AIDS directors seek help to fight epidemic in the South
Call to action for more money, resources, research
As HIV continues to spread faster in the South than in any other region, health officials from 13 states are sending out a strong message: The South needs help fighting an epidemic that is becoming increasingly rural, female, African-American, and poor.
"The South is in desperate straits now, and the disparity is so great that if we don’t act now, it’s going to be that much harder to catch up," says Evelyn Foust, MPH, director of HIV control for North Carolina in Raleigh.
Foust and AIDS directors from 12 other states have documented the growing problem in a 34-page document titled Southern States Manifesto; HIV/AIDS & STDs in the South: A Call to Action. In April, the manifesto will be sent to AIDS directors across the country, as well as to key federal and state public health partners, including the Centers for Disease Control and Prevention (CDC) and the Human Resources and Services Administration.
Endorsed by the National Association of State and Territorial AIDS Directors, the report is unusual in that it advocates special assistance for a region itself rather than for a specific population or risk group.
"When we met in Nashville, [TN] last summer, we were astounded at how much we had in common," Foust said. "There are strength in numbers and hopefully this says to our federal partners we are serious about this and more needs to be done."
Poverty is not unique to the South, but as the report points out, the region shares several characteristics that make it prone to the epidemics, particularly as the HIV profile has increasingly become rural, African-American, and female.
In November, the Kaiser Family Foundation, based in Menlo Park, CA, sponsored a regional summit focusing on the STD/HIV epidemic in the South.
It released a report showing that the South has a greater proportion of people living with AIDS than any other U.S. regions and the proportion been steadily increasing.
The estimated number of new AIDS cases in the South increased between 2000 and 2001, while other regions experienced declines or relatively stable levels. Eighteen of the top 25 U.S. communities hardest hit by the HIV/AIDS epidemic are in Southern states, according to Kaiser Family Foundation data. In addition to HIV, the South also has the highest case rates for syphilis, chlamydia, and gonorrhea in the nation.
"The HIV/AIDS epidemic remains a critical health concern for the U.S. as a whole, but is especially troubling for the Southern region," says Drew E. Altman, PhD, president and CEO of the Kaiser Family Foundation.
In North Carolina, more than 1,200 new HIV/ AIDS cases were reported from 2000 to 2002, with nearly half diagnosed only after developing AIDS, Foust notes. More than 70% of the new infections are in African-Americans.
Indeed, some North Carolina counties report HIV infection rates of 3% in African-American males. "This is a percentage we consider a tipping point, where looking internationally, you see the disease is probably going to take off and be worse in coming years," says Kathryn Whetten-Goldstein, PhD, assistant professor of public policy at Duke University in Durham, NC.
The persistently high rate of other STDs in the South is a major factor in the growing spread of HIV. Foust notes that genital ulcer diseases, such as herpes and syphilis, can pose a three- to five-fold increased risk of HIV transmission.
In 2001, the South continued to have a higher rate of syphilis than any other region of the country, accounting for 56% of reported cases. North Carolina ranks seventh in syphilis rates, and Robeson County now has the highest rate in the country. As with HIV, more than 70% of syphilis cases are in African-Americans, Foust says.
Another factor is the high rate of poverty (eight of the top 10 states having the highest population living below the poverty level are in the South). With poverty come its attendant problems, such as high uninsurance rates, less access to quality care, and lack of education about health issues.
Medicaid eligibility requirements also tend to be less advantageous in the South, the result being that many poor Southerners have no means to afford treatment and care, says Foust. Even if they did, the health care infrastructure is spread so thinly throughout large rural areas that access is a huge barrier. In Albany, GA, for example, one HIV clinic services 14 counties, forcing some patients to drive three hours one way.
"I consider it a terrible public health failure that we cannot guarantee that everyone infected with HIV gets access to medication," Foust says.
The unique history of the South, coupled with the history of the AIDS epidemic, has almost assured that infections would increase. For the first years of the epidemic, the South largely was ignored as funds and resources were focused in big cities on the East and West coasts.
Also, there has been little advocacy for poor, disenfranchised African-Americans to call attention to their needs. Consequently, HIV-infected patients in the South receive nearly $500 less in Ryan White funding than for the rest of the country, according to the report.
"Some of what all this means is that new dollars are needed for the South," Foust says.
It also means that the time has come for researchers and public health officials to devote more effort to determine what is driving the epidemics in the South and to develop interventions that are specific to its population.
"I don’t want the South to get lost in one of the topics discussed at a national conference," Foust says. "I want a discussion with the highest leadership at the CDC to say, Lets see what we can do to solve this problem.’"
As HIV continues to spread faster in the South than in any other region, health officials from 13 states are sending out a strong message: The South needs help fighting an epidemic that is becoming increasingly rural, female, African-American, and poor.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content