The Protection Racket

And the band plays on

With moribund state funding and the CDC slashing money to Reach 2010, Darrow called on the health department and others to declare an AIDS "state of emergency" in South Florida.

"A visible and viable coalition — and not just me and a few others — should call for a 'state of emergency' to address the AIDS situation in South Florida," Darrow says. "We should a have plan of action prepared to present with it that is credible, realistic, and worthy of support."

But Castrataro says that's unwarranted. After targeting prevention funding among blacks in Broward County for about a decade, he says, statistics show that HIV rates among that group have steadily declined. "The health department doesn't tell agencies what to do," he says, "but at that time we couldn't provide data to support the declaration of emergency."

The trouble with moving a finite amount of prevention money among at-risk groups, however, is similar to the carnival game in which you swing a mallet at toy gophers popping their heads out of holes: There's always another one jumping up elsewhere. So too is the case with beating back HIV infections in Broward. Just as the rates have gone down among blacks, infections among gay men — and Hispanics to a lesser degree — have risen, leaving the county with little overall improvement.

"It's very hard to have a persistent effort to try to deal with AIDS in South Florida," Darrow says.

After decades in the field, Darrow laments the current state of public health. "You can't make profit out of public health," he says. "It's a waste of taxpayers' money in a lot of people's minds, so it's not being supported."

For example, instead of increasing AIDS programs, the National Institutes of Health actually endured cuts for AIDS-related prevention of about $12 million last year.

Darrow mentions the disease that's galvanized the media recently, Asian bird flu. It may or may not become an epidemic, but he's pessimistic that the country, particularly South Florida, with its burgeoning population from around the world and strained health-care system, could handle such an outbreak.

"Sooner or later," he warns, "we're going to have to deal with piling people on top of each other, with a public-health infrastructure that's in decline."

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