IT’S A SOUTHERN THING // HOW HIV/AIDS FOUND ITS NEW HOME IN THE DEEP SOUTH

By Judah Martin

The southern United States is certainly synonymous with a lot of cultural references — football, benefit-of the-doubt-based hospitality, mouth-watering down-home delicacies, music… According to data from the Centers for Disease Control, AIDS can now be added to that list.
While the South accounts for only 37 percent of the U.S. population, it is home to 50 percent of new HIV infections.
Though the epidemic’s history in the United States began more than three decades ago, AIDS has gradually made its way south and, in the last ten years, the region has surpassed the Northeast in prevalence of HIV and AIDS.
Of the ten states reported by the Centers for Disease Control as having the most reported HIV/AIDS cases, eight were southern states. These include Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas, according to the Southern AIDS Coalition.
Also noteworthy, the period in which HIV crosses the threshold into full blown AIDS is statistically shorter for its Southern, often impoverished victims. Consequently, southern states also boast a higher AIDS mortality rate than any region in the U.S.
Kathy Hiers, policy committee chair for AIDS Alabama, says the reasons for the disproportionate statistics are complex.
“I think research shows this disease is inexplicably tied with poverty,” she said. “Much of it has to do with structural factors in our society: lack of access to healthcare, poor education systems, all of the things that help. We don’t have effective [awareness] campaigns, particularly in the south.”
While these systemic factors heavily influence the ease with which HIV is spread amongst the disadvantaged, Hiers points to a larger, more menacing culprit.
“The more rural you get, the more stigma,” she explained.
Hiers’ fears about stigma are confirmed by a survey from the National Alliance of State and Territorial AIDS directors, which found that Alabama has the highest amount of HIV stigma.
According to the survey, HIV positive respondents, blacks, Latinos, women and transgendered respondents perceived higher levels of HIV, race and gender-based stigma than any other surveyed groups.
With frustrated sarcasm, Hiers described some the misconceptions that hinder efforts to contain spread of the virus.
“We joke that we can’t say the c-word, we can’t say ‘condoms,’” she said. “So when school systems here are required to teach HIV education, they can just check it off by teaching abstinence-only. It’s definitely a lot more conservative down here in the south, and we’re really seeing a lot of young people increasingly contracting HIV here, with the primary means of transmission being sexual contact.”
Hiers finds that, in addition, lack of extensive sex education allows the uninformed to continue thinking of AIDS as an almost exclusively gay disease, or perhaps one that mostly impacts blacks and other minorities, or some other elusive plague to which they are immune.
This means that people still think that HIV positive people look different, or that they can’t contract the virus if they’re only sexually active with certain people.
“People think they can tell by looking because maybe they’ve seen people with in-stage AIDS,” Hiers explained. “Of course we know you can have HIV for ten years and still seem healthy. Additionally now, with meds people can live relatively normal lives for a much longer time.
“What’s worse is that people still think of this as a gay disease; 30 percent of AIDS cases are in heterosexual women, we still have kids being heavily impacted, one out of every three are in the 13-24 age range. In the south, we are among the highest rates of HIV infection among teenagers”
In light of modern breakthroughs in medical treatment options, Hiers said the assumption that HIV/AIDS is now a manageable disease promotes a false feeling of security for many.
“One of the biggest [misconceptions] is that HIV is handled, it’s manageable, so people aren’t that worried, but they don’t realize the number of people know they’re infected, the number of people that still hide their status, just because the south is so much worse about stigma,” she said.
As of 2012, 34 states and two U.S. territories have criminal statutes for HIV exposure, according to NASTAD. While these laws are meant to protect the general population from exposure to the virus, Rainey Campbell, executive director for the Southern AIDS Coalition, pointed out that such laws contribute to its spread.
“Criminalization laws are based on knowledge of your status, so even if you’re partner is aware that you are HIV positive you can still be prosecuted,” Rainey said.” Unfortunately, that drives people away from care because if you don’t know you have it then you can’t be prosecuted.”
While the south disproportionately accounts for the majority of the nation’s HIV and AIDS cases, little can be done to combat the statistics. According to Hiers, federal AIDS funding has been primarily directed eastern states and California, the starting points of the epidemic in the U.S.
“When the disease started that’s where it was, so the idea was to put the money where the disease was, she said. “But as the disease began to move to other places the urban areas didn’t want to let go of the money. So each state has two senators but the house members are based on the size of the state’s population, so of course its going to be really hard to get places like New York and San Francisco to let go of their funding.”
Recently, though, thanks to the Ryan White Care Act, named for the late teenage hemophiliac AIDS activist of the 1980s, the stark gaps in federal funding are now filled, providing assistance to people without access to the adequate healthcare necessary for fighting the disease.
Nevertheless, newly diagnosed AIDS cases increase annually, with reported cases increaling from 17,680 to 18,164 in Alabama alone, according to statistics from the Alabama Department of Public Health.
“The disease had moved south, the funding has not,” Hiers said we still have disproportionate funding going to urban areas, even with the Ryan White Care Act. The Ryan White bill got $30 million shifted to the south, now we’re working on the housing bill.”
Inherently, the stigma that encourages people to remain voluntarily oblivious of their HIV status inflates the southern AIDS mortality digits, something Hiers said should be easily avoidable.
“What’s important to remember is that in the last year [scientists] made a huge discovery,” Hiers said. “If a person is on meds and keeps their viral load low they’re not really transmissible. If we could just get everybody to get tested we can actually get everyone to end this thing.”