As far as skirmishes go at Miami-Dade County’s City Hall, this one last November was wild. HIVer Tim McCarron, 52, who’d put years into AIDS activism in New York City before moving south to rekindle ACT UP/Miami, accused city leaders of misdirecting precious funds for PWA housing—and said he wanted heads to roll.
That set the commissioners on him like ducks on a junebug. One called McCarron a “pitbull from the North.” Another said, “You may do things like that up there, but don’t come into our kitchen knocking over chairs. We do things differently here. In a Southern style.”
McCarron sarcastically asked what that was supposed to mean.
“Maybe you’re supposed to be polite,” the commissioner shot back.
It was then that AIDS advocate Vanessa Mills, 47, stepped up in a good-cop role to ease frayed nerves. Like McCarron, New Jersey–raised Mills is a Florida transplant. Unlike McCarron, she’s a black woman fighting the same epidemic in a culture wholly different from the gay one where McCarron began.
In the end, it all worked out—sort of. The city ordered the commishes not to throw around funds for PWA housing so lightly. Later, McCarron still seethed. He called AIDS in late-’80s New York “easier to deal with, because there was panic. We were dealing with people dying every day.” Earlier in the year, McCarron had paraded around town in a T-shirt that read “HIV/AIDS...Souvenirs from Sunny Florida” and heckled governor Jeb Bush at a posh business expo for aiming to cut $10 million from services that keep PWAs out of hospitals and in their own homes.
Meanwhile, just days before the City Hall blowout, some of McCarron's pals lived it up at the White Party, the annual circuit party (kind of like a way-gay dance-a-thon) that attracts some 7,000 men to Miami every year and raises 20 percent of the $6 million annual budget of Care Resource, Florida’s largest AIDS service organization (ASO). The bash was at the center of a new documentary, When Boys Fly, that the Miami Herald said “mortified” Care Resource by depicting the event as an orgy of drugs, overdoses, unsafe sex and gay body-fascism. To Kevin Garrity, 42, that scene sums up many of the pretty, young gay boys targeted by South Beach AIDS Project, his HIV-prevention group. “SoBe”—trendy South Beach’s trendier nickname—“is ground zero for new infections. There’s barebacking, seroconversion parties,” he says. “The drugs of choice used to be X [Ecstacy] and K [ketamine]. Now it’s tina [crystal meth] and Viagra, where you stay on the Internet for three days and have sex with 40 people.”
In another part of town—but worlds away from the White Party—Vanessa Mills was helping to make funeral arrangements for her best friend, Petera Johnson-Hobson, who’d died not long after she and Mills had founded Empower U., Inc. They’d hoped the new agency could bring badly needed services to Liberty City and other primarily black Miami ’hoods, where more of their brothers and sisters were picking up HIV every year. “In the beginning of this epidemic,” Mills says, “you had college-educated gay white men—lawyers, doctors. Now we’re talking about people who are poor.” In her world, she says, “you find people coming into care with full-blown AIDS.”
And in a third part of town, Luis Penelas, 50, the gay-activist brother of Miami-Dade County mayor Alex Penelas, had recently learned that Union Positiva, the four-year-old group he heads, would not be getting the $100,000 the county had granted him the year before to do HIV prevention among Miami’s Latinos. In tight times, those monies went to older, larger groups—and increasingly in Miami, those groups served blacks. Shortly thereafter, Penelas lamented the loss in the weekly Miami New Times, saying he’d secured that initial hundred-thou by arguing that “for the last three years the black community had been receiving...$300,000 to do AIDS prevention, and Hispanics had not received anything.” But Mills sees it differently: “We have a fight here between African Americans and Hispanics. It’s difficult for them to understand they’re actually a majority [in the area]. When you talk to them about disproportionate representation, sometimes they get offended.”
