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Lisa BiagiottiBack to OpinionLisa Biagiotti

AIDS in the Bible Belt

Why the Deep South is ground zero for the domestic AIDS epidemic.

I zigzagged 4,000 miles across the Deep South on a road trip this summer and fall.

After a jazz-filled weekend in New Orleans, I drove north into the “deep deep” of Louisiana, then crossed the great, flat floodplains of the Mississippi River under the expansive blue sky. I passed through catfish country, raked across the cotton kingdom and marched back in time through the Civil Rights era. I unintentionally visited a few towns named “Greenville,” rambled up Walker Evans’ Depression Era trail and drove the historic route that thousands walked, from Selma to Montgomery.

I came all this way to understand several startling statistics about the home of the Bible Belt, the Black Belt (known for its black soil) and the Stroke Belt (known for high incidences of strokes and cardiovascular disease). My mission was to investigate why the American South has HIV infection rates nearly 50 percent higher than the rest of the country, and why almost half of the people in the U.S. living with HIV — and dying of AIDS — reside in the South.

People usually furrow their brows when I tell them I’m reporting on HIV in the Deep South, so if you’re crinkled up now, yes, I’m referring to the American South. HIV is still very much an epidemic in this country, although the activist movement and media attention have gone global.

Across the country, every 9.5 minutes an American is newly infected with HIV. There are 56,000 new infections every year. Just more than 1 million people in the U.S. are living with HIV, and about 600,000 Americans have died from AIDS. This year, and for the first time in the history of the epidemic, the White House released a National HIV/AIDS Strategy to address the domestic epidemic.

A “perfect storm” of social and environmental conditions make the South ground zero for the domestic HIV/AIDS epidemic. The Southeast region of the U.S. has the most poverty, the weakest safety net programs, the most uninsured people, the most prisoners, the fewest needle exchange programs, and the least HIV/AIDS funding and abstinence-based sex education, according to a Human Rights Watch report released Wednesday.

HIV infections are crossing gender and race and spreading among minorities, young gay and bisexual men and heterosexual women. The disease is pooling in remote, rural areas with poor or nonexistent health and social infrastructure.

As I traveled throughout the South, I quickly realized that HIV takes advantage of the most vulnerable parts of society, and it doesn’t travel alone. For example, Mississippi leads the nation in chlamydia, gonorrhea and teen pregnancy. Then add in a good deal of obesity, heart disease, strokes, diabetes, high unemployment, welfare and imprisonment. And, finally, overlay the stigma, homophobia, racism, history of slavery and a culture where preventative medicine is not routine. And Mississippi does not stand alone.

Government AIDS drug assistance programs are closing because of state budget deficits. Federal funds tend to be distributed to big cities because funding streams focus on high concentrations of infections and count only cumulative AIDS cases from the beginning of the disease, including all of those who have died. The South has a newer epidemic and more HIV cases that have not yet progressed to AIDS. So, by not counting HIV cases, the South is being punished. Also, the sprawling, rural landscape of the South makes infection concentrations an issue.

Awareness campaigns have dwindled and don’t address the root causes. Rather, they focus primarily on testing and treatment for HIV, not preventing it. “Dead zones” — places cut off from access to care and services — remain. And because of all this, there are intergenerational consequences of an epidemic everyone ignores.

In the Deep South, those working to fight HIV are beginning to suspect that you can’t prevent the disease simply by looking at people’s sexual behaviors. The problem seems to have a much broader origin. The epidemic seems to be as much related to development — or lack thereof — as it is in the developing world.

Unlike earlier decades in the U.S. when the majority of those infected by HIV were middle class, urban, gay men, now the behaviors that lead to HIV infection echo those that cause kids to drop out of high school and commit crimes. HIV has become one of many lifestyle risks experienced by marginalized people in a collapsing society.

As such, the traditional methods of fighting HIV don’t work.

So, as we commemorate World AIDS Day, I worry we’ll be marking this day for many, many years to come if we continue fighting the old fight.

Antiretroviral drugs are essential, of course. And yes, a cure would be miraculous. But we will never test and treat our way out of this epidemic. If HIV isn’t viewed (and treated) as a social illness — with cultural roots and tentacles that extend beyond medicine and public health — the epidemic will never end.

I’m headed back down South to Alabama and Mississippi next week. I’m meeting with infectious disease doctors and riding along with rural social workers to those “dead zones.” I’m also working with a health consultant to map AIDS deaths in the South by zip code.

As I get ready to set off, I find myself eager to get back down South, not only to report this under-reported story but because I’m growing fond of Southern culture — its people, its fragile past and its resilient spirit.

Lisa Biagiotti is an independent journalist currently producing a documentary on HIV in the Deep South, with support from the MAC AIDS Fund.



  • Colin Fitzpatrcik

    How is this new? HIV and poverty have been inextricably linked for well over two decades now.

    I hope this doesn’t turn into some more scientifically disproven cultural commentary about how men on the DL must be spreading HIV to women like what you said during your reporting in Haiti.

  • World AIDS Day 2010

    How and where has it been scientifically disproven that MSMs spread HIV to the women they engage with sexually? If you understand one iota of the cultural barriers that MSMs face you would not make such a ridiculous comment.

