New HIV Cases And An Investigation On A Closed Street: Doctor Explains Situation Under 836 Overpass
There's a bridge in Overtown, under the 836 Expressway, that has long sheltered homeless people, many of whom are addicted to heroin.
Now a public health investigation is looking into a group of new HIV cases there. That’s part of what prompted Miami city commissioners to pass an emergency resolution to close the street two weeks ago.
A couple of sets of barricades block traffic to the area. Cars can't get through, but people are still staying there.
"The context of what happened in this area is that Miami has the highest rate of new HIV infections nationwide. In Miami, one out of every 85 adults has HIV," says Dr. Hansel Tookes, who treats many of the people who live in the restricted area.
Tookes is head of the IDEA Exchange, the state's only legal needle exchange program. Injection drug users can swap dirty needles for clean ones, thereby preventing the spread of viruses like HIV and Hepatitis C.
The exchange is also a chance to test for the viruses and link people up with medical care. Along with a fixed needle exchange site close to Jackson Memorial Hospital, IDEA has a mobile unit that makes rounds at the homeless encampment under the 836.
There's no public funding for this project; Tookes supports the screening piece with a grant from the HIV drug-maker Gilead.
Tookes sat down with Health News Florida and described how he and his team found the new HIV cases that led to the health department investigation, and what happens next.
Health News Florida: Does it look like there's a spike in new HIV cases then because you went looking for them? Or is there something else going on here?
Tookes: Testing people who have high risk every three months, you're going to pick up on new cases.
There were 11 people who became HIV infected within a six-month period. And so what we have to do at that point is you interview people, who they shared syringes with, who they had sex with, who might benefit from an HIV test. And the health department was able to embed one of their workers to conduct these interviews with us.
The other thing that you have to do is you have to actually take the virus and look at the genotype--that's the genetic material of HIV--and see how the infections are related to each other.
You can actually look at the virus itself and kind of figure out its lineage, like figure out who is passing it to whom?
You can't tell which direction it went in. But you can tell how closely related the HIV is.
At what point did you realize that this was more than the random odds that somebody would become HIV positive in this period, that there was something else going on here?
Yeah, I'm not actually sure that we know yet that this is a higher rate of HIV infection than would have happened.
If somebody was participating in the needle exchange, then how do they end up with HIV?
Behavior change isn't overnight. And if there are people that they have been injecting with for years, and nobody had HIV, all it takes is one person--who got HIV a different way, by having sex with somebody--all it takes is one person to get in that group for every single person to get HIV.
Tell me about who you work with. Who are you testing? Who's coming to the needle exchange?
We meet people who live in Coral Gables and are married and have kids. Then there are people who have had a lot of trauma and they're perhaps living down there. There are the people who have undiagnosed mental illness. The people who have diagnosed mental illness and they are treating themselves with these drugs. Because we don't have ideal access to mental health care.
They come to us because we have syringes, but they also want their antiretrovirals because they come to us for that, too. They have an innate desire to live.
Have you heard from anybody who is among this cluster about what it's like to be one of the 11?
Well I won't say that it's a cluster because we don't know that yet.
But the nine that are in care are very proud. They want to do well because they want to prove to the health department, they want to prove to society, they want to prove to themselves that they--given the opportunity--they can succeed.
And for the people who had been going to the needle exchange, what happened with the street closure?
We spoke to the Miami Police Department and they told us that we should continue to provide services there. So that's what we're doing.
The needle exchange doesn't just give needles, it gets people into drug treatment. And it doesn't just refer people to drug treatment. If people are ready, again low barrier: we put them in the car and we bring them.
If the area is dispersed without a solution for where these people will go, they will have no access to syringes. No access to their care. They will be dispersed into the city, with virus coursing through their blood. And I don't want to lose all these advances that we've made.