AIDS “catastrophe” in the American South

HIV/AIDS in America is more complicated than you might realize.  If you think of urban centers and the east and west coasts as the real “drivers” of AIDS in the US, you’re not alone.  You are, however, mistaken.

According to a Birmingham News article by Dave Parks, a report released by the Southern AIDS Coalition on July 21 warns that “HIV has burrowed into the Deep South, feeding off some of the most impoverished people in the nation and creating a health catastrophe.”  (I definitely recommend reading the whole article, or this summary from the Kaiser Network.)

The report paints a grim picture of a growing HIV/AIDS crisis in the rural South, fuelled by underfunding, logistical difficulties, cultural factors, and deep poverty.

The Southern AIDS Coalition points to a number of factors making HIV/AIDS an increasingly deadly problem in the Deep South, as this excerpt from the Birmingham News article describes.

“Rising infection rates coupled with inadequate funding, resources and infrastructure have resulted in a catastrophic situation in our public health care systems in the South,” the report says. “Unless we act to correct funding and treatment disparities, we endanger not just isolated communities, but our states and our nation.”

Kathy Hiers, chief executive officer of AIDS Alabama and co-author of the report, said HIV/AIDS has settled into remote areas of the South inhabited by black people who are at great risk for infection. “The ruralness of the epidemic is what’s becoming painfully clear,” Hiers said.

The report notes that the number of deaths from AIDS decreased in the rest of the nation 2001-05, but continued to rise in the South. During that period, more than 190,000 Southerners died from AIDS. […]

Now experts have zeroed in on the Deep South – Alabama, Georgia, Louisiana, Mississippi, North Carolina and South Carolina – and found HIV infections spreading in rural areas inhabited by blacks with overwhelming financial, health and social problems.

The South consistently gets less than its fair share of funding from both government and private sources.  Though recent changes to the way the federal government divvies up HIV/AIDS funding has provided some help, “the South, which ranks No. 1 in new HIV cases, still ranks last out of four regions in overall federal funding.”  Meanwhile, the South — the home of about 40 percent of people living with HIV/AIDS in America — the region got only about 19 percent of “U.S. philanthropic commitments for HIV/AIDS.”

The report discussed the situation in Alabama at some length.

“Like much of the Deep South, Alabama faces a growing HIV/AIDS epidemic in the context of broader health care challenges,” the report said. “Alabama is among the three poorest states in the nation and ranks 45th among all states in overall population health.”

High rates of other sexually transmitted diseases, a rural population, poverty, mental health problems, lack of insurance and a host of other factors make fighting HIV/AIDS in Alabama difficult and complex, the report said.

The article goes on to discuss problems arising from inadequate education, substance abuse, and widespread stigma.

When I first read this article, I was pretty surprised.  The rural South doesn’t exactly spring to mind when I think about HIV/AIDS in the US.  But the more I thought about it, the more I realized I really shouldn’t be surprised.  It makes a tragic sort of sense.

I spent most of my growing-up years in Canada, but after that and before I moved to my present location in the Chicago area, I lived for a while in central Florida.  (I also lived for a few years in North Carolina when I was pretty little — yes, I have a strange geographical history.)  People can and do debate about whether Florida can be properly considered part of “the South,” but I would say that much of rural Florida has more in common with the archetypal “Deep South” than it does with the chic urban centers on the coasts (or the surreal, Disneyfied atmosphere of Orlando, which — in my opinion — offers about equal parts glitz and kitsch).

Based on my admittedly limited experience, the Birmingham News article rings painfully true.  The rural South is home to many very, very poor people.  The poverty I saw in many places between Florida’s coasts saddened and frankly astonished me.  It’s well-known that poverty is a major factor driving HIV/AIDS, and you get a whole added set of logistical challenges when you’re dealing with relatively remote rural areas.

I don’t think it’s surprising that the southern US suffers from a lack of HIV/AIDS funding, especially from private donors.  The rural South is geographically and culturally distant from America’s main money and power centers.  Unfortunately, it often gets overlooked.  I would guess that when most people think of poverty in the US, they think of inner cities.  Urban ministry is hot stuff in the Christian subculture — I don’t know if the term “rural ministry” even exists.  The problems described in the Southern AIDS Coalition report just don’t seem to show up on too many radar screens.

And then there are cultural issues.  (I’m not trying to stereotype anybody here, just to point out some broad trends that I think you can see in many southern communities.)  Let me quote again from the Birmingham News article:

A further complication is that people in rural counties know each other well, and there’s a stigma attached to HIV. [Executive director of Selma AIDS Information and Referral Mel] Prince said some ministers still tell congregations that the disease is God’s punishment for homosexuals. (The state Department of Public Health reports that about as many people in Alabama are infected with HIV during heterosexual activity as are infected during homosexual activity.)

