As the gleaming white van pulls up to the curb near Northwest Eighth Street and Fifth Avenue in Miamis Overtown neighborhood, a slender woman materializes out of the night.
The mother of 13 children, Little Mama, as she is nicknamed, boards the van for a rapid, free HIV test because she doesnt trust her sexual partner. When her result returns negative she flashes a relieved smile.
Night and day, the Borinquen Medical Center mobile clinic that tests for sexually transmitted diseases roams Miami-Dade Countys most-under-served neighborhoods trying to reach people like her who might otherwise go undiagnosed and untreated.
Despite the war on HIV/AIDS that began in the 1980s, the number of new cases has remained stubbornly high. South Florida counties have some of the nations highest new-infection rates with 59 cases per 100,000 people in Broward in 2012 and 49.8 cases per 100,000 in Miami-Dade.
Borinquen, a nonprofit federally qualified health center with seven locations in Miami-Dade has two vans equipped to dispense rapid HIV pin-prick tests with a 15-minute wait for results. If the test is positive, a phlebotomist draws blood for a second test, which takes about two weeks to get results. From January 2009 through December 2013, Borinquen mobile units performed 18,157 HIV/AIDS tests with 575 positives, or about 3.2 percent.
On this Thursday night, six outreach and case workers are bound for Overtown, one of several neighborhoods the Borinquen van visits twice-weekly, offering blood pressure and other health screenings, as well as tests for sexually transmitted diseases, or STDs. They try to retest those who were screened after three months, the time it takes for people newly exposed to HIV to register the antibodies in their systems. The teams most valuable assets: cultural sensitivity and street smarts.
I try to meet clients where theyre at, says outreach specialist Don Crews, 56, as he steps into the night with a bag of condoms to hand out when he approaches people on the street.
He connects with some of them by recounting his own history. When Crews came to Miami from Atlanta in 1999, he was hooked on crack cocaine. Clean for 10 years, he continues to attend Narcotics Anonymous meetings. He says most of the new HIV-positive cases he sees are associated with drug use.
When I share my story, they know Ive been there, Crews says. It bonds us.
Catching substance abusers when theyre ready to get help, and finding a bed for them right away is where cases are won and lost, he says. Once he finds someone who wants help, Crews tracks them daily to keep their motivation high until theyre in treatment.
About 30 minutes have passed, and the team has tested six people a number deemed very good by Irose Dalce, the Borinquen medical assistant manning the case-watch computer, the heart of the mobile unit. Every factoid from Social Security number to medical history must be logged in the system for each contact made; some who visit the van are already recorded as HIV-positive cases.
We call them lost in care. They leave treatment, disappear and return to drugs, Dalce says. Its one of the reasons controlling the spread of infection is so difficult.
Crews observes a pair of drug dealers taking up positions on either side of the van. Were interfering with them, he says. The team moves on, to another Overtown location at Northeast 11th Street and First Court where Crews says theres likely to be lots of action.
The van stops next to an empty trash-strewn lot. Crews takes his bag of condoms to the corner where the lights of a convenience store draw neighbors to hang out, smoke and drink beer from cans in paper bags. Like actors passing through a spotlight, they move in and out, pausing to interact before vanishing into the darkness.
A man with a suitcase and a beach chair begins a monologue in the middle of the street, while another man approaches with politely cupped hands: May I have some condoms, please?
Some boys saunter up. Can I have some? says one, who might be 12.
Besides condoms, many request the gift cards worth $5 that the workers use to entice those at risk who dont volunteer to take an HIV test.
Tony, who refuses to give his last name, approaches Crews and says he wants to get into a substance abuse program, but was turned away at Camillus House because too many others were waiting to get in. He is Crews fourth substance abuser of the night.
I can get you a bed, Crews says. Tony measures the outreach worker with his eyes.
Crews repeats, This is for real, man. Ive got a bed for you if you want it.
I want it, Tony says.
The substance abuse program Crews has in mind is a one-year, faith-based program called New Hope in Homestead. They agree to meet the next day.
Ive got you, Crews says reassuringly as Tony walks away.
The sound of gun shots outside a nearby apartment building sends the crew hustling to the van, where one client remains in a testing room. Out of almost 30 HIV tests tonight, she is the teams first positive: a gray-haired, homeless woman with stress etched into her face and drug needles pricks into her arms.
Breaking the news of a positive result is the hardest part of the Borinquen crews job. Outreach specialist Ashley Byrd says when she told her first HIV-positive client the test results, the client took it well, but Byrd cried.
Wendy Aquino, the outreach worker on Thursday nights case, looks tired. It was hard. I tried to work with her, but shed been drinking, Aquino says. She refused treatment.
The rejection demoralizes the healthcare workers. Linking a client to medication and a case worker is the best feeling, Dalce explains.
As they roll back to Borinquens midtown office, the crew makes a plan to look for the woman tomorrow. Their moods in the van brighten.
Byrd, who worked the counter at McDonalds before discovering outreach work, says, I love this job.
This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.