Outdated Approaches, Ineffective Strategies, Punitive Laws at Nation’s HIV Epicenter
November 26, 2010
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The South is the epicenter of HIV infection in the United States, but southern states resist proven methods of HIV prevention and refuse to provide adequate funding for HIV care and services. This is a public health failure, but also a violation of fundamental human rights for those at risk and infected with HIV.
Megan McLemore, senior health researcher at Human Rights Watch

(New York) - Progress in the fight against AIDS in the southern United States is undermined by state laws and policies that impose ineffective approaches and fuel stigma and discrimination against people living with HIV, Human Rights Watch said today.

In the 23-page report, "Southern Exposure: HIV and Human Rights in the Southern United States," released in advance of World AIDS Day on December 1, 2010, Human Rights Watch documents the practices that undermine public health and progress on combating HIV in the region where the epidemic is growing at the fastest rate in the nation. These include the refusal of southern states to provide comprehensive sex education in the schools, state laws that impede access to sterile syringes, and criminal penalties for exposing others to HIV.

"The South is the epicenter of HIV infection in the United States, but southern states resist proven methods of HIV prevention and refuse to provide adequate funding for HIV care and services," said Megan McLemore, senior health researcher at Human Rights Watch. "This is a public health failure, but also a violation of fundamental human rights for those at risk and infected with HIV."

Human Rights Watch interviewed hundreds of individuals living with HIV and AIDS, AIDS service organizations, and public officials throughout the region.

The report describes the alarming progression of the HIV/AIDS epidemic in the southern United States. Roughly half of those who die of AIDS in the US are residents of the South, a 17-state region as defined by the federal Centers for Disease Control and Prevention. These states also report the highest rates of new HIV infections in the country. In the South, the epidemic has hit hardest among minority populations, and particularly African-Americans, who bear a disproportionate burden of infection.

"Nowhere are racial disparities in HIV/AIDS rates more visible than in southern states," McLemore said.

In 2008 in Mississippi, for example, African-Americans were 37 percent of the population but 76 percent of new cases of HIV. In South Carolina, African-Americans were 28 percent of the population but 72 percent of people living with AIDS.

Human Rights Watch highlighted the role of state governments in setting education policies, promoting HIV prevention, and ensuring appropriate treatment for HIV patients, and the ineffective approaches taken by many southern states. These states, which lead the nation in the percentage of people living in poverty, also lead in lack of access to health care, and numbers of people without health insurance, all factors that increase the risk of HIV infection or AIDS deaths. Southern states also report the nation's highest rates of chlamydia, gonorrhea, and syphilis, sexually transmitted diseases that can significantly increase an individual's risk of becoming infected with HIV.

While the federal government has recognized the importance of comprehensive sex education, many southern states continue to promote unproven and ineffective abstinence-based approaches. The result, Human Rights Watch said, is the denial of potentially life-saving information to adolescents at risk of HIV infection. Abstinence-based programs often include, and even require, negative messages about homosexuality, which can stigmatize gay youth and drive individuals in need of HIV information away from essential treatment and services.

In many southern cities, injection drug use remains a significant mode of transmission. But programs to exchange used syringes for clean ones, a proven method of reducing the risk of HIV transmission caused by needle sharing, is largely unavailable. Drug paraphernalia laws and regulation of syringe access create legal uncertainty and fear among advocates for people with HIV/AIDS.

The report describes the attempt of the director of an HIV/AIDS organization in South Carolina to discuss with local law enforcement the establishment of a syringe exchange program.

"It was a very short meeting," said Carmen Julious, executive director of Palmetto AIDS Life Support Services in Columbia, South Carolina. "They said, ‘We'll arrest you,' and that was that."

Human Rights Watch highlighted the negative consequences of laws in 12 southern states that target individuals who potentially expose another person to HIV. National and international public health guidelines advise against such laws, which often poorly define "exposure" and can penalize those who know their HIV status, providing an incentive for people to avoid HIV testing. In addition to increasing stigma surrounding the disease, the report notes that these laws promote misinformation about HIV as they often include bans on behavior, such as spitting, that have not been documented to transmit HIV.

Human Rights Watch also criticizes the failure of states and the federal government to fund HIV/AIDS programs in the South adequately. According to the report, federal HIV/AIDS funding through the Ryan White program has consistently shortchanged the South due to outdated formulas based on cumulative AIDS cases rather than on new HIV infections. At the same time, investment by many southern states in HIV/AIDS prevention, treatment, and essential support services such as housing and transportation has been low or nonexistent, and states fail to maximize federal matching funds that are available.

Medicaid eligibility set by southern states is the most restrictive in the nation, leaving many people with HIV unable to afford health care. In Alabama, Arkansas, South Carolina, Louisiana, Mississippi, and Georgia, 40-65 percent of people diagnosed with HIV are not in regular treatment, compared with the national average of 30 percent.

"Immediate action by both federal and state government is needed to turn around the HIV crisis in southern states," McLemore said. "Ineffective, ideological, and outdated approaches need to be replaced with proven strategies that are adequately funded and that ensure respect for human rights."