HIV/AIDS IN MIAMI DADE COUNTY:

A METROPOLITAN AREA WITH THE HIGHEST
REPORTED ANNUAL AIDS RATE IN THE U.S.
Florida is among one of the major states where HIV/AIDS epidemic has been a major issue. While the state accommodated 6% of the total U.S. population in 2004, it accounted for 11% (96,712) of the reported cumulative AIDS cases (888,795) and 15% (33,048) of the reported cumulative cases of HIV infection (222,926) through 2004 (U.S. Census Bureau, 2004; CDC 2005). According to CDC (2005), Florida ranked third in the nation in the number of AIDS cases, behind New York and California, and second in the number of HIV cases in 2004 (California did not report HIV cases). From 2003 to 2004, however, reported AIDS cases increased the most in Florida (by 25%) compared to New York (by 15%). There was a decline in reported AIDS cases in California (by 18%) during the same period. While the number of HIV cases also declined both for Florida and New York between 2003 and 2004, the percentage drop was 5.6 times higher for New York (39%), as compared to Florida (7%) (CDC 2005, 2004).

Miami-Dade County, the most populous County in Florida, is also deeply impacted by the HIV/AIDS epidemic. The metropolitan area in which the County is located had the highest reported AIDS annual rate among all metropolitan areas in the U.S. (53.8 per 100,000 population), even ahead of New York Metropolitan Area (41.9 per 100,000 population) in 2004 (CDC 2005). Reported AIDS annual rate in Miami Metropolitan Area was 3.6 times more than the overall rate for U.S. (15 per 100,000 population). Reported AIDS cases also increased the most in Miami Metropolitan Area between 2002 and 2004 (15.3%), compared to New York (3.9%) and overall U.S. (2.5%) (CDC 2005, 2004).

Miami-Dade County Health Department (2006) reports that a large percentage of Miami-Dade County’s HIV and AIDS cases were Latinos in 2005, 38% and 32% respectively. In line with the overall trends in the nation, AIDS cases have been increasing among the Latinos in Miami-Dade County. Between 2003 and 2005, Latino AIDS cases rose by about 5% in the County. Latina women especially experienced a sharp increase in AIDS cases (34%) during this three year period. HIV cases among Latina women also increased slightly (2.7%) from 2003 to 2005. Furthermore, Latinos formed 28 percent of the HIV related deaths in 2005.

With respect to risk factors, exposure through IIDU and Men having sex with men (MSM)/IDU constituted approximately 13% of the adult/adolescent AIDS cases in the County in 2005. However, exposure through IDU use increased by 10% from 2003 to 2005 in the County. Increase in exposure through MSM/ IDU was even higher (41%) during the same period.

SUBSTANCE ABUSE IN MIAMI DADE: A GATEWAY FOR ILLICIT DRUGS
In addition to IDU, other substance abuse factors continue to be a major issue in the County. As noted in NIDA’s Community Epidemiology Workgroup report (Hall, Comejo, and Oharm 2005), the County and its surrounding areas are exposed to the entry and distribution of illicit drugs from Latin America and the Caribbean destined for other areas in the US. Indeed, South Florida is designated “High intensity Drug Trafficking Area.” It is considered as one of the leading cocaine importation centers in the U.S., a gateway for heroin from Colombia and for MDMA (“ectasy” or “TXC”) tablets via the Caribbean. Indeed, cocaine import was the highest in Miami in 2004 (69.1%), followed by New York (48.9%).

Partly due to steady flow of illicit drugs into South Florida, the area has one of the highest morbidity and mortality rates from the cocaine use (Hall et al., 2005). In 2004, 59% of the 9,255 Miami-Dade major substance abuse reports in local emergency department visits involved cocaine (not including alcohol in combination with another drug, any alcohol below the age of 21, and medications). Among the 5,420 cocaine related emergency department patients, Latinos accounted for 17%. Marijuana use is also a significant public health issue in Miami-Dade. Among middle and high school students in the County, for instance, 8.6% reported current marijuana use in 2004. This rate was up 6.5% from 2002.

Drug abuse treatment admission data collected by the Florida Department of Public Health (FDH) also reveals the extent of substance abuse problem in Miami-Dade County. The data indicate that, in 2000, admissions to drug treatment programs in Miami were 40% higher than the statewide rate (FDPH, 2000). In addition, the admission of injection drug users to drug treatment programs in Miami in 2000 was almost three times the statewide rate. Unfortunately, these data do not include ethnicity or native-foreign born identifiers to assess such issues for Latino immigrants. Nevertheless, treatment admission records kept by several drug treatment programs serving the Miami-Dade area indicate that about 70% of all of the individuals who were admitted to these programs in 2000 were Latino males (FDH 2000). These public health problems are exacerbated by demographic and socio-economic characteristics that affect health disparities.