Welcome to Miami, Florida, metro population 2.2 million, which trades off with New York City for the highest per capita AIDS rate in the U.S. That may astonish those whose first associations with the city are swaying palms, dazzling Deco hotels and glamorous jet-setters (plus plenty of workaday Jet-Bluers) frolicking on what's often called America's Riviera. If you're familiar with the party scene in the heavily gay South Beach, the numbers may make more sense. But those high rates actually come out of a polyglot of worlds in Miami very much like New York City's current “face of AIDS”--overlapping parts gay, black and Latino. And guess what? They’re not all having fun in the sun.
“Growing up an immigrant here,” says Cuba-born Penelas, “I didn’t realize it was a party town because my family had to work so very hard. Most people here are just trying to put food on the table. The city’s just so spread out it doesn’t look like [what you think of as an] urban area.”
But that it is—and, like New York, it’s intensely diverse. Its over 50 percent Latino population is made up of not just highly visible Cubans, but Venezuelans and other South Americans, and its 25 percent black population includes not just African Americans but Haitians and others of Caribbean descent. But whereas New York’s density—its daily crush on subways, sidewalks and elevators—leads inevitably to cultural mixing, “the communities here are really divided,” says Garrity. Certainly New York is no stranger to tensions among tribes for AIDS funding and influence, with all their underlying whiffs and whispers of racism and homophobia, but here they seem heightened because advocates from different backgrounds are more isolated to begin with.
Then there’s that tropical mid-summer swelter, whose agonies tourists seldom know. “By August, people here are ready to kill each other,” says Penelas with a laugh. And if Miami’s frightening AIDS rate is any indication, that’s exactly what they’re doing.
Climbing Numbers, Shrinking Funds
In 2001, the Centers for Disease Control and Prevention ranked the Sunshine State fourth in total AIDS cases—after DC, New York and Maryland—with an estimated 68,545. Just over 19,000 of those cases are in Miami-Dade County, which has alternated with New York City in recent years as the metropolitan area with the highest AIDSrate. Nearby Fort Lauderdale and West Palm Beach ranked third and fourth, making South Florida the epicenter of a new trend in rising infection in the South overall. That was the central message of a conference of HIV coordinators from 14 Southern states plus DC last December—and the primary reason the American Foundation for AIDS Research (amfAR) held its annual National HIV/AIDS Update Conference in Miami this year after 14 years in San Francisco. (Penelas says it was hungrily received here by “a community starved for information.”) Not only is the city a primary doorway for HIV to get in and out of the U.S. from the Caribbean and South America, but, predicted North Carolina researcher Peter Leone, MD, in December, the area’s high concentrations of HIV “will spread up and down I-95 into communities that don’t have access to care.”
Beyond gay South Beach, HIV is hitting Miami hardest on streets that tourists seldom see—black, Latino and often desperately poor neighborhoods like Little Havana, Liberty City, Little Haiti, Sistrunk, Belle Glade and Riviera Beach. Latinos here have an AIDS rate of 56 per 100,000 cases compared to a national rate of 29. Blacks make up just a quarter of Miami-Dade but 55 percent of the county’s AIDS cases.
Worse, as AIDS rolls rise all over town, funding isn’t rising to meet them. Florida receives more than $230 million a year in Ryan White CARE Act dollars, one of the nation’s fattest Ryan White checks—and that’s in addition to the millions funneled to PWAs through Medicaid. But as in many states, Florida AIDS advocates fear that their share of the extra $80 million recently passed in DC for Ryan White’s ADAP, which covers HIVmeds, will barely cover the skyrocketing costs of those drugs, and that there won’t be enough for other crucial PWA services—like case management, day care, dental care, meals, and visiting nurses—the CARE Act is supposed to cover. Worse yet, at presstime Florida legislators were considering governor Jeb Bush’s proposal (the same one McCarron heckled him over) to disqualify most beneficiaries of the Medicaid PAC Waiver program, which covers PWAs who make too much for Medicaid but not enough to pay their pharmacy or medical expenses. Cut off from that, they’d be forced to crowd the Ryan White rolls—along with the steady stream of newly diagnosed cases which all Miami-area advocates foresee.