Given the stigma, people don’t want to get tested and don’t want to get treated, Prince said. “They’d rather die.”

Again, this doesn’t surprise me.  Small-town gossip can be a powerful thing, and southern communities tend to be quite conservative (in any number of ways).  It would probably be safe to say that homophobia is, if not more common, at least more socially accepted, than it is in the broader American culture.  (Just for the record, I’m not talking about religious or ethical codes that view homosexual activity as morally problematic.  I’m talking about serious, deeply-ingrained, often vitriolic, sometimes hateful, prejudice against gay people as people. . . . Let me note again, I’m not saying everyone in the South holds these kinds of views!)  My brother, who attended a Florida high school for a couple years, once described a bitter debate on gay rights in a classes, where defending even as simple a position as “gay people should be treated with kindness and respect just like anyone else” got him a ton of flack from many classmates.  So — I say it with deep pain and regret —  I find it easy to believe that some churches still promote the “punishment for homosexuality” stance on AIDS.

Well, there you have my two cents on HIV/AIDS in the South.  I really hope that this recent report focuses more attention on the situation and stirs policy-makers, advocates, donors, and churches to make anti-AIDS efforts in the southern US more of a priority.  I hope to hear more about this issue soon.  (By the way, it will be interesting to see if and how all this is reflected in the CDC’s new batch of stats, set to be released in early August.)


~ by h.e.g. on July 24, 2008.

3 Responses to “AIDS “catastrophe” in the American South”

  1. Insofar as this is a blog about the Christian faith and its interaction with HIV/AIDS it seems only appropriate, indeed necessary, to make a critique of the Southern Church’s (I speak here of the Apostolic Church, not merely, say, the Southern Baptists) treatment of the HIV/AIDS crisis and the people involved in it. The Southern Church, in their noble goal to emphasize orthopraxis has forgotten the very core of Christian ethical teaching: Grace.

    It is right for the Southern Church to oppose sin, but all too often it succumbs to a legalistic mentality characterized by hatred. It often vilifies homosexuals or the sexually promiscuous. But this attitude is simply unacceptable. (The fact that they often associate HIV/AIDS only with homosexuals, dead wrong as it is, is not my chief concern here, the attitude is much more dangerous). Bonheoffer had a phrase for this: “cheap Grace”. It is cheap because it is easy, and the fact that it is easy points to the fact that it is inauthentic Christianity.

    Even the most casual reading of the Gospels cannot escape the fact that Jesus was not concerned with the “righteous”, but he spent his time with sinners and outcasts. Yes, Jesus told sinners to “go and sin no more”, but only after he extended his loving arm to them. The Church would be wise to follow in the footsteps of God incarnate.

  2. I’m a 33yr man dealing with HIV in Mississippi and the church has been a huge part of my growth. I have given my testimony and received nothing more than love from everyone. People tend to say churches will turn away those dealing with HIV, in my case, the church loved me and made me apart of their family. They have been encouraging, uplifting, supportive and prayful over me. This Church has shown me what Jesus is all about! They include me in everything they do! I can’t understand why churches would turn those looking for God away-To me, it makes no sense. Churches are not perfect either. Just because one church is a certain way, doesnt mean the next church you visit will be the same.

    Mark 1:40-41

    But we have to keep in check that when we are going to Church, we are doing it to understand God more-not the people in the church. Going to Church is about praising God, not pleasing people. I am blessed-

    Faith plays a ‘BIG’ part in the lives of those dealing with HIV. It gives us hope and lets us live again. At least, God has given me a reason to live angain. And for that, I am eternity grantful!
    Proverbs 3:6
    God bless,

  3. Chad, thank you so much for sharing your story and perspective! I’m so glad that your church has been supportive of you, and that they have truly displayed God’s love.

    I also like your point about about the distinction between God and the behavior of churches. Christians are flawed and often sinful, like everyone else, but our failures aren’t God’s. God is perfect in love and compassion, even when His followers fall short in these virtues.

    That being said, I know many Christians who are passionate about treating people living with HIV with respect, compassion, love, and friendship. I spent the last four years attending a Christian college and working with a campus HIV/AIDS organization, and based on these experiences I hope and truly believe that these attitudes are becoming more and more common. And I’m sure this makes God incredibly happy.

    Thanks again for your comment, Chad. I hope you’ll visit again — your thoughts are always welcome.

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