HIV/AIDS in the Southern United States

The South is made up of 16 states—Delaware, Maryland, West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Arkansas, Tennessee, Kentucky, Louisiana, Texas, Oklahoma—and Washington, DC.^* According to the Kaiser Family Foundation, the South is the only region in the United States where the rate of new AIDS diagnoses continues to increase, while the rest of the country has remained relatively stable.² From 2000 to 2004, new AIDS cases in the United States increased by less than one percent; however, new cases in the South increased by nine percent.³

Southern myths
One factor fueling the HIV epidemic is that many Southerners mistakenly believe they are safe from AIDS.⁴ Most people associate HIV with large urban areas, like New York City, San Francisco, and Los Angeles. They also still see AIDS as a "gay disease."⁵ In reality, about a third of new HIV infections in the United States are passed through heterosexual contact.⁶ In recent years, the disease has changed course, moving from the large cities to attacking the rural poor. The Deep South, in particular, (Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina), has been hit the hardest. From 2000 to 2003, the number of new reported AIDS cases increased 35.6% in the Deep South. The Deep South also has some of the highest levels of poverty and uninsured individuals, factors that complicate the prevention and treatment of HIV infection.⁷

Too polite?
Another factor contributing to the epidemic may be the "culture of politeness"⁸ infused in the traditional South. Cultural taboos against discussing sensitive topics—such as drug use, sex, and homosexuality—may prevent Southerners from having necessary conversations in their homes and schools about safer sex.⁹ Religious conservatism also contributes to the spread of HIV by affecting education. Many Southern states like Texas and North Carolina mandate that school-based sex education programs teach abstinence as the only method of HIV and STD prevention.¹⁰

Southern blacks most affected
African-Americans are disproportionately affected by HIV and are becoming infected at higher rates. Although they represent only 13 percent of the U.S. population, they account for nearly 50 percent of newly reported AIDS cases. The disparity is most obvious in the Deep South, in particular in Alabama. According to AIDS in Alabama, a Birmingham-based advocacy group, African-Americans account for 70 percent of new infections in the state. ¹¹

Most don't know they're HIV-positive
Up to half of all HIV infections in some Southern states are not identified until the onset of AIDS-related opportunistic infections. These late diagnoses are problematic, not only because they require an immediate need for aggressive treatment, sometimes even expensive hospital stays, but also because people with undiagnosed infections might infect others without knowing it.¹²

HIV Vaccine Research in the South
The HVTN has five sites in the South, including two newly joined clinics at Emory University in Atlanta and the University of North Carolina in Raleigh. While we believe that an HIV vaccine is the best hope to end AIDS, we constantly stress the importance of safe sex and behavioral changes. Many of our volunteers in the vaccine trials become much more educated about HIV and the ways in which to prevent infection.

The HVTN strongly believes in meaningful community involvement in the search for an HIV vaccine. Many of our sites in the South work actively with faith-based groups to promote HIV awareness. During the past year, our colleagues in Birmingham coordinated a "Pastors versus Personalities" basketball game during World AIDS Day and the Atlanta site hosted a symposium titled "There's Hope in Our Soul," a free public symposium focusing on the role of the black church in combating HIV. HVTN hopes that by working with local churches, valuable discussion of AIDS prevention and HIV vaccine research will be fostered in the community at large.