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South Beach is the casual-sex capital of America or at least that's the reputation. So it was a surprise when, this past March, a sign appeared on the glass door of the Miami Beach Planned Parenthood clinic on Sixth Street announcing it would be open only two days a week.
Lack of funding? Well, no. The problem is lack of patients.
In Miami-Dade County, only 5000 men and women used Planned Parenthood's services last year, compared with 20,000 at the Palm Beach/Treasure Coast clinics and 29,000 in South Palm Beach/Broward. For Miami-Dade, a county where the percentage of uninsured hovers around 30 percent of the population some 700,000 people that's a drastically low number.
Along with the county's 28 health department clinics, Planned Parenthood is one of the few places that the uninsured or those who want confidentiality can receive reliable care and advice about sexually transmitted diseases (STDs) and family planning. And, unlike the health department, Planned Parenthood can usually schedule appointments for patients within 24 hours.
"I think that people are simply not getting the care they should," says Kathleen Mahoney, community director of Planned Parenthood of Miami. "They're forgoing their annual exam, their Pap smear, and their breast exams."
Planned Parenthood opened in Miami in 1975. Until five years ago, the affiliate had only one clinic, on NW 27th Avenue. It received a grant to open three more in 2001 (in North Miami, Kendall, and Miami Beach), but the number of patients did not rise accordingly.
To address the issue, the Miami affiliate merged with Planned Parenthood of Palm Beach and Treasure Coast this past October. The merger doubled Miami's staff from 20 to 40 employees, all of whom hope to increase the clinic's visibility. "We serve about 5000, but we'd really like to serve 60,000," says chief operating officer Triste Brooks, who now commutes to Miami from Palm Beach twice a week.
Among other initiatives, administrators opened a 24-hour call center last fall and expanded the hours in clinics like Kendall, where they minister to a growing number of teenagers seeking care. They also received a $125,000 grant from the South Florida Health Foundation and a $50,000 grant for La Promesa, a bilingual educational program.
In South Beach, though, these efforts haven't increased the number of patients. So to cut costs and direct resources elsewhere, new management slashed visiting hours by 60 percent. Maggie Turmel, lead clinician for the eight Planned Parenthood clinics in the region, says, "We're still trying to figure out the issue in Miami."
Although Planned Parenthood's staff is diverse, one problem cited by its clinicians and educators is that the city's cultural mix poses barriers to communication. Another challenge is shedding the organization's antiquated image of serving predominately Anglo women.
"Planned Parenthood nationally still predominantly sees and serves white people," says Brooks, who estimates that 80 percent of the organization's clients across the nation are Anglo. "In Miami I would like our clientele to mirror the population. In order to do that, we have to be culturally sensitive to how people plan their families and space their babies."
Marie-Jose Ledan, a health educator with Planned Parenthood and a native of Haiti, agrees. "In this city, there is a large community of immigrants who, because they are Catholic or even some Protestants don't believe in family planning, or they think that having children will change their immigrant status, or that the more babies you have the more fertile you are," she explains. "A lot of them [come from] male-dominated societies as well, where the men control the birth control."
One indicator of some women's desire to seek birth control secretly is the number requesting a Depo-Provera shot, a birth control method that doesn't require daily administration. "Sometimes they have to go against their family and sometimes against their spouse," Ledan adds.
But Planned Parenthood is not the only organization whose numbers are on the low side. Lori Jordahl, who manages community relations for the health department's sexually transmitted disease program, says Miami-Dade County STD clinics saw just more than 10,000 patients in 2005. "In our community, enough people don't come in," she admits. "We know that partners are sharing infections with each other, but not their sexual history. There is a lot of secrecy involved around sexual issues, but more so in a place like Miami because of all the different cultures."
Indeed testing is particularly important here. The latest Centers for Disease Control reports, from 2004, place Miami's rate of reported AIDS cases at 45.2 per 100,000 residents, second in the nation only to New York's. Miami's rate of syphilis infection was ninth in the nation.
In South Beach, however, the problem seems to be one of impermanence. "I used to drive my educators around Miami Beach and have them hand out condoms and flyers," says Ledan, "but a lot of people there are tourists."
Jordahl agrees: "There's a mentality that what happens in Miami stays here. Except for the STDs."