What does the money crunch mean here? Perhaps not much for large, well-established health care and service providers like Mercy Hospital, the University of Miami, Care Resource, and the primarily black-serving MOVERS (Minorities Overcoming the Virus Through Education, Responsibility and Spirituality). But Daniel Wall, who heads up Miami-Dade’s AIDS grants program, says “any change in funding could have significant impact” on smaller, scrappier agencies trying to fill in gaps, like Mills’ Empower U. or Penelas’ Union Positiva.
“We had a meeting,” recounts Mills in her sandpaper-sassy voice. She’s referring to the Miami-Dade HIV/AIDS Partnership, the lone forum in which all area AIDS groups, large and small, convene to hash out which groups get how much of the portion of the total $127 million in federal AIDS funds the county has given them control over. “The vote was to suspend food vouchers starting around July 1. We had to make cuts, and what’s most important? Medications. But Ryan White is an emergency-care act. [My clients] need things like food and transportation to live holistically with this disease.”
Her gripe hints at the public and private bitterness that often emerges as the Partnership’s old-line gay and newer black and Latino members jostle for fiscal pie slices. By most accounts, despite its let’s-work-together title, that’s all the Partnership does. That, says Penelas, is largely because “a lot of this money is put out for very specific target populations, which leads to [each group] being protective, not working across ethnic or other borders. The way the money is segregated segregates us.” That often makes sense, as outreach that speaks to SoBe’s gay white party boys doesn’t necessarily speak to Liberty City’s street hustlers, who in turn don’t have much in common with Little Havana’s secretly bisexual husbands and their deeply Catholic families. Still, Garrity says there are common themes across neighborhoods: “We’re dealing with African Americans in denial, Hispanics in denial and gays who aren’t in denial but who are backlashing against everything we’ve been doing for 20 years.” But, he laments, “there’s no force that drives prevention or treatment here except the health department. There’s no grassroots coalition.”
The Partnership, insists Mills, should be “our unified voice.” But in a city that could do more with less by sharing strategies among tribes, AIDS advocates do what everyone else does at workday’s end—retreat to their own enclaves. And Miami remains part of the Deep South, after all, where religiosity, family honor, an aversion to the unvarnished truth and an “I can do it myself” bootstraps ethic still burrow deep beneath its cosmopolitan gloss. The result? “We don’t work together enough,” states Penelas flatly. Garrity, who himself proudly refers to South Beach as “the turf I’ve been given to protect,” concurs: “Everyone’s so focused on their own community.”
Liberty City: Breaking the Silence
On an unseasonably hot Friday morning in February, a park is transformed into an outdoor clinic just blocks from Miami’s urban core. A marching band from a local middle-school blares renditions of hip-hop tunes. Flag girls, majorettes and musicians high-step into formation, beckoning neighbors to wake up and listen. The neighborhood is a case study in contrasts. The tree-lined streets surrounding the park shade the well-kept homes of retired African-American educators, owners of mom-and-pop stores and other strivers who “moved on up” a generation or two ago. There seems to be at least one church, sometimes more, on every other block. A bit north of that, though, the scenery deteriorates quickly into buildings that hope gave up on long ago. They provide shadowy sanctuary to crackheads, drug pushers and hookers, who can tuck in for a quick hit on the pipe or to turn a fast trick.
Sometimes spent condoms are left outside doorways or on sidewalks. Ugly as they are, Vanessa Mills wishes she’d see more. This corner of Liberty City is Miami’s so-called dead zone—the locus of much of the HIV epidemic among black Miamians and the home of several groups scrambling to turn back the virus’ decimating toll on their community. One of them is Empower U., Inc., launched about a year ago by Mills and Petera Johnson-Hobson, two old friends who’d long ago walked away from drugs and crime (“I came to my senses,” recalls Mills, who went on to get a nursing degree) with a mission to help address HIV among black Miamians on the skids as they’d once been. Only a few months after launching Empower U., Johnson-Hobson, who Mills said had survived an array of past AIDS-related conditions including non-Hodgkin’s lymphoma, succumbed to skin cancer at 44. “I lost my best friend,” Mills says.
