Why Miami Is the Epicenter of New HIV Cases in the U.S.

Judy Woodruff:

And now we continue our series on The End of AIDS.

Tonight, we turn back to the U.S. and to the epidemic that continues in the South.

The state of Florida accounts for 10 percent of all HIV cases in America, and it is home to four of the top 10 cities in the U.S. for new HIV diagnoses.

While the state has begun an ambitious plan to tackle the crisis, it has also cut health spending for years and chosen not to expand Medicaid.

William Brangham and producer Jason Kane report from Miami, where the problems go deeper still. This series was produced with support from the Pulitzer Center.

William Brangham:

Natasha Dixon needs help. She’s addicted to heroin and HIV-positive, and not being treated for either.

She’s come to this mobile needle exchange van parked under an overpass in downtown Miami. If you want stop the spread of HIV, a woman like Natasha Dixon should be a top priority. Her untreated HIV means she likely has high levels of virus throughout her body, and sharing needles with others is one of the easiest ways to spread that virus around.

Natasha Dixon:

I have seen people pick up syringes on the ground to use them, if they don’t have anything to get high with. So, believe it or not, most of the people out here have it, whether they say it or not, you know? So, I mean, everybody shares needles around here.

William Brangham:

But, remarkably, this is the only needle exchange program in the entire state of Florida. Two years ago, this proven HIV prevention tool was illegal in Florida.

That only changed when this man, Dr. Hansel Tookes, then just a med student, fought for its creation.

So, just a few years ago, you could’ve been arrested for doing this?

Dr. Hansel Tookes:

Absolutely. It would’ve been a third-degree felony for us to give syringes to people who want to protect their health.

William Brangham:

Tookes says regulations prohibits him from treating Dixon’s HIV right here in the van. She has to fill out paperwork, go somewhere else, get another test. He says all these little impediments exacerbate the spread of HIV.

Dr. Hansel Tookes:

For people like Natasha, who indicated to me in the van that she wants to be in HIV care with me, somebody who has high-risk drug behavior, high-risk sexual behavior, there literally should be a conveyor belt, with a red carpet, to move her from the mobile unit into a clinic, with me sitting there smiling to welcome her into care, because as long as she remains with these high-risk behaviors, the epidemic will not be contained.

William Brangham:

Miami, Florida, with its miles and miles of beautiful beaches, draws visitors from around the world. But it’s also a hotbed of HIV transmission.

Nationwide, new HIV cases are declining, but Miami’s are on the rise. The rate of new diagnoses in the Miami area is three times the national average. It’s the highest rate anywhere in the country, far higher than in New York or San Francisco.

Mario Stevenson:

Miami is an epicenter, but, in fact, the epicenter of the epicenter of HIV/AIDS in the United States.

William Brangham:

Mario Stevenson is one of the world’s leading HIV researchers. He runs the infectious disease division at the University of Miami’s Miller School of Medicine. He worked with the Department of Health to help Miami develop its recent plan to reduce new infections.

Mario Stevenson:

Twelve million tourists visit Miami every year. People come here for the nightlife. They come here for sex. They’re coming to an area that they’re unfamiliar with. They can do whatever they want to do.

We have to reach this vulnerable population. We need to make sure that they understand the risks, because, frankly, they might not understand the risks.

William Brangham:

That’s partly what happened with this Colombian man. He asked that we not show his face. Miami is also known for its thriving gay scene. It’s where he believes he became infected.

He says, paradoxically, the availability of lifesaving antiretroviral drugs mean some in the gay community don’t fear HIV the way they used to.

Man:

OK, we have pills. We have the solution. Nobody is dying for that situation, from that illness, and the people don’t care too much.

William Brangham:

So you think people have sort of forgotten that HIV/AIDS is really a problem?

Man:

Yes, yes, yes. I think so, that.

William Brangham:

Gay and bisexual men account for over half of new infections here, and Florida has been remarkably slow to promote a once-a-day pill known as PrEP that’s proven to protect against HIV infection.

The state says, by the end of this year, they will be offering it for free in all its 67 health departments.

Jon Cohen:

Florida’s just rolling out PrEP. It’s 2018. PrEP was approved by the FDA in 2012.

