Why is Miami Still Hit Hard by HIV Rates?
First, the good news: The HIV incidence rate in the U.S. dropped 12% between 2017 and 2021, from 36,500 to 32,100 new cases, according to data released by the Centers for Disease Control and Prevention. This is an encouraging, if muted, decrease for a virus that has proven stubbornly difficult to control.
The bad news, however, paints a mixed picture that underscores continued disparities between demographic groups. South Florida experts who have been treating HIV for years note that Miami remains the epicenter of new infections, and Florida remains one of the top states in the number of cases.
“The incidence rate is going down in other parts of the country, but we’re not seeing it here,” says Allan E. Rodriguez, M.D., director of Population Engagement core of the Miami Center for AIDS Research (CFAR). “The rates are still high for new infections in Miami.”
Dr. Rodriguez, who is also a professor of clinical medicine in the Division of Infectious Diseases at the Miller School of Medicine, adds that those numbers are fueled by rising cases among foreign-born individuals. Some don’t know they are HIV positive when they settle in Miami, while others contract the immune-attacking disease here. In addition, this is a particularly difficult group to reach as they are less likely to access health care.
“A significant amount [of our clinic patients] find out they are HIV positive when they go to the emergency room or urgent care for something else,” Dr. Rodriguez says. This means that it is highly probable they have been unknowingly transmitting the virus to sexual partners.
The decline in incidence rates between 2017 and 2021 was driven mainly by young gay and bisexual men.
This included an impressive decrease of 45% among whites 13 to 24 years of age. However, the decline was only 36% for Latinos and 27% for Black men.
Those disparities are also evident in treatment, particularly when it comes to the use of PrEP. These pre-exposure prophylaxis medications can protect sexually active people at higher risk from getting infected. While Black and Latino people have the highest rates of new infections, the CDC report shows that white men in this group receive anti-HIV treatment at disproportionately higher rates than young black and Hispanic men.
And when accounting for all age groups, those numbers are just as alarming. Of the 1.2 million Americans eligible to take PrEp, only 11% were Black, and 21% were Hispanic. In comparison, 78% were white. This may have to do with a lack of awareness.
Dr. Rodriguez sees this in his clinic.
When we ask recently diagnosed patients if they are aware of PrEP, about 75 to 80% aren’t. We really don’t have a lot of minorities or women on PrEP.
This is especially frustrating because the treatment is free and effective.
In addition to low awareness, “a lot of physicians don’t want to deal with PrEp,” he says. This exacerbates the existing gaps in healthcare access. Minorities are also less likely to have insurance and sick leave. Many, especially the foreign-born, also have trouble navigating the labyrinthic health system.
“The structure of life itself gets in the way,” Dr. Rodriguez says. “They can’t take time off from work, they don’t have transportation, and their money goes to pay other needs.”
The CDC wants to reduce new cases of HIV by 90% by 2030.
But to reach that lofty goal, Dr. Rodriguez believes there must be a concerted, coordinated effort to remove the obstacles to testing and treatment for marginalized groups.
“Make it easier to get care,” he says. “Make care more accessible.”
He remains optimistic that a renewed campaign to target hard-to-reach marginalized communities, especially about the availability of PrEP, is paying off. The number of new infections has been declining nationwide since 2016, and prescriptions for the use of pre-exposure prophylaxis medications are also increasing among the youngest gay and bisexual men.
“At least the numbers are not getting worse,” he says.