At Empower U., with a staff of three, she continues their mission, serving 60 clients in the so-called hard-to-reach category: drug users who frequently relapse and homeless people. “These are labor-intensive folks,” she says, noting that she often puts in 80 hours a week combing crack dens, flophouses and highway underpasses searching for the ones who haven’t shown up for appointments or are most likely off their prescribed meds in favor of street drugs. If she didn’t do it, she says, who would? Still, days are long and tiring.
That’s why she likes events such as this one in the park, to mark National Black HIV/AIDS Awareness Day. In addition to the band, state health officers, case managers from an array of service providers, DJs and local celebs are all here. Their goal: to coax passersby into taking an HIV test. A few do. Patricia Kelly is thrilled with the ruckus. A nurse by profession, she heads MOVERS, the state’s largest black-run ASO. Founded by Kelly and Rev. George E. McRae—acclaimed for transforming staid Mount Tabor Missionary Baptist, Liberty City’s oldest black church, into a service ministry for the neighborhood’s addicts, prostitutes and PWAs—MOVERS is where Mills and Hobson-Johnson got their start as AIDS workers. It’s also where Kelly has learned the valuable art of holding her tongue: “People have tried to create tension [between Miami’s black and Latino AIDS groups], but I ignore it and move on. I learned a long time ago if you just shut up, you can’t be accused of saying something.” Her policy has served MOVERS well: In 13 years, it’s grown into a $3 million operation serving 15,000 clients.
Right now, though, Kelly doesn’t mind saying she feels great. Today’s event has drawn about 200 people—not bad for a workday health fair. More importantly, two black sororities have either donated money or set up exhibits. “You don’t know how long we’ve waited for them,” Kelly says. Sororities and fraternities hold a lot of influence in black communities—and she hopes their involvement will go far in breaking black Miami’s AIDS silence.
Little Havana: Culture of Denial
Fast-forward a few weeks to 6 a.m. on a hot Sunday along Calle Ocho, the heart of Cuban Miami. Elsewhere, most people are either still in bed or headed there after another night of Miami vice. But Calle Ocho is prepping for the event of the same name—a 22-block street festival that bills itself as the nation’s biggest Hispanic bash. Already scents of corn, cumin, garlic and sour oranges permeate the air. Luis Penelas and his crew from the HIV-prevention group Union Positiva are in the mix as well. With 1.5 million people expected, Calle Ocho is a prime venue for them to spread their message to Miami’s Hispanics. Still, this is only the five-year-old group’s second year here. AIDS is not talked about much in this world—especially in Miami’s large, often conservative Cuban population.
Those attitudes have to change, says Penelas, one of the key players in recently preventing the overturn of Miami-Dade’s ordinance protecting gays against discrimination. “I want to break the mores of our culture,” he says—particularly the one that tacitly permits men to seek sex beyond their wives or girlfriends, including with other men. Such men who secretly get with men are called bugarons, he explains—“the Latino equivalent of ‘on the down-low.’” He cites stats showing that local Hispanic men have higher HIV rates than black men, but Hispanic women have far lower rates than black women—and says it can only mean one thing: “Hispanic women don’t know they’ve been exposed, so they haven’t been tested.” He also points a finger at the Catholic church, which has a strong hold on Miami Latinos, for its gag rule on HIV and condoms.
Still, since it was founded in 1998 by Denise Pinkus, an HIV positive woman from Venezuela who saw little AIDS outreach to Miami’s Hispanics, Union Positiva has done its share to break that gag rule—like peppering Miami-Dade with billboards that flirtily remind “Quien dijo que yo no puedo traer el condom?” (English versions read: “Who said bringing the condoms was a guy thing?”) They hand out flyers in Little Havana, speak on Spanish-language radio and cable-access TV, and reach out directly to bugarons in the little pool-table cantinas, late-night parks and triple-X bookstores where they look for sex. In small ways, they’re making progress: In two years, they’ve gone from HIV-testing 20 people a month to 100 (with about three positive diagnoses per). Penelas isn’t afraid to work his family ties, either: He says it was his influence that got his brother Alex, Miami-Dade’s mayor, to add $200,000 to a fund for county ASOs.
