach workers. MOVERS was the single most prolific tester in Miami-Dade, aside from the county health department itself. From its beginnings in 1991 as a ministry of Mount Tabor Baptist Church, MOVERS has grown in a separate nonprofit, employing 80 and operating Liberty City's only physician-staffed medical clinic solely for AIDS patients.