Fighting HIV in Miami, one dirty needle at a time
Jose De Lemos, 53, and Hansel Tookes, M.D., a University of Miami medical resident, outside of Jackson Memorial Hospital after a recent visit. De Lemos, who has HIV, is being treated by Tookes.
By Amy Driscoll, Miami Herald
(Last of a 3 Part Series)
‘People Are Still Dying’
No one knows exactly why Miami-Dade’s HIV infection rate remains higher than other metropolitan areas, even as medicines are better than ever, statewide rates have declined and mother-to-child transmissions — AIDS babies — are rare.
Public health officials rattle off a variety of contributing factors: Thirty-five years into this epidemic, younger people think of HIV as a treatable, chronic disease. Drugs like Truvada, which can prevent HIV infection if taken as a precaution, have added to that perception. HIV is largely an urban disease.
Immigration brings people to Florida from places without much access to healthcare or health education. Miami is an international party town, and the highest risk for HIV is un-protected sex, especially for men having sex with men. Testing and medication in South Florida can be difficult to find.
Also, HIV has fallen out of the headlines for the most part, added AIDS Healthcare Foundation’s advocacy and legislative affairs manager Jason King.
“People are still dying. But you don’t get the press coverage. … So it’s not at the forefront of people’s minds.”
Stigma is part of the problem, too. If you can’t admit you have HIV, your sexual partners are probably at higher risk.
“It’s not a death sentence like before, but the stigma still exists,” said King, who is HIV positive. “And then they have to be conscientious about dis-closing it to their next partner and they fear rejection.”
That’s definitely true in Miami-Dade, said Dr. Cheryl Holder, a general internist who works at Jessie Trice Community Health Center and is an associate professor at Florida International University.
Holder says stigma, especially in the African American community, is one of the toughest issues she combats when she sees patients with HIV.
“We’re seeing changes in communities, but it’s still labeled as wrong and there’s something wrong with you. … I still have patients who hide their medicine.”
Walking out of the health center at the end of a day not long ago, she saw one of her patients, a young man in a hoodie, waiting for a ride from a family member. “If it weren’t for his diagnosis, I would have waited with him for his family. But as I walked by, he didn’t look at me and I didn’t look at him. And that’s when I know it’s stigma. He couldn’t just pull me over and say, this is my doctor. We need to normalize health care so I don’t have to walk past my patient and not meet his mom.”
In some ways, Tookes’ work starts again now. Though Congress lifted a ban on federal funding for needle exchanges late last year, no federal money can be used on needles them-selves. And Florida’s bill specifies that no public money can be used for the program.
That leaves Tookes, working with UM, raising it all — about $500,000 a year. And the pressure is on: Other counties in Florida are watching to see how well the program works.
“This pilot program is going to make a big dent in the infection rate in Miami. All eyes are on us. We have to make this a success.”
He has raised $100,000 from private donors locally — including Joy Fishman, the widow of the inventor of Narcan, the “save shot” for people who are overdosing — and another $100,000 from the MAC AIDS Fund.
Nancy Mahon, global executive director of the fund, said that syringe exchanges are key to fighting HIV/AIDS. “Needle exchange programs like this halt new infections, period. There is still work to do, but providing sterile syringes and supportive services to IV drug users is a solid step in order to begin saving lives.”
Miami-Dade’s health department is joining the effort.
“Definitely, we will be helping in any way we can,” administrator Lillian Rivera said. “We can’t buy the syringes, but we definitely will be providing wrap-around services. As the patients come in, we will be ensuring that they will be tested for HIV and hepatitis. … All of the services that we have will be available to the patients that come through the door.”
The IDEA Exchange, which will be run through UM, comes too late to prevent De Lemos’ infections. But it’ll help others as the 35-year war on the epidemic continues — as many as 2,000 in the first year, Tookes said. A project manager will start work in August, and other staff members are next. The AIDS Healthcare Foundation is donating the HIV and hepatitis C test kits with the agreement that those identified with one of the diseases will be linked with medical care. Tookes is hoping that other groups will follow.
And De Lemos — at 53, homeless no longer — will do his part, inspired by the fight of his doctor to pass the law. His viral load is so low it’s considered undetectable, and he is looking at life with new eyes. Service is part of his personal plan now. “I really want to be a part of this needle exchange program. If he can do that, I can do any-thing.”
Tookes says he will measure success with each HIV test, each syringe handed out.
“This has been a long journey … It’s a very exciting time for Miami. We’re going to save a lot of lives. We’re going to save a lot of money. We’re going to give people a lot of clean needles. We’re going to provide HIV tests. We’re going to get people into treatment … We’re going to change the world.”
By Amy Driscoll, Miami Herald
This copyrighted story comes from the Miami Herald, produced in partnership with KHN. All rights reserved.
This article was reprinted from Kaiser Health News with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a non-partisan health care policy research organization unaffiliated with Kaiser Permanente.