AIDS deaths rise 15 percent in Miami-Dade

BY KAREN RAFINSKI

The steep three-year decline in AIDS deaths in Florida may be over. Deaths in Miami-Dade County actually rose 15 percent last year.

The state Department of Health released preliminary data Wednesday indicating that 1,631 Floridians died of HIV-related diseases last year, up about 5 percent from 1998. State officials say that represents just a leveling off of the trend and not a true increase because the definition of an HIV-related death was changed in a way that increased the number by about 5 percent.

In Miami-Dade County, there were 512 AIDS deaths in 1999, up from 444 the year before. But researchers cautioned that could be due to a one-time fluctuation and might not represent an important trend. In Broward County, 210 people died of AIDS last year, the same as the year before.

The news came as no surprise to AIDS experts, who had seen the rate of decline dropping off nationally as well as locally. The death rate is down 62 percent for the state since the peak of 4,336 deaths in 1995. But the new statistics prompted fears that AIDS deaths could once again begin to climb.

"It’s a call to arms that this epidemic is not over," said Rick Siclari, executive director of Care Resource in Miami, which cares for HIV-positive patients and does research. "We need to redouble our effort."

The causes for the reversal aren’t clear, and the state Department of Health plans to study death certificates to get a better handle on what’s going on, said Tom Liberti, chief of the Bureau of HIV/AIDS. The state will focus particularly on the increase in Miami-Dade because it has a third of the state’s AIDS deaths.

Changing epidemic

Part of the problem is probably due to the changing face of an epidemic that is now hitting hardest among poor and minority residents. Because of the demographics of Miami-Dade, that may be what’s driving the problem here, several local experts said.

Those patients are more likely to lack regular health care and therefore delay seeking treatment. As a result, they often don’t seek care until they have full-blown AIDS, when it may be too late for doctors to help them.

"There’s part of the population that’s not getting evaluated early, is not getting on the newer medications and is still dealing with severe disease," said Margaret Fischl, director of the AIDS clinical research program at the University of Miami.

Statewide racial disparities remain a problem, but 1999 marked the first year that they began to narrow. While black people accounted for 58 percent of AIDS deaths and only 14 percent of the population, deaths among black women declined 8 percent and stayed the same among black men. All other groups had increases.

Drugs limited

But the stabilizing of deaths from AIDS shows the limits of the new generation of drugs, experts said.

"The AIDS cocktail is not the final answer," said John Weatherhead, director of CenterOne, Broward’s largest AIDS service organization. "It gave us some breathing room, but that breathing room is running out."