The Protection Racket

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Darrow transferred out of the infectious disease branch in 1987, taking charge of a section that developed intervention programs and community pilot programs, although at times he was called upon for AIDS research projects.

"I tried to start and guide this effort to get CDC and state and local health departments involved in interventions in health promotion in the absence of a vaccine," he recalls.

Darrow left the CDC in 1994, primarily because his wife had had enough of his workaholic ways. He landed a professorship at FIU, a location that made his wife happy because of the Miami airport's direct flights to Holland. Since then, he's coauthored a number of peer-reviewed articles concerning HIV and gay men living in South Beach.

Darrow saw a chance to increase HIV prevention work in a Clinton administration initiative intended to eliminate health disparities among minority groups. Out of that was born Darrow's Reach 2010 Coalition to Reduce HIV in Broward's Minority Communities, which was to receive just under $1 million a year until 2007.

The project contracted with several community organizations, including Hispanic Unity and Minority Outreach & Development, to work on prevention outreach and education.

"The difference between our plan and others in Broward County is that we were going out to the community and looking for residents who are at risk and delivering them prevention messages specifically at their houses, laundromats, houses of worship — wherever they hang out," says Claudia Uribe, the project coordinator, a serious young woman with long dark hair.

Unlike most prevention efforts, Reach 2010 meticulously measures whether its outreach is actually having an effect. Kenneth Obiaja, the research coordinator, whose desk is surrounded by stacks of interview notes received from outreach workers, says that the data doesn't point toward the kind of behavior changes they'd expected. But with funding cuts, he adds, "We haven't been able to spread our wings as wide as we'd have liked."

"The problem is that just about all the money currently being spent in South Florida to prevent HIV infections is federal," Darrow says. "Few Florida general-revenue dollars, if any, are used to prevent HIV infections, unless you count the matching funds the state legislature puts up to support Gov. Bush's 'It's Great to Wait' teen pregnancy prevention program."

The health department's Castrataro, a young man with a shaved head and buffed physique, admits that prevention money has been and will likely remain flat. That has meant shifting prevention money among certain groups with rising HIV rates.

Tallahassee's way of dealing with the static funding, Castrataro says, has been to instruct local health departments to "be more creative, be more efficient, find new opportunities to use what you have to address everyone's needs without hindering any one population."

One casualty of low funding was local prevention plans. The state had mandated that local health departments, in partnership with community-based organizations, produce three-year prevention plans tailored to meet the needs of the groups most affected by HIV. Last year, the state stopped requiring the plans, which it had never sufficiently funded in the first place. (Castrataro says his office is developing a five-year plan anyway.)

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."

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Wyatt Olson
Contact: Wyatt Olson