March 9, 2011

I. Executive Summary

Donna M. is homeless and living with HIV in Jackson, Mississippi. In a conversation with Human Rights Watch, she described how the intense stigma surrounding HIV in Jackson made living without housing an even more frightening experience. Even when Donna lived with relatives, fear that her HIV infection would be discovered kept her from being treated:

First I tore the labels off [my medicines], then I ended up throwing them away. I was scared [my family] would kick me out if they found them.

Robert B. is a gay man living with HIV near Jackson. He lost many of his health benefits after he moved from New York, but he also endures the constant pressure of homophobia.

Being gay with HIV in Mississippi is a terrible curse. I came here from New York and it is like going back 40 years in time. Everyone treats you like dirt.

More than 1.1 million people in the United States are living with HIV and an estimated 56,000 people become newly infected each year. Some of the highest HIV infection and AIDS death rates in the US are found in southern states such as Mississippi, where Donna M. and Robert B. are struggling for survival. Mississippi not only fails to invest in HIV/AIDS prevention and care, it also promotes punitive, stigmatizing, and discriminatory policies that undermine efforts to reach the populations most vulnerable to HIV. Mississippi has actively resisted increased federal funding for HIV/AIDS programs and services. This report presents the voices of people living with HIV in Mississippi and highlights state responses that leave people with HIV/AIDS without treatment at rates comparable to those in Botswana, Ethiopia, and Rwanda.

From Jefferson county in the West to Noxubee county in the East, a picture emerges in Mississippi of people with HIV and AIDS unable to meet their basic needs including housing, transportation, and access to health care. Despite these hardships, Mississippi’s investment in HIV/AIDS programs and services remains minimal. The state relies almost exclusively on federal programs to provide care and services for HIV and AIDS. Despite clear evidence, often prepared by its own state agencies, that relying on limited and incomplete federal programs is not sufficient to meet Mississippians’ urgent needs, the state fails to maximize the federal benefits it could receive for housing, medical care, and other services vital for people living with HIV and AIDS. Most disturbing is Governor Haley Barbour’s attempt to block health care reform that would expand Medicaid benefits for people living with HIV in the state.

Throughout Mississippi, people living with HIV, their advocates, health providers and public officials describe an extreme stigma surrounding HIV that is, for many, more frightening than the disease itself. Human Rights Watch found that Mississippi laws and policies promote prejudice and discrimination against those vulnerable, and perceived to be vulnerable, to HIV, thereby contributing to the problem. Numerous legal provisions, including constitutional amendments, discriminate against homosexuals and state sex education laws marginalize lesbian, gay, bisexual, and transgender (LGBT) youth. In Mississippi, the criminal law penalizes those with HIV for failing to disclose their positive status, an approach that public health experts deem likely to undermine, rather than promote, the public health.

Mississippi’s sex education policies also play a harmful role in the state’s HIV epidemic. The state has the highest rates of sexually transmitted disease (STD) and teen pregnancy in the nation and alarming rates of HIV infection among young black men who have sex with men (MSM). Yet Mississippi’s legislature remains stubbornly committed to failed messages of abstinence in sex education, ignoring evidence that such approaches have little effect on reducing HIV or STD transmission. Despite the fact that students in Mississippi are having sex earlier than in any other state, the state suppresses information about condom use and effectiveness in sex education, denying youth access to accurate and relevant health information that can prevent HIV infection.

The sex education curricula in Mississippi also mandates negative messages about “homosexual activities,” creating hostile school environments for LGBT youth and interfering with their right to health. Combined with other state laws that discriminate against homosexuals, Mississippi promotes a culture of homophobia that, according to state public health officials, endangers the health of gay, bisexual, and other men who have sex with men by keeping them away from HIV testing and treatment services.

The HIV/AIDS epidemic in the Southern US has been particularly devastating for minority communities.Nowhere is the dramatic racial impact of the epidemic more apparent than in the state of Mississippi, where African-Americans are only 37.5 percent of the population, but comprise 76 percent of those newly infected with HIV. Mississippi’s failure to embrace evidence-based approaches in the face of increasing health threats to minority populations conflicts with fundamental principles of human rights.

An alarming rise in HIV infection among young black men who have sex with men recently prompted an investigation by federal and state health authorities, who recommended implementation of comprehensive sex education at an early age in order to increase awareness of risk and to promote condom use as a proven method of prevention. These recommendations have been utterly ignored in the public schools despite evidence that once infected these young men are unlikely to access adequate health care. Similarly, though African-American women have the second-highest HIV infection rate in the state, Mississippi’s “Just Wait” abstinence campaign does not provide evidence-based HIV prevention education to this very vulnerable population.

The factors identified in this report are not the only contributors to the HIV epidemic in Mississippi, an impoverished state with poor rates of overall health, education, and development. Stigma and discrimination, fueled by community attitudes, religious beliefs, and other societal forces are also contributing factors. But government action plays a significant role, and the harmful policies highlighted here undermine efforts to combat the HIV/AIDS epidemic and disregard national and international guidelines on best practices for effective management of the disease. These policies combine to create a high-risk environment where it is difficult for many people to avoid HIV infection and to access life-saving treatment and support. If there is to be meaningful progress in access to HIV services, Mississippi’s obligation to protect public health and human rights should be the immediate focus of both federal and state governments.