William Brangham:

We reported this series with “Science” magazine’s Jon Cohen. And we visited places like San Francisco and New York and even Kenya that are deploying PrEP much more aggressively than Florida.

Jon Cohen:

Now, to be fair, it’s taken everywhere quite a while to get PrEP up and running. So Florida is still really far behind, but they’re now really aggressively trying to embrace that.

William Brangham:

As we saw here at the HIV clinic at Jackson Memorial Hospital, HIV is afflicting all kinds of people. In just a few hours, we met people from all walks of life, from all over the world. Many patients show up in the late stages of AIDS.

Dr. Michael Kolber runs this clinic.

Dr. Michael Kolber:

Forty-nine percent of our clinic are foreign-born, a lot of poverty in various areas. So getting the message out is always a challenge. Going into the right community is a challenge.

I mean, we don’t have one Hispanic group here. We have a large number of them. and they’re not the same.

William Brangham:

Since 1980, Florida’s population has doubled, in part thanks to an influx of immigrants from Latin America and the Caribbean, home to many countries where HIV is more prevalent than in the U.S. and where HIV education is lacking.

Chimens Point Du Jour was part of that migration. He’s HIV-positive, from Haiti, and he spent many, many years infected and untreated. He speaks very little English, and it’s an hour bus ride to the nearest clinic.

So, how do you reach him?

Suzie Armas is an HIV specialist in Miami’s Little Haiti neighborhood, and a regular on this popular Haitian radio show.

Suzie Armas:

Go and get tested, number one. That is the first thing.

William Brangham:

Armas says traditional HIV outreach often misses this population.

Suzie Armas:

You can come and you do not need to give us your name. We just want for you to get tested.

The Haitian population do not read newspapers. Or the majority of them do not read at all. The best way for you to reach them is through the radio.

William Brangham:

Armas is careful how she delivers her message. She doesn’t want to offend her audience or the influential Catholic Church. For example, to talk about condoms, she uses the Creole word for sock.

Suzie Armas:

If you use your socks, you’re not going to get infected. So, we will push about that.

William Brangham:

Even more importantly, Armas sends a van, emblazoned with her face on the side, to fetch her patients, like Chimens Point Du Jour, to bring them to and from the clinic.

Point Du Jour says he was surprised and upset with his diagnosis, but now his virus is fully controlled, and he never misses an appointment.

Chimens Point Du Jour (through translator):

This clinic is like an extension of home, because I’m around my people.

William Brangham:

Spreading this kind of streamlined, easy-to-access HIV care statewide is part of Dr. Jeffrey Beal’s job. He’s helping implement Florida’s new statewide HIV/AIDS plan.

They want to expand testing, and then treat as many people as possible, expand the use of PrEP, and promote better outreach and education, all this even though the state health department has seen years of cuts.

We met up with Dr. Beal as he was doing a site visit in the Keys with a fellow HIV doctor.

Dr. Jeffrey Beal:

The purpose behind the plan was to eliminate any and all barriers that we possibly could, so that no one can really look me in the face in the state of Florida and say, I can’t get the medicines I need. We know that everywhere in the state, we can meet the need if people will just come.

Jon Cohen:

There is an epidemic that goes along with HIV that is called allergy, and it’s an allergy to self-criticism. And we have seen it in Russia. We have seen it in Nigeria. Anywhere.

And Florida seems to be getting over that allergy. They seem to be willing to actually look critically at where things are failing, and to say, let’s change it.

William Brangham:

For some on the front lines of Miami’s epidemic, the state’s new HIV/AIDS plan is welcome news, but they say it’s late in coming.

Dr. Hansel Tookes:

I think, unfortunately, what’s happened in Florida and here in Miami is, in the absence of needle exchange, in the absence of comprehensive sexual education, in the absence of widespread access to PrEP, this is what happens. You have a city that has no control over the current HIV epidemic.

William Brangham:

When we left, Dr. Tookes hoped that Natasha Dixon would return for her appointment. We checked in with him, and nearly two months later, Dixon is still not getting HIV care.

For the “PBS NewsHour,” I’m William Brangham in Miami, Florida.

Judy Woodruff:

And you can see all the stories in this series, "The End of Aids: Far From Over."

They are on our Web site, PBS.org/NewsHour.