adminOcho and Little Havana,” read a certain online advert and pamphlet.
Nestled on the Atlantic coast in southeastern Florida and the county seat of Miami Dade county, it is the most populous county in Florida and the eighth most populous county in the US.
Miami is a major centre and a leader in finance, commerce, culture, media, entertainment, the arts and international trade.
In 2010, Miami was classified as a Alpha- World City in the World Cities Study Group’s inventory.
That same year, it also ranked seventh in the United States in terms of finance, commerce, culture, entertainment, fashion, education, and other sectors.
It ranked 33 among global cities. In 2008, Forbes magazine ranked Miami “America’s Cleanest City”, for its year-round good air quality, vast green spaces, clean drinking water, clean streets and city-wide recycling programs.
A 2009 UBS study of 73 world cities ranked Miami as the richest city in the US, and the world’s fifth-richest city in terms of purchasing power.
Miami is nicknamed the “Capital of Latin America”, is the second largest US city (after El Paso) with a Spanish-speaking majority, and the largest city with a Cuban-American plurality.
Indeed, there is a lot of glitz, glamour and flamboyance associated with Miami and this is this face a tourist first sees when first visiting.
The other face of Miami is unveiled when one gets deeper into the way of living of most of the people. A story of a population at war with the spread of HIV and Aids, which has polluted the social fabric of the county, “shredding it into pieces” and making it the melting pot of HIV and Aids in the US is told.
This is a story that left 25 journalists, who visited the city during an HIV reporting tour which ran alongside the XIX International Aids Conference recently quite interested.
In Miami Dade, one in 108 people have HIV. About 25 000 people are living with HIV and Aids which is still among the top 10 leading causes of death in the
county.
“Rates of HIV infection are going up in Miami. They have been going up for decades,” said honorary chairperson of the Test Miami Initiative, Donna Shalala.
An administrator with Miami Dade County health department Lilian Rivera in their promotional DVD said: “When you have an epidemic of this sort in a community that’s so diverse, every single minute that is wasted is another person that dies from this disease or get infected with it.”
Addressing journalists, Miami-Dade County Health Department BA Epidemiology & Disease Control, HIV/Aids Surveillance, Rodolfo Boucugnani bemoaned the increase in HIV cases but explained it is because of some varying factors.
“It is the melting pot of nationalities and diversities. There are tremendous social and economic disparities that are challenged by poverty, substance abuse and mental health,” he said.
For instance, he added, the diagnoses of HIV infection rates per 100 000 population stood at 56,2 percent in 2009 with the figure rising to 56,6 in 2010.
“One possible reason for the increase in HIV cases is the recent lowering of the limit for undetectable HIV viral load results.
“Many persons who had undetectable HIV laboratory for years (and thus not reportable in Florida since the law changed in November 2006, and there were no documented WB since July 1997) are now showing detectable HIV results now that the tests have become more sensitive resulting in a marked
increase in HIV cases,” questioned Dr Boucugnani
He said the reporting changes could have masked an exaggerated increase in HIV cases.
“Furthermore, in the past several years, there has been an increase in the number of laboratories switching from paper to electronic lab reporting, which also had an impact on increased reporting as well.
“In 2009, a new HIV/Aids reporting system was implemented, called “eHARS’, which resulted in unavoidable data entry delay in the early part of the year.
“This produced the false impression that HIV and Aids cases were deceasing in the early month of 2009. Thus, the early months of 2010 will have much higher number of cases, compared with the same months of 2009. Again this could mask an exaggerated increase in trends,” he said.
He pointed out that the number of tests performed in their county increased from 62 470 in 2009, to 73 394 in 2011, which represents an increment of 16,2 percent.
Of the reported Aids cases, 51 percent were blacks, 34 percent Hispanic, 14 percent white and 1 percent were classified as other.
Of the 33 621 Aids cases reported up to date 74 percent are men, 26 percent female and 1 percent children.
Cumulative Aids cases through December 2011 stood at 33 622 in December 2011. Of the 33 622 Aids cases, 13 614 are still alive.
The cumulative HIV cases during the same period were 13 135. Of the 13 135, 12 196 are still alive.
In Miami-Dade County the black community is varied in comparison to the entire US.
This population includes a mixture of African-Americans, some people who have emigrated from countries in the Caribbean, South and Central America. More than half of Miami residents are foreign born, the largest percentage for any urban city in the United States.