  • Colin Fitzpatrcik

    It’s been shown that MSM communities do not act as a major disease vector in spreading HIV within straight communities. But they are constantly blamed for it! You see this with all the “Men on the D/L are giving black women AIDS” hysteria in the media, and it is simply just NOT supported by epidemiology.

    Here’s a great article from The Body on the matter:

  • Colin Fitzpatrick

    I’d also like to add, that having their bodies, identities, and behaviors constantly maligned as inevitable disease vectors that destroy straight society is one of the major stigmas that MSM men DO face that we should be working to change in order to broaden education and prevention efforts.

  • RachelW

    Just a small nitpick: the phrasing “and the least HIV/AIDS funding and abstinence-based sex education” makes it seem like part of the problem is a *lack* of abstinence-based sex ed in the South (i.e., it has the “least…abstinence-based sex education), when the HRW report actually criticizes the lack of *comprehensive* sex ed.

  • RachelW

    Just a small nitpick: the phrasing “and the least HIV/AIDS funding and abstinence-based sex education” makes it seem like part of the problem is a *lack* of abstinence-based sex ed in the South (i.e., it has the “least…abstinence-based sex education), when the HRW report actually criticizes the lack of *comprehensive* sex ed.

  • Fake

    Ignorance and religion go together like herpes and AIDS.

  • Dama9ed

    This article is way too short. A grand opening and then no juice. It ends too quickly, without any details or insight. Teaser.

  • Dorothygist

    Very interesting. I look forward to seeing the documentary.

  • Lila Dori

    We will have to watch the documentary I agree too short and I am very interested.

  • Lila Dori

    To Colin:
    I think your confusing this article with the “Old Fight” as she stated. This is not geared toward MSMs alone. It’s not geared towards that at all and it clearly states that it was an issue in the early 90′s. It is now a social crisis that they are thinking maybe can be assisted by starting with the economic aspects of the disease rather than sexual. Poverty is just one of those aspects. Goverment plays a huge role in this now. She is talking about getting to the root of prevention and that you cannot prevent by simply knowing sexually how a disease is carried but by looking at the social issue surrounding it. The “Dead Zones” where people are unreachable and the Lack of Teen awareness because government funding is not eligable in those areas that need them most. This article is not focused on MSMs being the reason for the spread of HIV/AIDS but rather the opposite. Saying this has spread to a much larger social group and it needs to be looked at as a social illness.

  • Lila Doris

    That’s what she meant. There is a lack of “HIV/AIDS funding and abstinence-based sex education” in these areas that have the most infection.

  • Luke Versher-AAIM

    Lisa article was not pointing fingers at the MSM population nor did it try to link the dl men to the infection rate. she was stating that MSM and women of color are the hardest hit population, and poverty and stigma is the driving force. I met Lisa while she was here in Mississippi and look forward to her return. She is helping to bring attention to how HIV is rapidly spreading in the south due to stigma,homophobia and poverty to name a few reason. Also we are fighting hard here to get a comprehensive sex ed. bill past and thats another challenge. It is obvious that abstinence-only programs are not working here

  • southerner

    Ummm, there’s no ‘here’ here. Kinda tired of outsiders passing through and then passing on their stereotypes of the south. Really poor ‘journalism.’

  • Proofpozi

    No she said exactly what she meant. The south has the least funding AND focuses primarily on abstinence based sex education (which has been proven to not work).

  • Proofpozi

    Just because she’s passing through doesn’t mean she didn’t get it right. I’m a Yankee transplant to the south and have done HIV advocacy for a long time in the South and the article is spot on. Just because you don’t like the message doesn’t mean it isn’t so.

  • Gvt2me

    I didn’t see stereotypes. I saw statistics.

  • Lkane

    I can’t wait to see the documentary! The statistics are shocking and seem to sound more like a third world country rather than America.

  • thezak

    How widespread is the strategy?… of
    “BEFORE we have sex let’s get tested TOGETHER
    for A VARIETY of STDs.”

    Do sexual health checkups reduce the ambiguity and can they be like anything else POTENTIAL sex partners do together?…

    If you needed surgery would you want the surgeon to wash
    before operating?…

    If you needed a blood transfusion would you want the blood tested before or after the transfusion?…

    see also

    “tested together” alerts

  • Debnwade

    Please contact Dr. Barbara Hanna, Infectious Diseases Physician in Anniston, Alabama who is the Medical Director of a Ryan White federally funded HIV/AIDS Medical clinic and has worked since 1991 to cover care for HIV+ individuals in 14 counties of Alabama. Prior to this she worked in New Orleans where she diagnosed the first case of HIV at the VA medical clinic there when AIDS was only known as GRID (Gay Related Infectious Disease) and the virus as yet unknown. She did all of this while rearing her 6 children, etc.

  • Lisa B.

    Many thanks, Debnwade. I visited Dr. Hanna at her clinic in Hobson City. She provides great care in her corner of Alabama. Thanks again, all the best, Lisa

  • Naive waspette

    What does MSM stand for that can’t be spelled out?

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