The first cases of HIV in the United States were seen more than 30 years ago, largely in West and East Coast cities like Los Angeles, San Francisco, and New York. Today the epidemic’s profile looks very different – it is spreading fastest in the southern US, which now accounts for half of new HIV infections in the country. Today, as we mark World AIDS Day, it’s worth reflecting on the factors that made the US South a center of the HIV epidemic – and the lessons we can draw from the failure of its response.
The tale of the rise of HIV in the South is captured powerfully in deepsouth, a documentary film that elevates the voices of those who fight for equal access to HIV services despite stigma, discrimination, and the lack of investment in HIV prevention or treatment. Particularly at risk are minorities and those often pushed to the margins of society – gay men, transgender women, sex workers, and people who inject drugs.
In states such as Alabama, Louisiana, Georgia, and Mississippi, African Americans comprise approximately 30 percent of the population, but they make up 65 to 75 percent of the cases of HIV. Unstable housing, lack of transportation, and food insecurity are key barriers to HIV prevention and care. Southern states have more individuals and families living below the poverty line than any other region in the US.
Late diagnosis and lack of medical care also contribute to a rate of deaths from AIDS in the South that is higher than most other regions of the US. Southern states have among the strictest Medicaid eligibility requirements in the country, leaving many HIV-positive people living in poverty without coverage. The Affordable Care Act provides states the opportunity to expand their Medicaid programs, with the federal government absorbing most of the expense. However, 11 of the 17 southern states are currently not moving forward with Medicaid expansion, largely out of opposition to the Affordable Care Act.
Stigma and the criminalization of sex work and drug use also fuel the epidemic, with southern states prioritizing punishment over public health, making it harder to reach sex workers and people who inject drugs. As Human Rights Watch documented last year in its report on Louisiana’s response to HIV in New Orleans, states ignore, underfund, or outright criminalize proven strategies for preventing HIV.
The documentary deepsouth opens a window into how the US response to HIV has failed, showing, for example, the struggle of teachers in Mississippi (which has the highest teen birthrate in the US) to talk about sexual health, disease, and pregnancy prevention without saying “condom,” a word prohibited in some school districts by law.
Today, on World AIDS Day, it’s important to remember that the HIV epidemic can be ended, but only when human rights are respected and proven, evidence-based approaches are adopted.
