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.