Health workers and AIDS activists in south Florida are scrambling to combat recent jumps in HIV infection rates that mirror similar trends in major urban areas across the United States.
Armed with an engaging smile, HIV counselor Donovan Floyd encourages club-goers in Miami Beach to take condoms and other materials from a table he has set up near the front door of a popular nightspot. He says success or failure in reaching people is all a matter or attitude and approach. "People do not always need to hear about getting tested. Sometimes they just need to know that you are there and available," he says. "So that when they want to get tested, they can say, 'By the way, where is that clinic you told me about? I'm ready.'"
Alarmed by a rapid worsening of the HIV infection rate in Miami and elsewhere, health officials and AIDS activists are revising safe sex outreach programs. In Donovan Floyd's case, rather than pressing condoms into the hands of everyone he sees, he makes himself a regular patron at certain dance clubs. He socializes and, in so doing, develops friendships that can foster the trust someone would need to approach him for help.
Donovan Floyd works for a local organization called United Foundation for AIDS. The group's president, Marc Cohen, has found another way to reach people who are at risk for HIV infection: the Internet. Using the screen name "HIV Outreach Miami," Mr. Cohen visits online chatrooms, sending messages to people whose user profiles indicate an appetite for risky sexual behavior.
Over time, he has developed a following of people who look to him for help and advice.
"I am asking him if he is working and going to school," he says while typing on the computer. "He had a difficult time last year. He was dealing with some relationship issues and trust issues with men. And it was leading him into risky behavior. Now he is telling me that he is not working. And that indicates that he may be having difficult times right now, but he just has not gotten to the point of saying it yet."
At the Miami-Dade County Public Health Department, HIV/AIDS education director Kira Villamizar says health workers are trying out a new program called "Ride the Bus." "We go out to different areas in Miami and we actually ride the bus. We go to the bus stops and we meet people there. We educate them and we give them condoms and we refer them for [HIV] testing," she says.
Ms. Villamizar says distributing condoms at nightclubs is not enough, that health workers must reach broad segments of the population, including that which is served by Miami's mass-transit system. She says staffers got strange looks when the program was first launched, but that most bus riders have grown accustomed to the health workers' presence.
Even so, she says broaching thorny sexual topics in a region as culturally diverse as south Florida is no easy task. "You are looking at people from different backgrounds," she says. "Not only are they coming from different countries, there are language barriers. Some people are very open to talk about sex; others are very shy. You need to vary your approach, it is quite a challenge for the health educators out there."
But for all their efforts, health workers and AIDS activists admit that it is one thing for people to accept condoms or listen to advice in a controlled situation. It is quite another for people to employ the knowledge and use a condom when it counts. When asked about it, Kira Villamizar shrugs. "It is very hard for us to [find out] whether the person is going to use the condom. At least the intention of getting the condom is telling us that the person might be considering the use of a condom," she says. "And that is better than nothing."
One factor is substance abuse. "Jeffrey," who lived in Miami Beach until last year when he tested positive for HIV, says putting on a condom was the last thing on his mind while under the influence of drugs. "I just felt like, 'Why bother wearing a condom?' And when you are [using drugs], you do not want to feel restricted," he says. "That is the whole point of partying. You do not want to feel restriction; you want to feel free. The condom brings you back to not feeling free."
University of Miami AIDS researcher Margaret Fischl says HIV prevention is a matter of lifestyle. "We now see a young population that goes out "partying." And when you do that, you [become careless]. If you have a sexual encounter, are you using a condom? The next day we might see someone who says, 'I went out last night and I am not quite sure what happened. Can you test me for HIV and syphilis?' That is the concern, that the lifestyle is not really conducive to staying healthy," she says.
But AIDS activist Marc Cohen says there is nothing wrong with going out to have a good time so long as one retains a certain amount of control. "HIV is not inevitable. It is something that people can protect themselves against," he says. "And if they were to maintain that level of awareness they could still have a fabulous time; they could still go to the clubs and dance all night."