The author is a former infectious disease health worker and leader in the Florida state worker’s union, AFSCME.
On Jan. 22, the Miami Herald published an article entitled “Florida leads U.S. in new HIV cases after years of cuts in Public Health.” The title, although accurate in its assessment of the growing crisis in South Florida in the sheer number of new HIV infections, fails to account for the concerted effort between private health care and its public managers to dismantle a system that could have lead the nation in addressing and preventing the spread of HIV.
New HIV infections in Miami have risen each year since 2012 while rates dropped everywhere else in the country. A significant number of these infections were never detected before, meaning that large numbers of those infected with HIV have been living untreated for long periods of time. If these individuals had been found through early intervention (testing) and prevention efforts, the current epidemic could have been stopped. However, the profit system and its managing partners in government took the opposite approach, dismantling the state’s public health system and turning it over to private and semi-non-profit hands as well as channeling funding into initiatives that have been proven time and again to not be effective in reaching those disenfranchised from health systems altogether.
A significant portion of funding that goes to Metropolitan Statistical Areas like Miami and Fort Lauderdale from the federal government—$34 million for the entire state—ends up, for example, in bus advertisements. These have never demonstrated any effect in identifying undiagnosed people living with HIV. Left unfunded is the seemingly counterintuitive yet effective method of social networking testing approaches that recruit those who test HIV negative by assisting in finding possibly infected partners based on practices that put individuals at risk for HIV.
Florida lacks any centralized system to monitor care of those who are HIV positive. The existing decentralized system does not assure that those infected with HIV are receiving the care they need, but a systemic approach could have stopped infection rates. HIV infected individuals in treatment are shown to be extremely unlikely to infect others. All of this creates what is called a high “community viral load.” In other words, there are so many untreated individuals with HIV that exposure to the virus is multiplied by many times.
Now, as a result, Miami-Dade and Broward account for 38 percent of the new infections—last year totaling 6,240 infections—the highest increase since 2002.
It is a reality that the reactionary state government has moved to dismantle public health services for the people of Florida. The state health department which functions on the county level (or in some cases for more rural counties, one health department for several counties) have slashed staff—not only those who provide key services, but also the vital behind the scenes work of surveillance and infrastructure building that can detect shifts in the spread of disease and quickly address them.
Florida, the third most populous state in the nation with nearly 20 million people, has one of the lowest ratios in the country of state health workers to population according to 2014 data from the Bureau of Labor Statistics. Since 2011, 2240 state health worker jobs have been cut despite alarming increases in disease incidence in a number of areas.
In the early 1980s, Broward County wrote a grant and received funding to open the first full service HIV/AIDS clinic in the United States on Sistrunk Blvd., the gateway to the historic African American community and adjacent to the large LGBTQ area of Wilton Manors—two of the most affected communities.
This clinic played a historic role in turning the tide of the HIV/AIDS crisis in the early days. By 2010 this clinic began to be phased out and then finally completely closed. All the services formerly available at the clinic were auctioned off to private health care agencies where clients had to secure insurance to access services.
Although Rick Scott can easily be identified as the poster child for the current onslaught against public health, the focus can in no way remain on him alone. The public health system in Florida and elsewhere is clearly dominated by the insurance companies, big pharmaceuticals and even junior partners at the local level who have eagerly dismantled a system that could have been used to enhance the health of all the people of Florida.
Former Florida Governor Jeb Bush played a horrendous role in his attack on AFSCME, the union representing Florida’s public health workers. Bush during his tenure redefined who was “management” and who was part of the collective bargaining unit. The result removed from the bargaining unit team leaders, managers of processes and others who were some of the strongest members in the state workers’ union. This, coupled with Florida being a misnamed “right-to-work” state, left the state workers union—one of the biggest advocates for health for the people of Florida—with fewer than 10 percent of the potential number of those who could have been in the union.
All that has been won in the fight for services for HIV/AIDS has been accomplished through mobilizations of the communities most impacted by the virus, including the lifesaving treatments that exist today. It will be through such continued struggle that the people wrestle control from those who care more about profit than health to win not only treatment, but health for all though free universal care.
