POZ examines HIV/AIDS in U.S. south

POZ in its November issue examined HIV/AIDS in the U.S. South. The South -- which includes 14 states and Washington, D.C. -- accounts for 45% of new U.S. HIV cases and 50% of all AIDS-related deaths, according to CDC. Seven of the 10 states with the highest AIDS rates also are located in the South, and an increasing number of people living with the disease reside in the region.

Causes for the region's increase in new cases are "varied and contentious" and include extreme poverty, unreliable HIV/AIDS-service infrastructures, and large minority and rural populations, according to POZ. The regional epidemic has been "further complicated" by the "lingering effects" of Hurricane Katrina and a lack of federal HIV/AIDS funding, particularly compared with larger urban areas, POZ reports.

Charles van der Horst of the University of North Carolina-Chapel Hill said that "[c]rushing poverty and malnutrition" are factors in the South's HIV/AIDS epidemic, adding, "We're dealing with poor people who don't perceive themselves at risk, people who are addicted to drugs that make them take chances and a lack of comprehensive sex education."

John Paul Womble, director of development for the Alliance of AIDS Services-Carolina, said that the federal response to the U.S. HIV/AIDS epidemic "correctly began with the areas that needed it most -- large urban areas." He added that "when the infrastructure that was built (no longer served the need of the people in the same way), the government didn't want to change it, because they created it, and it worked. It's easier to maintain the status quo than to change."

More than 21,000 people living with HIV/AIDS in Alabama, Louisiana and Mississippi were affected directly by Hurricane Katrina, according to a Kaiser Family Foundation fact sheet. In addition, half of community-based prevention providers went out of business in New Orleans, where a large percentage of people living with the disease did not return after the hurricane or came back months later to "find their medical coverage was lost or in disarray," according to POZ.

In addition, the "mere act of labeling" HIV/AIDS in the South as a "regional problem" continues the "cultural stigma and interstate funding fights" that advocates "hope to prevent," according to POZ. Addressing the disease in diverse states "means understanding the complex array of factors contributing to its spread and responding with cultural sensitivity and accuracy," POZ reports.

A number of HIV-positive people, community-based organizations, foundations, public health officials and faith-based groups are "raising a louder call" for increased HIV/AIDS awareness and support in the South, according to POZ. Although there are reasons for "pessimism and disappointment" regarding state and federal responses to HIV/AIDS in the South, there have been "notable successes and lessons learned" that could be "applied throughout the country," POZ reports.

Andrew Spieldenner, director of programs at the National Association of People With AIDS, said that "many of the Southern states have taken creative steps in meeting the needs of people living with HIV in their jurisdictions, including those with health departments, elected officials, faith-based groups and other businesses servicing the same populations." He added, "Some of this has been necessary in order to maximize resources; some of it has come out of extensive relations already existing in the respective communities" (Briggs, POZ, November 2007).