The Protection Racket

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"Calm down," she coos. "I know it sounds like I'm creating a crisis in your lives, but there are solutions. You have to be conscious about what you're doing. It's not who you are; it's what you're doing."

Still, the mention of abstinence as one possible means to prevent infection prompts a 40-something woman with short hair and a husky build to sputter. "No, impossible," she declares. "There's no way to be abstinent, no, no, no."

Shortly after the presentation is done, Alvarado and Hidalgo walk across Johnson Street back to their office.

"When we first ask what they know, we look for the level of the people in the room," Alvarado says from the small cubicle space she shares next to Hidalgo. "That way, we can approach them in a different way. If they have no knowledge, you have to speak in a much simpler language. This was a medium-level group."

Hidalgo interjects: "We never, in my experience, have found a high level. Low to medium, that's it."

Preventing HIV anywhere in America is a tough task, and tackling the job in a place as diverse as South Florida is even harder. Here, the challenges in reaching immigrant communities are layered: language and cultural barriers that are divided yet again by country of origin, family makeup, and plain personality.

"When we talk about preventing HIV in Hispanics, I don't think there's one program that works across the board for all Hispanics," says Guillermo Prado, an assistant professor at FIU's public health school who specializes in HIV prevention in minority families. Baby-faced with a dark goatee, Prado is young and energetic. He's currently involved in a project looking at the most effective ways to prevent Hispanic adolescents from engaging in risky sex and using drugs, the two greatest risk factors in infection.

"The research out there shows that HIV rates and drug-use rates are not the same for all Hispanics," he says. "We know that certain Hispanic subgroups are at risk. Puerto Ricans tend to use intravenous drugs at higher rates, so they're at higher risk of HIV. Hispanics are a very heterogeneous group."

Research has consistently shown that enculturation, which is the process of an immigrant's assuming the values of his new country, plays an important role in HIV and drug use. Ironically, in South Florida in particular, the more encultured a teenager becomes, the greater his chance of risky behavior.

"What we've started to believe," Prado says, "is that it's not so much that the adolescent becomes subsumed in the American culture per se that puts them at risk; it's that they also lose the values of their country of origin." That's nothing new, of course, for a country that's been attracting immigrants for a few hundred years, but there's a twist here.

"The reason we believe this is such a risk factor is that their parents tend to be older, and coming to an area like Miami where Hispanics have political and economic power, they really don't need to speak English. They don't tend to gain American values." Meanwhile, the kids Americanize quickly, which heightens a cultural mismatch that affects family communication and can, Prado says, lead to risky behavior.

Haitian immigrants also face a readjustment in thinking about HIV when they arrive in America, says Edele Firmin, the HIV/AIDS outreach worker at Minority Development & Empowerment, a Fort Lauderdale agency that serves the Haitian community.

"To be honest, it's the newer immigrants that are more motivated about prevention, more open," says Firmin, who sports chin-length dreadlocks and round, black-rimmed glasses and speaks with a distinctive Creole accent. "When I recently had a focus group here, they were so shocked, the new immigrants, that there were Haitians living here who were not willing to disclose their status when they find they're HIV-positive."

But Firmin knows that many of those same Haitians will clam up as the realities about AIDS in America become clear. Many immigrants send money home, sometimes supporting an entire family. Some Haitians learn that they have a lot to lose in America by disclosing their HIV status, whether that's a job, spouse, or the support of friends.

By 1987, Darrow had been studying the transmission of HIV for more than five years, but he'd grown frustrated that he couldn't work directly on preventing the spread of the disease. His bosses at the CDC kept telling him they wanted him to work on vaccine studies, telling him that a vaccine was "just around the corner." Fifteen years later, there's still no vaccine.

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Wyatt Olson
Contact: Wyatt Olson