Florida is the epicenter of the nation's HIV and opioid crises. This doctor is battling to stop the virus and winning.

MIAMI – Dr. Hansel Tookes hops out of the back of a white medical van in his signature tailored scrubs with a stash of HIV antiretroviral meds tucked under his arm.

A Black elderly woman waits by the doorway of her white and red bungalow. As Tookes approaches, a rooster and some chickens dart past him on the sidewalk. The woman offers a wide grin.

"Isn't it lovely to see you, Ms. Angie," Tookes says with a warm voice.

Tookes hands over her medicines and chitchats for a few minutes about her health before saying goodbye with a hug.

"I love you, Dr. Tookes," she tells him.

"I love you, too, and I'll see you soon," Tookes responds.

Back in the van, Tookes and two other members of his IDEA Exchange team, the first legal syringe exchange program in Florida, are on the road again, circling some of Miami’s most dangerous and low-income neighborhoods. They drive past dilapidated homes, piles of mattresses on sidewalks and Latino supermarkets where the workers and patrons speak Spanish or Haitian Creole.

In Liberty City, a once-thriving Black neighborhood ravaged by the poverty and crime that ensued after the construction of Interstate 95 in the 1960s, four patients wait outside the Yellow Meat Market, their backs leaning against a mural adorned with drawings of a liquor bottle, a pack of Newport cigarettes and a sub sandwich.

"It's Uber Eats," one of the team members shouts as she rolls down her window.

The patients smile back.

A young woman being treated for HIV approaches the van. She tells Tookes she's going through a rough patch after her baby was taken by child services because of her severe opioid use disorder.

"You've come a long way. You took your antiretrovirals every day because you wanted to protect her," Tookes tells the woman as she wipes her face. He hands her medication, along with a stash of clean needles. In return, she dumps her used syringes in a container that Tookes will take back for proper disposal.

That's Tookes’ method for fighting the spread of HIV in the middle of a pandemic: discarding one dirty needle at a time.

In less than 20 months, Tookes’ hybrid needle exchange telehealth and HIV medication outreach program has become the most successful HIV suppression campaign in the nation. Of the 35 patients treated as part of the pilot, 78.1% were undetectable within six months, which means patients cannot transmit the virus to others and the virus does not appear in routine bloodwork.

The pilot will soon be expanded to 240 people receiving similar treatment.

Part of the program's innovation is that it offers unhoused people the option of connecting with Tookes through iPads anywhere in the city and having medicines delivered. Tookes’ patients are mostly people of color and people experiencing homelessness, two groups that suffer from disproportionately high rates of drug use and HIV.

IDEA Miami exchanges up to 10,000 syringes weekly and operates three fixed and five mobile sites within Miami-Dade County. Beyond that, IDEA Exchange serves nearly 2,000 people by providing recovery counseling, medical treatment and access to supportive housing.

"The work we do is heavy, our patients are really at the risk of dying every day," Tookes says. "My question is how did this all go down before we existed, were they accessing care? The answer is no."

Tookes, 40, detailed the success of his program in the October edition of Drug and Alcohol Dependence, a scientific journal. The National Institute on Drug Abuse awarded him $2.3 million to bankroll a clinical trial in Miami and Tampa and possible expansion across the state.

Florida leads the USA in the number of new HIV cases and has the nation's third-highest infection rate, according to the Centers for Disease Control and Prevention. At its epicenter, Miami-Dade County, which is ground zero for the state's opioid crisis, saw a 34% spike in opioid overdoses during the pandemic.

Research has long shown that the uptick in people injecting drugs and using needles skyrockets the risk of contracting HIV.

"We often hear a misguided belief that people who use drugs and who face adverse circumstances ‘can’t’ adhere to treatment. This is not true," says Dr. Nora Volkow, director of the National Institute on Drug Abuse. "This intervention is an example of how, by taking into account the actual experiences of people with HIV and addressing their health care needs, we can achieve goals that otherwise seemed impossible."

To many of the people whose lives Tookes has helped put back on the right track, he is more than an innovator. He is the person who saved them from a too-soon death.

"He took an approach that accepts the reality of people who inject drugs," says Sarah Wallace, 64, whose opioid use disorder was active for 60 years. She signed a one-year apartment lease in part because of Tookes’ intervention and support.

"Tookes is my baby, that's my son," Wallace says.

New medical approach helps stop HIV transmission

For five years, Tookes has sought out HIV patients. Under bridges. In convenience stores. Down back alleys.

He is on a mission: Stop the transmission of HIV.

Tookes' journey started in medical school in 2012, where he lobbied the state Legislature for four years to legalize a pilot needle exchange program.