Amid sounds of salsa, soca and merengue, Union Positiva workers fan out with baskets full of brochures—and condoms. They’re targeting Hispanic men and women ages 16 to 24. But that doesn’t stop las abuelas (grandmas) from trying to sneak goodies. They gasp and retreat when they learn what’s inside. Penelas laughs but says it’s a minor miracle Union Positiva was able to pitch camp here at all; organizers initially balked, calling Calle Ocho a family event. “They don’t want us passing out condoms,” he says—but goes on doing it just the same.
South Beach: Barebacking Busboys
No one stumbles onto the headquarters of South Beach AIDS Project (SoBAP). It’s tucked inside a pharmacy on chic Lincoln Road, about two blocks from SoBe’s bustling beaches. One weekday midmorning, spring-breakers—sporting fresh tans, skimpy bikinis and flip-flops—traipse through chi-chi boutiques. Older folks wearing wide-brimmed straw hats plod across busy streets, oblivious to the traffic jams they create.
At the very back of the pharmacy, SoBAP executive director Kevin Garrity, his staffers and a slew of volunteers confer. Six nights a week, outreach workers head to gay hotspots like Twist and Score to get HIV prevention to guys mostly under 30. Amidst the pounding house music and dance floors packed with sweaty, shirtless bodies, they casually pass out small care packages of condoms, lube and brochures advertising SoBAP’s safe-sex counseling and HIV testing. “If you can get someone to come in and take a test, that’s a successful intervention,” Garrity says . It may sound like a modest coup, but it’s not—especially since, he says, “there’s a complacency now” about getting HIV “that wasn’t there before protease inhibitors.” Plus, crystal meth has become the drug for a new generation of SoBe party boys: “When you’re 25, you’re invincible,” says Garrity, who estimates he’s lost 35 to 40 friends to AIDS. “When you’re 25 and on crystal, forget about it.”
Still, the party-’til-you-drop mentality never really left South Beach. Perhaps that’s why, even though HIV prevention has been on the radar in gay ’hoods longer than in black ones, South Beach’s gay infection rate currently competes with Liberty City’s, according to SoBAP. And if you think those cases are mainly among affluent guppies with great private health care, think again. Garrity says it’s more likely a twentysomething busboy making $300 a week (without health benefits) in a tony bistro “and spending every dime on overhead” like rent and partying—precisely the kind of client he routinely steers down Lincoln Road to Douglas Gardens Community Health Center to sign up for Medicaid or ADAP after his HIV diagnosis. “The substance abusers are the hardest to reach,” he says, noting that Crystal Meth Anonymous meetings have mushroomed in the neighborhood.
Garrity says he’d also like to reach a “shadow group” at risk for HIV: Miami Beach’s large population of widowed or divorced seniors, who—thanks to Viagra—are having their best sex in years, have no need of birth control and have never made whoopie in the age of safe sex. It’s just that set, he says, that HIV educator Marilyn Brand of nearby Palm Beach County’s health department has been wooing, using silly props like penis-shaped pasta and whipped cream to break the ice. After all, Garrity shrugs, with bubbes present, “You can’t exactly bring out the biggest dildo.”
But sex-toy talk isn’t verboten in SoBAP’s Q groups, where HIV-negative gay guys talk about how to stay that way. One Sunday afternoon in spring, a rainbow coalition of toned hotties kicks back at a pool party, one of the alternatives to SoBe’s fast-paced club scene that SoBAP offers Q-groupers. Among the gaggle is Long Island native Edison Farrow. “It’s great,” he says of the SoBAP shindig. “We need more activities like this.”
