HIV/AIDS in the Deep South
Melony C. Haynes
Baptist College of Health Sciences

Abstract
This paper examined HIV/AIDS in the Southern Region specifically the Deep South. Fundamental Causes and Proximate Factors were examined to explain and understand the high cases of HIV/AIDS in the Deep South. Poverty, lack of access to health care, lack of education, and prison policies were the reasons examined to explain the high cases of HIV/AIDS in the south. Populations at higher risk and why they are at higher risk were examined. These populations were: drug users, prisoners, African Americans, and women who experience domestic violence.

HIV/AIDS in the Deep South HIV/AIDS at one time was considered a death sentence. There was not much information about the disease, much less a cure for the disease. However, there have been many strides made over the years. More money, time, and resources have been provided for the research of the virus. The research has identified how the virus is contracted and spread, as well as how it affects an individual’s body. The research also identified prevention methods and the medication that can be taken to treat the disease. Since the first cases of the disease in the late seventies to current day, the life expectancies of individuals are improving. For example Irvin “Magic” Johnson a famous ex-basketball player announced twenty years ago he was HIV positive. Very few people expected him to live this long because at that time the life time expectancy was low. Due to the education, knowledge, financial resources the HIV/AIDS epidemic is decrease in the North, West, and East region of the United States. However in the southern region, the HIV/AIDS rates are increasing, more specifically the Deep South. The southern region as defined by the US Census Bureau is: Delaware, Maryland, West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Arkansas, Tennessee, Kentucky, Louisiana, Texas, Oklahoma, and Washington D.C. The US Census Bureau defines the Deep South as Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina. According to the US Census Bureau, “From 2000 to 2003, the number of now reported AIDS cases increased 35.6% in the Deep South and only 4.0% in the other Southern States”. Reif, Geonnotti, & Whetten reported (2006), “The deep south has some of the highest death rates from AIDS in the country” (para. 3). In the Deep South HIV/AIDS is still considered an epidemic and there has been research to suggest the Deep South is not doing a good job addressing this issue. Human Rights Watch (2010) states, “Many southern states are failing to meet these obligations both by neglecting the epidemic and by enforcing laws and policies that fuel the disease and intensify its impact on communities of color” (para. 2).This paper will examine the various reasons for the Deep South having an alarming increase of HIV/AIDS cases. One factor to look at is poverty. This fundamental cause of social and financial inequality is a big risk factor in the spread of HIV/AIDS in the Deep South. According to Human Rights Watch (2010), “The South is the poorest region in the United States. The southern states have more individuals and families living below the federal poverty level, more children living in poverty, and the lowest median household incomes in the nation” (para.16). Due to the lack of money, they do not have adequate housing and unemployment is high. Also transportation becomes an issue. If they are unable to get a health care provider, they will not be able to get the care they need. Lacking these resources prevents a person from receiving education about the illness, prevention information, and treatment of the illness. The south is considered a medically underserved community. According to Human Rights Watch (2010), “The south has fewer medical providers with more people living in federally designated health professional shortage areas than any other area of the country. Nearly two in five southern residents are considered medically disenfranchised meaning they lack access to a primary health care provider”. (para.17). One may think poverty and lack of access to health care are two sides of the same coin. One may think this is due to the fundamental cause of social class. They are correct on aspects, poverty and lack of access to health care are two sides of the same coin and it is a fundamental cause of social class. When a person is unemployed, more than likely they will be uninsured. This provides a ripple affect where the proximate risk factors become a part of the individual’s decision making. If an individual is not feeling well, they will try various methods of home remedies before going to the doctor, due to the cost that is associated with going to the doctor. Once they make it to the doctor the HIV virus could have progressed as AIDS. This could be considered a death sentence for a poor person who does not have access to healthcare. Another cause is lack of education. The Deep South is also considered “the Bible Belt”. Their approach to sex education is abstinence based education. The CDC Task Force on Community Preventive Services does not recommend abstinence based education, however southern states continue to do it. According to the Human Rights Watch (2010) “The CDC Task Force on Community Preventive Services recommends “comprehensive risk reduction” education that may or may not include abstinence but which directly addresses use of contraceptive devices such as condoms and may include condom distribution and demonstration” (para. 32). Sex is one means of transmission and there are various Sexually Transmitted Diseases in the community. Chlamydia, gonorrhea, herpes, syphilis are a few examples of STDs. Reif et al. (2006), stated, “STDs have been consistently found to facilitate HIV transmission” (para.10). Reif et al. (2006) also reported “The high levels of STDs in the Deep South offer some explanation for the higher incidence of AIDS in this region” (para. 10). In Alabama their state law requires that sex education class must emphasize abstinent until marriage. They are not teaching education on HIV/AIDS prevention.
