The Protection Racket

A quarter century after the advent of AIDS in America, Professor William Darrow's sense of urgency about one thing remains undiminished: This state, this country, isn't doing enough to stop the disease.

Although new treatments have made AIDS less deadly, a vaccine remains chimerical, and prevention efforts are flagging. We are as far from eradication today as we were 25 years ago. Last summer, Darrow, putting the considerable heft of his reputation as a groundbreaking AIDS researcher on the line, called for a "state of emergency" in South Florida. He called on Florida health officials to begin kicking in the state's own money for prevention. Nothing happened.

"We have known about the serious problem of HIV disease in South Florida for at least the last decade," says Darrow, a professor at Florida International University and a medical sociologist. "If you want to have a good program of public health, someone has to pay for it. Right now, the story line is that underfunded programs don't work."

Darrow is uniquely qualified to understand the implications of the disease. Back in 1981, he was a member of the scientific team with the Centers for Disease Control and Prevention (CDC) that first cracked the mystery of an ailment killing gay men. For the past ten years, as a professor at FIU's school of public health, his research has focused on the spread of the HIV virus in South Florida, particularly among gay men and minorities.

Ignorance and "safe-behavior fatigue" are the great enemies of prevention, AIDS specialists say.

"Few people seem to be interested in AIDS," Darrow declares. For those too young to remember the epic saga of AIDS in the 1980s, the disease can seem abstract or a relic from the past now that death rates have declined. For some new immigrants in America, HIV/AIDS simply wasn't discussed publicly where they came from. Others, however, who might have taken the disease seriously in the past have grown more complacent, wearied of keeping a constant vigil.

Still, HIV/AIDS remains a scourge. South Florida has long possessed higher-than-average rates of HIV/AIDS cases, and things are only getting worse. Much worse. According to CDC statistics released in November, Broward County led the nation in new AIDS cases in 2004, with 58 cases for every 100,000 people — up from fourth place in 2003. That's higher than Miami-Dade County. Even higher than New York City. Florida's overall rate jumped by 24 percent in one year, but Broward rose a staggering 49 percent.

Broward's minority population is especially affected, with the rate of AIDS three times as high for black men and twice as high for Hispanic men and women than it is for white people. Darrow's researchers found that less than a quarter of Broward's minority population living in the neighborhoods hardest-hit by the disease even know that the county is a high-risk place.

There's also been a recent upsurge of HIV infections among the county's gay men. Among white gay men, the jump has been a whopping 139 percent from 1999 through 2004.

This might seem like an auspicious time to redouble prevention measures. But the opportunity is passing us by.

If the past quarter century has been a war against AIDS, then Broward County has done fairly well caring for its wounded: those infected with HIV or who have developed AIDS. But this is a Bush-era war. When it comes to prevention, we've been scrimping on the body armor.

Almost all money used for prevention in Broward County comes from federal grants through the Florida Department of Health. The level of those funds, however, has remained stagnant for many years, even as the amounts needed for treating people already infected has increased.

"Patient-care dollars certainly increase because we're continuing to deal with a larger and larger population living with HIV," says George Castrataro, assistant director of the state's health department in Broward County. "The number of people living with HIV might be 16,000 right now, whereas it was at 10,000 a few years back. To care for 16,000 versus 10,000 people is a huge increase."

Without a vaccine, however, prevention is the only way of eradicating HIV and AIDS. "We certainly put a lot of money into treatment once somebody becomes positive, but not a lot of money is put into prevention," says Kathleen Cannon of Broward House, which provides an array of services for those with AIDS or at risk of contracting the disease. "If we just continue to Band-Aid this, we're not going to get anywhere as a nation. There's not enough right now in prevention, and I don't know if there will be more in the future."

Yet there's little sense of urgency, Darrow argues. For the past five years, he has headed a project called Reach 2010, funded through a grant from the CDC. The project's goal is to slow the spread of HIV in Broward County among African-American, Hispanic, Haitian, and Caribbean islanders in Broward. Its emphasis is primary prevention — keeping someone from becoming positive in the first place.