South Beach AIDS Project executive director Kevin Garrity is typical of his generation of gay men in that, at age 43, he's lost dozens of friends to AIDS. He figures it's easily a hundred people in the last twenty years. Those losses have made the California transplant a very careful boy in the bedroom. So Garrity found himself a little flabbergasted at the laissez-faire attitude toward safe sex he discovered upon moving to South Beach two years ago to work at SoBAP, www.sobeaids.org the AIDS Project's acronym. "My first two weeks at SoBAP, this nineteen-year-old kid comes in," he recounts. "He was down for the White Party or something like that and fell in love with this guy who told him he was HIV-negative. He lied. The kid got HIV and then the guy doesn't want to see him anymore. Not only that, the guy hadn't been keeping up on his [anti-HIV] drugs, so he'd developed a super-resistant strain, which he passed on. That was an eye-opener. It was like, 'Welcome to South Beach. It's all about me.'"
Greater Miami has always been a national hot zone for HIV/AIDS, with gay-friendly areas like Miami Beach, and black ghettos like Liberty City consistently the most blistering. County health department statistics (as of December 2002) reported 2822 adult AIDS cases and 1118 HIV cases in Miami Beach, more than two-thirds of which resulted from sex between men. Liberty City had 5318 adult AIDS cases and 1537 adult HIV cases, but only a fraction of those claimed to be from gay sex. As scary as those statistics are, though, even more frightening is the state's guesstimate that almost a third of the people who are HIV-positive don't know it. Considering how often state and federal agencies tend to underestimate South Florida, it wouldn't be too shocking if that percentage was actually higher.
One reason, Garrity says, is that a significant number of the people who are tested never return to learn the results, despite attempts to contact those who test positive; the state figures it's as high as 50 percent. At least this was the case until this past September, when SoBAP (a nonprofit prevention organization that targets gay and bisexual men between ages 16 and 29) began offering new rapid tests, in which the outcome is known in twenty minutes instead of the usual two weeks. It's part of a pilot program the state plans to expand to nearly every city sometime next year. Why wouldn't people come back? Fear and denial, basically, with a bit of plain laziness or instability thrown in the mix.
But with the new test, no excuses. Called OraQuick, the free, appointment-only test requires a pinprick of blood, which is swirled into a solution inside a small plastic vial. Then a plastic rod resembling the dipstick in a home pregnancy test is put in the solution for about twenty minutes. If two lines appear on the indicator, the blood tested positive for HIV. A second test with another product is then administered to make certain the first result was accurate. The client is immediately offered counseling and help obtaining medical services. Garrity says SoBAP was testing about 60 people a month with the old test. The convenience of the rapid test has brought more people through the doors. "We have tripled the number of tests we do," he reports. "That's the good news. The bad news is a lot more of them are testing positive." Garrity declines to offer specifics, saying he'd rather wait until there's enough data to determine whether a higher percentage of people coming in for rapid testing are HIV positive, or whether it's a statistical fluke.
Best guess, though, is that it's a real trend. South Beach culture, such as it is, has a notorious reputation for being consumed by pleasure-seeking in its least subtle forms. And it shows. A Florida International University study released this past summer revealed that 6.3 percent of men between ages 18 and 29 who lived in South Beach in the late Nineties were newly infected, compared with a national average of less than one percent.
The population is also in constant flux, both from new residents and tourism. "The problem is that all these numbers are snapshots," Garrity admits. "The average stay among people in our target ages is eighteen months. They're here, they hang out, party, work or go to school, and they leave." Miracle drugs that help control the disease have been a double-edged sword -- they're extending life but also reducing the perceived consequences of infection. "This generation doesn't see the face of AIDS," he complains. "We get a lot of, 'Oh well, if I get it, I'll just take a pill.' Like it's no worse than diabetes."
The steady expansion of HIV and AIDS among heterosexuals is aided by bisexual men, many of whom are in relationships with women who may not know of their partner's extracurricular activities. "We get lied to all the time," Garrity says. "There's a whole network of guys who are married or have girlfriends, but they do a little something extra on the down low."
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This is especially apparent on the other side of the causeway, where HIV awareness is even more underground. The Borinquen Health Care Center on 36th Street at NE Second Avenue in Miami also began to offer the new rapid test in late October. Borinquen's clientele hails from working-class and poor neighborhoods like Wynwood, Little Havana, and Little Haiti. Vincent Delgado, who directs the center's AIDS program, says a lot of men refuse to talk about what they're doing to put themselves at risk for the disease. "There's a lot of cultural stigma," he explains. "A big percentage of these cases are men having sex with men, but they don't admit that. It's the down-low syndrome."
"Down low" is a term coined by African-American men who have sex with other men but don't consider themselves gay. Delgado believes that attitude has also contributed to many of his clients not returning to learn test results. "It's their baggage -- they don't want to identify with the homosexual community," he says. "Haitians are even more closeted. I've been trying to start a Haitian gay men's support group but it's impossible."
Delgado says another problem is undocumented immigrants who are afraid the government will find them if their infection is confirmed; they also mistakenly believe they won't be able to receive medical services because of their illegal status. "There's still a lot of ignorance," he notes. The clinic is now trying to induce more people to return for results by testing for HIV, hepatitis, and syphilis in one session (syphilis infection has increased exponentially in South Florida over the past couple of years).
Another problematic issue for Delgado is age. Although much of the focus of AIDS prevention is on young people, the actual statistics show that older individuals are more likely to carry the disease. According to county health department statistics (October 2003), people under 30 make up less than 17 percent of AIDS cases in Miami-Dade County, and about 24 percent of HIV cases. People between the ages of 30 and 60 account for 78 percent of AIDS cases and 71 percent of HIV cases. "I feel like we neglect those people," he says. "We don't identify them as a risk group and so we don't pay as much attention to them." www.dadehealth.org/hiv/HIVservices.asp