A County’s Challenge
But Miami’s “AIDS picture” started changing in the mid-’90s. Two old-line ASOs, Body Positive and the People with AIDS Coalition, closed their doors. Wynn says that when he started serving on the HIV/AIDS Community Partnership board, it was primarily with other gay activists from posh areas like SoBe and Brickell Avenue, but by decade’s end, more people of color had come on board, demanding that services and prevention messages extend into newly affected areas like Liberty City, Kendall and North Miami Beach. Tension and suspicion crept in behind brittle words, Wynn recalls, noting, “the culture of South Florida is not as cohesive as in other areas.” Garrity says that when the initially mainly gay-serving Health Crisis Network merged with another group to become Care Resource (and the state’s largest ASO), it took on a more diverse client base and “got a lot of shit from certain segments of the gay community—not publicly, but muttered in circles.” Today, nonwhites make up two-thirds of Care Resource’s clients, 70 percent of its board (headed by a Hispanic woman) and over 80 percent of its staff, says executive director Rick Siclari, who calls his all-purpose ASO“a comfortable home for diverse clients.” It’s a measure of how little Partnership groups communicate beyond budget basics that one nonwhite advocate thought Care Resource’s board was still “entirely gay white men”—and chalked it up, off the record, to “prejudice.”
Prejudice or no, overall, new AIDS money has followed new numbers in Miami-Dade, with half of the county’s Title I Ryan White funds now going primarily to black-serving groups (add in other titles under Ryan White, plus funds from the federal Minority AIDS Initiative, now threatened under president Bush, and black groups have far more). With blacks making up over half of Miami’s AIDS cases, most, but not all, feel this is fair. “The problem today is the [Partnership] is catering to a certain group,” grumbles one gay white man who doesn’t want his name used. “This is not just a black disease.”
But, Vanessa Mills says, even though they get half the money and make up roughly half the membership, blacks on the Partnership are still not on equal ground because they “aren’t effective. You’re in a meeting with all these powers-that-be deciding what you’re going to get, with their degrees, speaking properly about utilization and cost of services, and you may talk out of turn, and they say ‘We’re not on that issue right now.’” Mills won’t let that happen to her—she’s currently getting her master’s in public health to talk the talk with the best of them. Still, she says, blacks in AIDS “need a lot of training, because we’re new to the arena of lobbying, funding, having true input into the planning process.”
Separate groups, statistics, neighborhoods and monies all beg the question: Is there any room for collaboration among Miami’s AIDS camps? The answer, surprisingly, is yes—especially when it comes to protecting money in the aggregate (so they can fight over it later in Partnership meetings). ACT UPer McCarron and Empower U.’s Mills were but two of several advocates who coordinated that successful attack on City Hall last fall to protect PWA housing funds. Penelas’ Union Positiva will soon join La Liga Contra SIDA and the Center for Haitian Studies and travel as the Unity Coalition to the state legislature in Tallahassee to fight Jeb Bush’s proposed cuts in Medicaid’s PAC Waiver program. They did so last year and managed to retain $7.5 million out of $10 million in proposed cuts.
Slowly, too, these disparate tribes are joining forces for more than mere funding. Mills says that thanks to money from the private Dade Community Foundation, Empower U. will partner with Community Case Management, a newish AIDS group in North Miami (atypically multiethnic for the city’s balkanized ’hoods), and La Liga Contra SIDA to form the smiley-titled Miami Is Working Together, a black-Hispanic community outreach initiative. And there are pockets of personal goodwill that bode well for bonding. Mills says the area’s United Foundation Against AIDS, “basically a gay white male group,” has been “very supportive” of Empower U., while Garrity says of Mills “you can’t be an activist here and not know and love her. She and [the late] Petera [Hobson-Johnson] are my ideal activists.”
“My funding sources tell me to work [only] with the Hispanic community,” Penelas says, “but I go to black events, work closely with the Haitian community.” With Miami facing an AIDS dilemma no sunnier than New York’s, he says, staying in such close contact is “the only way we’re going to make it. Blacks don’t just go to bed with blacks, or Hispanics with Hispanics.” He speaks with pride of an upcoming weeklong series of HIV-prevention events for young people, sponsored by the city and the public schools, involving 50 groups from every possible neighborhood in this pastel-hued but decidedly urban city. It will culminate with a youth march and rally called Keeping It Real. It’s likely not many tourists will attend.