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prostitution or early marriage. Then there’s the problem of political violence—sexual coercion associated with armies, rebels, and police.

Our corrections institutions long ago abandoned any attempt at rehabilitation. They have become revolving doors of drug users, sex offenders, the homeless, and the mentally ill. Prison authorities turn a blind eye to sex, coerced and uncoerced. Some in society even see the rape that invariably occurs in prisons as part of the punishment due a prisoner who’s committed a crime. Lack of access to care, the cost of medicines, and inadequate public health and public education are fueling the epidemic. Even immigration policies have helped spread the disease, breaking up stable relationships as one partner or the other is allowed to emigrate legally or flees to work as an illegal alien.

In Miami the war against AIDS has been a virtual stalemate for several years. Newer AIDS medicines dropped the death rates among known AIDS patients for a while, but problems like drug resistance and serious side effects have surfaced. Meanwhile, the number of new cases keeps rising. This should not be surprising. First, the programs funded to care for the poor with HIV emphasize expensive medical treatment in the advanced stages of the disease. There is little attention to prevention or primary care. More importantly, in a country that has yet to acknowledge health care as a right, both the programs and the people who provide the care find it impossible to escape the “zombie curse” of prejudice, blame, and conventional thinking.

For example, a young working mother of two recently walked into our private practice complaining of two weeks of the flu. As soon as I saw her, it was clear she was desperately ill with pneumonia associated with AIDS. As I delved further, I discovered the following: She learned that she had AIDS while pregnant with her second child and had been on highly active antiretroviral therapy until she started working. At that point her Medicaid was cut off. She made too much money! To make matters worse, she was told by her employer that she’d have no health insurance during her probationary

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