At the time, providing any person with syringes was a crime in Florida, where lawmakers had long claimed syringe exchanges promoted intravenous drug use and other unsafe behaviors. The arrival of more dangerous synthetic opioids, such as fentanyl, which led to soaring overdoses and high HIV rates, prompted lawmakers to change their minds.

The IDEA Exchange, short for the Infectious Disease Elimination Act, opened its doors Dec. 1, 2016, World AIDS Day.

The HIV/AIDS crisis that began in the 1980s killed more than 700,000 people in the USA. Though more people live longer because of medical advancements, the CDC says 13,000 die from the virus every year. People of color represent the majority of new HIV diagnoses and deaths among people with HIV, according to a report by the nonprofit Kaiser Family Foundation in San Francisco.

What was born as a scrappy student-led project soon became a thriving boots-on-the-ground operation, with a team of four full-time staff and a dozen volunteers, including doctors, therapists, researchers, community outreach workers and students.

Then the COVID-19 pandemic hit.

Tookes feared pandemic public safety measures would shutter the center. And the city was moving unhoused people who tested positive for the coronavirus into motels miles away.

The solution was more tech. The clinic purchased iPads and began offering telehealth services to patients. Staffers hit the streets with tablets and shared screens.

The team upped deliveries to patients unable to visit the clinic from twice a week to 682 medicine drops.

"Health care in the U.S. operates in a 'build it, and they will come' philosophy. But the primary barrier is actually access," says Alex Kral, an epidemiologist specializing in syringe exchanges and drug use with RTI International, an independent nonprofit research institute in North Carolina. Kral has co-written research with Tookes.

He says, "For people struggling with mental health to get the necessary care, you have to overcome the high costs, transportation, administrative hurdles and also culturally inappropriate workers and structures."

Wallace is among Tookes’ earliest patients.

She found out she had HIV in 2012 after she agreed to take a blood test in exchange for a $5 McDonald’s coupon. Her plan was to turn around and sell the certificate to score a hit of fentanyl.

The diagnosis petrified Wallace, whose mother was HIV-positive and struggled with side effects and endless medications. Wallace was experiencing homelessness, sleeping on two chairs on a sidewalk in Overtown, a historic Black neighborhood in Miami devastated by the crack epidemic of the 1980s and now opioids. Wallace’s opioid disorder had left her body covered in injection scars, nearly crippled from arthritis and with an ulcer on her left leg.

The threat of death haunted her: Her end would come, she fretted, from violence, a fatal overdose or her HIV.

“Every night before going to sleep, I would pray, ‘Jesus, help me not get raped or murdered tonight,’” Wallace says. "I was so tired of being afraid of the darkness."

By then, Tookes had garnered a reputation on the street for helping patients, including those who were injecting drugs.

Before accepting medical treatment, Wallace had one question for Tookes: "Why did he do this for us? The broken-spirited, the bruised and battered."

Tookes told her all patients deserve dignity, respect and trust.

"Harm reduction is love," he said.

After her treatment, Wallace is undetectable and has been in recovery for more than 2½ years.

'We are treating the whole city'

After leaving the Yellow Meat Market, the white van returns to the IDEA Exchange's home base, a collection of converted beige shipping containers on a gravel parking lot. The medical clinic houses a wound center, a blood testing area and exam rooms. There are no signs posted outside the chain-link fence.

As he walks in, Tookes’ iPhone is buzzing. It’s a staff member calling to help a patient living under a bridge in Overtown check in for his telehealth consult.

"I'm here, I'm here," Tookes says as he rushes to lock himself in his office – a storage room full of boxes of different-sized needles, N95 masks and printing paper.

On his way in, Tookes waves hello to Chetwyn Archer, a staffer who was one of the IDEA Exchange's first clients.

Archer, 61, started injecting drugs in 1977. He says he avoided contracting HIV for 40 years until May 2018. Archer got tested monthly because his partner partook in sex work.

He hated hospitals. He hated waiting rooms. He says doctors left him to sit in pain for hours while giving him filthy looks.

"They didn't believe that I was in pain," Archer says. "They didn't believe that if I was there, it was because I had a legitimate ailment, not to score."

It was different at IDEA, where participants could make their own choices, including the location where they wanted to meet staff to receive care. Staff reviewed medications, displaying the patient’s weekly pill box and discussing any dosage changes.

"I didn't feel like some sort of junkie here," Archer says.

In 2020, he was hired as a peer educator. He tells clients about treatment options, calms their fears.

"By treating people under the bridge and making sure they have medicines and clean needles, we are treating the whole city," he says.

HIV patients can be reluctant to seek treatment

Tookes is back in the van, cruising for more patients with his outreach team. They spot a blond man on a bicycle who was supposed to come by the clinic a few days ago.

