XPost: ba.politics, dc.media, soc.penpals   
   XPost: alt.burningman   
   From: jariush@nbc.com   
      
   Barack Obama and his policies are helping to spread AIDS.   
      
   MIAMI—The glittering skyscrapers seen from the streets of   
   Overtown may as well be visions from another planet. The largely   
   African-American neighborhood has among the highest poverty   
   rates in Miami. At night, children bicycling up and down the   
   sidewalk pass drug users lighting up in plain view.   
      
   One recent Thursday evening, a mobile clinic pulled up outside a   
   bar in Overtown and about four outreach specialists got out.   
   They handed out condoms, chatted with locals, and encouraged   
   listeners to head inside the van for free, fast HIV testing and   
   other screenings. At one point, a couple of specialists ran into   
   the street and helped a falling-down drunk woman out of the path   
   of an oncoming bus.   
      
   On a team known for dedication and street sense, outreach   
   specialist Donald Crews is considered something of a master.   
   He's the quiet, fatherly presence who knows where to park the   
   van, whom to approach, and whom to avoid. He's the guy who will   
   not only help the dangerously drunk woman out of the road but   
   who will sit with her until the ambulance arrives. "I can really   
   connect with the people, as I've been there and done that,"   
   Crews says. He became involved in outreach work after kicking a   
   crack cocaine habit of his own.   
      
   Six days a week, Borinquen Medical Centers of Miami Dade's   
   mobile clinic heads to neighborhoods where doctors are scarce.   
   The program's goal is to find HIV-positive men and women and   
   link them to medical care as quickly as possible. Combating the   
   spread of HIV in Miami's most disadvantaged neighborhoods starts   
   with testing and depends on building trust.   
      
   Lack of Access to Care Drives the HIV Epidemic   
      
   HIV, the sexually transmitted and blood-borne virus that leads   
   to AIDS, can now be as manageable a condition as diabetes. The   
   key word is "can." In Florida, the HIV death rate is almost 10   
   times higher for African-American and Afro-Caribbean residents   
   than it is for whites. Nationwide, minorities are more likely to   
   become infected with HIV, less likely to be know they're HIV   
   positive, and less likely to be consistently taking the   
   antiretroviral medication needed to suppress the virus.   
      
   The Obama administration wants to reduce racial disparities in   
   infection and treatment, and has called on federal agencies to   
   work together to meet that goal. Borinquen, a community health   
   center that primarily serves low-income black and Latino   
   clients, knows firsthand that taking on HIV also means   
   addressing the overlapping problems of substance abuse, mental   
   health, and stigma.   
      
   Miami ranks second in the country both in the number of   
   residents living with HIV and in the number of new infections.   
   Here and nationwide, the hardest-hit populations are black   
   people and gay men. New infections are often linked to drug use,   
   primarily because people have riskier sex when they're high. A   
   recent study from Fort Lauderdale's Nova Southeastern University   
   found that, of gay men who moved to South Florida and got   
   involved in the area's drug-fueled party scene, about 30 percent   
   became HIV positive within five years of their arrival.   
      
   While risk-taking behavior helps fuel the epidemic, it doesn't   
   explain racial disparities. To understand why not, it helps to   
   take a look at the U.S. population hardest hit by HIV: black men   
   who have sex with men. That group, comprising less than 1   
   percent of the population, accounts for one in three new HIV   
   diagnoses. Yet the Centers for Disease Control and Prevention   
   has found that black gay men are no more likely to engage in   
   risky sex or to use drugs than other gay men.   
      
   Almost certainly, the disparity is driven by the fact that   
   African-Americans are less likely to receive medical care, says   
   Ronald Stall, professor at the University of Pittsburgh Graduate   
   School of Public Health. Disparities exist "around finding out   
   whether you're HIV positive; and if you're positive getting into   
   care; and if you're in care being able to achieve an   
   undetectable viral load," he says.   
      
   Because black gay men tend to get diagnosed later, they're   
   sicker when they are diagnosed and their survival rates are   
   lower. HIV positive people who are out of care are also   
   significantly more likely to infect others, because they're not   
   taking medication that both substantially reduces the presence   
   of HIV in their bodies and the risk of transmitting the virus.   
   Adding fuel to the fire, Stall says, is that race is a strong   
   predictor of whom Americans will have sex with.   
      
   The availability of life-saving medications has made many people   
   apathetic about HIV testing. But people at high risk of   
   infection—gay men, drug users, sex workers—should be getting   
   tested every three months. Medically underserved communities   
   need access to both testing and treatment.   
      
   Borinquen's Response   
      
   Borinquen Medical Centers of Miami-Dade started its outreach   
   program in 2001. Funded through federal grants, the program   
   currently involves two vans, 19 staff members, and a focus on   
   substance-abuse prevention. Outreach specialists are recruited   
   locally, as the National Institute of Drug Abuse suggests.   
   Almost all of the specialists are bilingual, and most are fluent   
   in three languages: English, Spanish, and Haitian Creole.   
      
   Last year, the team conducted 5,100 HIV tests and connected 120   
   people to care at one of Borinquen's seven locations. Typically,   
   about 3 to 4 percent of people who receive an HIV screening test   
   positive.   
      
   To reduce the stigma of HIV testing, Borinquen rolls it into a   
   bundle of other tests, including screenings for hepatitis, blood   
   pressure, and glucose. Results are processed in 15 to 20   
   minutes. In Overtown, it didn't take long before residents   
   started forming a loose line outside the mobile clinic. "Where   
   are my familiar faces?" one young woman asked, recognizing the   
   van but not the outreach specialists outside it.   
      
   The van doesn't leave a neighborhood until residents lose   
   interest. Once, the team stayed at a trailer park until midnight   
   in order to serve a large group. "It was almost a mob, not a   
   line," recalls Blanca Galvez, an independent evaluator of   
   Borinquen's program who sometimes travels with the team. To   
   leave before everyone waiting had seen a medical assistant would   
   have been a betrayal. "If you were ever planning on coming back   
   to that area, you couldn't just leave," Galvez says.   
      
   Winning the trust of local communities makes what comes next   
   possible. When someone tests positive for HIV, the outreach   
   specialist who delivers the news also shares his or her cell-   
   phone number, so the recently diagnosed person can call when   
   ready to get into treatment.   
      
   Reactions to a diagnosis range from fear to denial to   
   indifference, outreach specialist Moises Hernandez says. Some   
   people fear cost of the treatment more than the virus itself.   
   Some are too depressed to care. While the mobile van lingered in   
   Overtown, an androgynous, stick-thin person got up close to   
      
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