UPDATE : Small Town Offers Disturbing Look at Future of the AIDS War : In Belle Glade, Fla., the disease has spread by heterosexual contact to become an epidemic. But there are signs of hope.


Plumes of black smoke rise into the pale winter sky, and huge open-bed trucks crowd the two-lane roads, spewing chaff and clouds of dust as they rumble from field to mill.

“Her soil is her future” reads a sign at the edge of town that welcomes visitors, and now that it’s sugar cane cutting time again, the future is now.

But for the United States, there is another future to be seen in the slums and run-down migrant camps of this isolated city located southeast of Lake Okeechobee. Here in this predominantly black and poor town that years ago, following a devastating study, earned the epithet “AIDS capital of the world,” research shows that the disease is being spread by heterosexual contact. This at a time when AIDS is still considered by many a threat only to gays or intravenous drug users.

In the last decade, 381 AIDS deaths have been recorded here--a rate four to five times the national average.

“Belle Glade is the bellwether; this is what’s coming down,” said Tedd V. Ellerbrock, an epidemiologist with the federal Centers for Disease Control and Prevention. Ellerbrock is the principal author of a new study documenting the incidence of HIV infection among pregnant women in the Belle Glade area. The study was published recently in the New England Journal of Medicine.


“In fact, it’s already going on, especially in the Southeast,” Ellerbrock said. “If you want to know what community this epidemic is going to affect next, give me the ZIP codes of places where crack cocaine use and sexually transmitted diseases, such as syphilis, overlap.

“The region that lights up is the Southeast U.S., and Florida is particularly bright.”

The tentacles of the disease reach beyond Belle Glade. In western Palm Beach County, an area with a population of some 36,000 people, 60 AIDS deaths have been reported in the last year. Officials are currently monitoring 456 patients with the human immunodeficiency virus, which causes AIDS.

Equally alarming, Ellerbrock says, is anecdotal evidence that there may be several towns in Florida and throughout the South where the HIV infection rate is as high or higher than in Belle Glade. In Florida, for example, 1% of the state’s adult population, or 120,000 people, are believed to be HIV-positive. But there are many areas, including Miami, where the rate is much higher than that.

Yet no single town in America has suffered more from the stigma of AIDS than Belle Glade. Despite a bustling $3-billion-a-year agricultural industry, unemployment remains high. In the last seven years, virtually no new businesses have come to town and some community leaders have moved out, says Harma Miller, a Belle Glade city commissioner.

There was a time when some southern Florida high schools refused to play Belle Glade in football for fear of catching AIDS, Miller says.

Since the disease was first identified in the early 1980s, no town has been more studied, no population more examined, questioned and tested than that of Belle Glade, where 52% of the 17,000 year-round residents are black and 12% are Latino. And no town is more scarred.

“No one likes to be known as being from the AIDS capital of the world,” said A. H. Rackley, vice president and general manager of the Florida Sugar Cane League, a trade association. “But when people make that comment to me, I say: ‘Listen, you folks ought to learn from this. This is a snapshot of what you’re facing in future.’ That’s the scary thing.”

In recent years the CDC has spent more than $1 million in the Belle Glade area on AIDS prevention and treatment programs, and, according to Jean Malecki, Palm Beach County public health director, there is some evidence of progress. “Being labeled the AIDS capital was really something people got angry and depressed over,” she said. “But from it came a fighting spirit to combat the disease and the social problems.”

On the front line in the combat zone is Patricia E. Harrington, who directs the HIV Prevention Center, a model program run by Florida’s Department of Health and Rehabilitative Services and funded by the CDC.

During a normal month during the harvest season, when Belle Glade’s population swells to 24,000 with Jamaican sugar cane cutters and migrant vegetable pickers--many Latino and Haitian--Harrington and her staff may pass out as many as 10,000 free condoms. In most of the town’s bars, beauty shops, grocery and liquor stores, boxes of condoms can be found next to the cash register.

AIDS is believed to have come to Belle Glade early, in the late 1970s, possibly with the migrant stream of farm workers who pick tomatoes and beans, or cut long rows of sugar cane with razor-sharp machetes. By the time the disease was diagnosed here, it had become an epidemic, spread by prostitutes, drug users and cavalier sexual attitudes. In 1985, researchers found an infection rate of 1.85 per 1,000 people, higher than in New York City or San Francisco.

By then it was clear to researchers that there was something different about most of the people who developed the disease in Belle Glade. They were not homosexual men or intravenous drug users, as were most victims elsewhere.

As near-hysteria swept through Belle Glade and the nearby communities of South Bay and Pahokee, bizarre theories concerning the spread of the disease were advanced. Experts in tropical medicine said they thought HIV was passed on by mosquitoes; others wondered if pigs and a new strain of swine fever were to blame.

Poor sanitation, and Belle Glade’s historically wretched housing, depicted in Edward R. Murrow’s “Harvest of Shame” TV documentary in 1960, also were suspect. In 1986, the American Civil Liberties Union issued a report describing Belle Glade residents as living a marginal existence in the “Third World of the U.S.”

It wasn’t until Deanna R. James, director of the local county health clinic, told a congressional committee that “the minority community of western Palm Beach County is threatened with extinction” that many agencies began to take notice of the misery here.

“Education is the only weapon we have,” said Harrington, who opened the HIV Prevention Center in 1988. “If people would stop risky behavior, we could stop this epidemic in its tracks.

“Abstinence is not realistic, and monogamy does not seem a viable solution for the majority of people.”

So that’s why Harrington, a woman in her early 50s who says she never saw a condom until four years ago, is often on the streets, on farm workers’ buses or in the bars, pulling silver-foiled strips of prophylactics from her tote bag.

“I have men tell me they don’t like to wear a condom because it restricts them,” Harrington said. “They say they are too big. That’s when I like to pull the condom over the head of a parking meter. No excuses.”

But of course, people do make excuses.

In the study conducted by Ellerbrock, Harrington and others, more than 5% of 1,011 pregnant women seen at a local public health clinic tested positive for HIV. The highest rates of infection were found among black women. Additional risk factors included use of crack cocaine, multiple sex partners and syphilis.

Ellerbrock calls the study results “frightening.”

“People wonder when AIDS is going to break through from being a disease primarily of gays and drug users to the heterosexual community,” Ellerbrock said. “Well, this is it, guys. It’s here.”