The HIV/Aids epidemic is a major health threat for black communities in Miami-Dade County. One out of 45 blacks in Miami-Dade County is living with HIV or Aids, in comparison to one in 179 for the Hispanic/Latino and one in 130 for White.
Blacks account for 20 percent of Miami-Dade County’s population compared to 52 percent of reported Aids cases and 44,7 percent of HIV reported cases through December 2008.
Blacks represent the largest racial/ethnic group of those individuals living with HIV or Aids and those who have died from Aids since the beginning of this epidemic.
Hispanic/Latino comprises 62 percent of the total population in Miami Dade county and they represent 36 percent of all reported Aids cases and 41 percent of HIV reported cases through December 2008.
Women are most severely affected by HIV/Aids where heterosexual contact is a dominant mode of transmission like in Miami-Dade County.
In 2008 women accounted for 30 percent of reported Aids cases and 24 percent of HIV case.
Black females represent 75 percent of reported Aids cases in that year and 71 percent among HIV cases. Regardless of race/ethnicity increased risk for HIV and Aids can also be related to poverty, unemployment, financial dependence of their partners, lack of health insurance, homelessness and other social and economic factors.
The epidemic among men who have sex with men [MSM] is intense in virtually every county and racial/ethnic group in Florida.
In Miami-Dade County, the most populous county, at least one in eight white MSM, one in eight Black MSM, and one in 12 Hispanic/Latino MSM are living with HIV or Aids.
“Issues related to stigma, homophobia, discrimination and denial continue to contribute to HIV/Aids racial and ethnic disparities fuelling the epidemic in our county,” says the Miami Dade County official website.
The Black Aids Institute says approximately 125 000 people, roughly 11,7 percent of the national total, currently live with HIV infection in Florida, which ranked number one among states in the number of cases of HIV infection reported in 2010, according to the Florida Department of Health Annual Report for 2011.
In 2011, Miami-Dade County reported the highest number of HIV cases and the greatest number of new Aids cases in the entire state of Florida. Broward County (which includes Fort Lauderdale) currently ranks number two in the nation for cases of people infected by HIV, logging the second highest number of new Aids cases per capita in the United States.
“The most important thing we can do now is to act: To take what we learned at the International Aids Conference back into our communities.
“Words are not enough now; we are beyond the meetings and the conversations — we can end Aids in South Florida; if we act decisively, boldly and locally,” said Phil Wilson, president and CEO of the Black Aids Institute.
Executive Director of Empower U Inc Ms Vanessa Mills says they make testing accessible to the people by taking it to them rather than waiting for the community to come to them.
“We go to nightclubs and encourage testing of people who would not consider taking an HIV test. We also go to their homes, street corners, crack houses day and night and encourage them to test. We go to places where other people may not want to provide services,” she said.
Organisations like the Ryan White Program which was established in Miami-Dade County in 1991 to address the need for HIV/Aids-related services among the
economically disadvantaged and underserved residents of this community and has been the fall back for those who have no health insurance.
The programme is currently funded by the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), under Part A of the Ryan White HIV/Aids Treatment Extension Act of 2009.
Ryan White Programme services include outpatient medical care, prescription drugs, oral health care, substance abuse treatment, mental health counselling, medical case management, prescription drug co-payments, medical insurance deductibles, support to Aids Insurance Continuation Programme (AICP), legal and food assistance, and transportation services.
Approximately 10 000 persons living with HIV or Aids are served through the county’s Ryan White Programme on an annual basis.
Miami-Dade County receives additional funding under the Ryan White HIV/Aids Treatment Extension Act to reduce disparities and improve health outcomes for eligible HIV+ persons from racial/ethnic minorities. This funding is known as the Ryan White Minority Aids Initiative (MAI) Programme.
With all these challenges, the Miami Dade County Health Department, Office of HIV and Aids on June 25, 2009, launched Test Miami, an innovative and pivotal countywide initiative promoting the Centres for Disease Control and Prevention (CDC) recommendation of HIV testing as part of routine clinical care in all health care settings.
The campaign has been combining the resources and expertise of state and local health departments, public and private community institutions and not-for-profit and private sector partners. Miami became the first county in the State of Florida to undertake such an extraordinary collaborative and unprecedented multi-level approach to reduce the transmission of HIV.
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