Sharing needles is another way of HIV/AIDS transmission. Teaching about the importance of not sharing needles is also shameful in the Deep South. When HIV/AIDS were high in the other regions there were programs where they gave new needles to drug users. These programs were called the “syringe-exchange program”. This was done to prevent drug users from sharing an infected needle. In some states of the Deep South it is considered illegal to carry drug paraphernalia. Syringes could be considered drug paraphernalia if you don’t have a medical reason for having one. The tolerance for the Lesbian, Gay, Bisexual, and Transgender community is also very low. There is a social stigma placed on this community, which causes them to delay seeking medical care and non disclosure. This social stigma also prevents them from informing the physicians of their partners for fear of outing and criminal prosecution. In Alabama the school must emphasize that homosexual conduct is a criminal offense under state law, however this law was declared unconstitutional by the US Supreme Court in 2003. The prison policy is another reason for HIV/AIDS in the Deep South. Currently there is nothing in place for the prisoners re-entering society. If a person is receiving medical care in prison, they have difficulty accessing HIV medications on release. This affects their health and the high probability they will transmit the disease. Also if men are having sex with each other in prison, they are more than likely to transmit it to their female partner/wife when they get home. There are populations that are at greater risk; African Americans are one population. In the south the poverty is increasingly higher. According to Reif et al (2006), “In the deep south half of African Americans live below 200% of the poverty line, and the number of people lacking health insurance among AfricanAmericans in 1/5 times that of whites” (para 8 ). According to National Alliance of State and Territorial AIDS Directors (NASTAD 2008), “African American communities make up less than 13 percent of the United States population, African American accounted for nearly 50 percent of all HIV/AIDS cause diagnosed in 2006” (para 1). African American females are now the face of HIV/AIDS. According to NASTAD (2008) “HIV disease was the third leading cause of death for African American females, age 25-34, in 2004. One factor that contributes to this is African American relationships. African American women are less likely to date outside their race, which makes it less likely they would marry. There are more African American female than African American males. Due to this imbalance in African American relationships it is harder for women to negotiate condom use. Drug users and prisoners are also a high population. When individuals are under the influence of drugs and alcohol, they are less likely to make sound decisions like wearing a condom or not sharing needles. Prisoners are confined for a long period of time. Rape occurs in jail and some men may be too ashamed to report, while other men may engage in consensual sex, but to ashamed to acknowledge this behavior. Lichtenstein, B. (2004) reports women experiencing domestic violence is a population that is at risk in the Deep South. Lichtensten (2004) definition of domestic violence as HIV risk is as follows:
“Not disclosing HIV-positive status to partner; infecting a partner with STI; deliberately infecting a partner with HIV/AIDS; refusing to use condoms; rape; manipulating, nagging or making her feel that she has to have sex in order to stop the abuse to self or children; insisting on frequent and unprotected sex; non-disclosure of intravenous drug use, same sex activity, and prior criminal record of domestic violence; having sexual affairs with other women as a male prerogative; introducing her to drugs and then pimping her out for money; insisting that she “shoot” drugs with him; “cutting” her during physical or sexual violence; “keeping her down” so she becomes depressed and unable to take care of herself; instilling a sense of desperation or revenge so that she takes sexual risks with other men; evicting her so that she becomes homeless or dependent upon other men for rescue; preventing her from having contact with family and other support systems; being secretive; being a chronic liar, stealing her money and other possessions”(para.21). This definition alone, explains the risk factors for women who are experiencing domestic violence. Lichtenstein (2004) reported this behavior started as childhood and continued throughout their adult life. Lichtenstein (2004) stated, “Violence to HIV risk in US Women focus on a “continuum of risk” that begins with childhood abuse, followed by risk-taking through sexual promiscuity and illicit drug use, and vulnerability to rape and other violent acts” (para. 1). When women are being abused the likely hood of them keeping the doctor’s appointment is low, which makes it difficult to provide the necessary medical care needed. In Summary the Deep South have an HIV/AIDS epidemic that needs to be addressed more aggressively. It is imperative for them to change some of their views on sex education. Research has shown proper knowledge about the disease and prevention is the key to decrease infection rates. Also the Deep South needs to make necessary changes to their prison policy. There needs to be something in place to test the prisoners when they are released and have a physician appointment made for them. Also have follow up to ensure they have are getting the necessary treatment. There need to be more support groups and awareness to domestic violence. There also need to be stronger laws in place to combat this awful experience women endure. Lastly the federal government need to utilize the taxes collected to put more resources in the Deep South community. There needs to be more health care clinics and programs that can help with transportation to the doctor and the needed medication.

References
Human Rights Watch. (2010, November 26). Human rights and HIV in the southern United States. Retrieved from http://www.hrw.org/news/2010/11/26/souther n-exposure
Lichtenstein, B. (2004). Domestic violence, sexual ownership, and HIV risk in women in the American Deep South. Social Science and Medicine, 1-14. doi:10.1016/j.socscimed.2004.06.021
National Alliance of State and Territorial AIDS Directors, (2008, May). The landscape of HIV/AIDS among African American women in the United States (Issue Brief No. 1). Washington, DC.
Reif, S., Geonnotti, K.C., & Whetten, K. (2006). HIV infection and AIDS in the Deep South. American Journal of Public Health, 96. doi: 10.2105/AJPH.2005.063149
US Census Bureau Census. Census Regions and Divisions of the United States.