He goes by the nickname Bama because he moved to Florida from Alabama. Bama is HIV-positive and returned to injecting drugs during the COVID-19 outbreak.

Chevel Collington, the outreach worker behind the wheel, puts her foot on the gas and makes a left turn to catch Bama before he pedals off.

"Hey, Bama, we have pizza and cupcakes tonight at the clinic. If I were you, I'd head on over," says Elisha Ekowo, a member of the community engagement team.

"Yes, it's the good stuff, the fancy stuff today," Tookes blurts from the backseat.

Bama stands by the van window, straddling his green bicycle seat.

"You know I love y'all," Bama says. "You think I can get one of those cupcakes?"

Ekowo hands him one covered in vanilla frosting and sprinkles. Bama devours it and asks for another one.

"Have as many as you want," Collington tells him.

Bama starts to open up. He says he let his girlfriend know they have to break up if she isn't willing to also go to treatment.

"You think we could find a place where I could go by myself," Bama asks.

"Yes, we can totally help you with that, Bama, why don't you come to the clinic tonight to talk about it. You can also catch a ride with us," Tookes responds. "We can make a plan while you're there."

Bama is noncommittal: "How about I come through later?"

Tookes nods. He is used to patients who need a little extra encouragement.

That's what happened to Melissa Hendren, a former certified nursing assistant who hid her diagnosis for four years after she became infected with HIV. She avoided getting medical help, ashamed to tell anyone, including her husband.

Four months ago, Hendren woke up to find her husband dead from a fentanyl overdose.

His death gave Hendren the courage to detox and treat her substance use disorder.

Hendren learned from an outreach worker she could rely on the IDEA Exchange to deliver her medication.

"They would find me wherever I was and deliver the meds to me," says Hendren, 52. "They brought them to me, and it felt safer."

Adam Pearson, 50, first met Tookes in 2016 at the emergency room at Jackson Memorial Hospital when the doctor was a medical resident.

Pearson, who was HIV-positive, came in because of a skin and soft-tissue infection – a condition that can be life-threatening for people with the virus.

"Our meeting and his entry into HIV care at that time was fortuitous," Tookes says. "His immune system had weakened significantly with untreated HIV."

Pearson says Tookes talked to him "like I was a person."

After their encounter, Pearson made Tookes his primary physician. Tookes put him on antiretroviral therapy to treat his HIV.

Pearson, who grew up in a very religious family that disapproved of his sexual identity as a queer man, was anxious that his family would find out he had the virus.

"I can't imagine what they would say to me if they knew that I had HIV," Pearson says.

He says Tookes and his psychologist empowered him. They helped him make a plan, find a safe place to live and leave his partner. Those changes allowed him to keep up with his medications to the point that he is undetectable.

"At the lowest of the lows, they helped me where I was at," Pearson says of Tookes’ staff. "My family had given up on me. But they haven't given up on me."

Few medical students understand addiction medicine

Tookes and his team head back to the clinic. It’s Thursday night, the one day a week patients can show up and seek treatment for any kind of ailment: an ultrasound, a wound that needs to be patched up, new medications or counseling.

Groups of medical students and residents in scrubs, some in their first or second year of medical school, speak to Tookes about each patient. Then they evaluate them together.

This is an uncommon sight in medical training and another one of Tookes' innovations.

A report by the National Center on Addiction and Substance Abuse revealed medical students were exposed to only a few hours of addiction medicine over a four-year period.

"When I got out of medical school, I didn't even know how to write a prescription for Suboxone," Tookes says, referring to a medicine that helps people with opioid use disorder stay in recovery.

A 44-year-old man walks into the clinic wearing a black ski mask and hauling a big duffle bag.

He fidgets, looking behind his shoulder. He says he doesn't want to give his name because he has left his violent partner and is looking to reenter care. He is HIV-positive.

Tookes writes him several prescriptions and enrolls him for treatment under the Ryan White HIV/AIDS program, a federal program created in 1990 that guarantees HIV treatment at no cost.

"We are saving lives today, people,” Tookes says. “Yes!"

A few more patients make their way in. Two patients sign up for HIV medication. One asks to go to detox.

Tookes peers out the window to see if any of them are Bama.

He says respecting patients' choices each step of the way is what makes his program successful.

"My patients trust me because I trust them. It is mutual respect," Tookes says.

By closing time, students begin to clean up exam rooms.

Bama doesn't show.

Maybe tomorrow, Tookes says.

Follow USA TODAY national correspondent @RominaAdi on Twitter.

This article originally appeared on USA TODAY: HIV transmission is this doctor's mission. His unique plan pays off.