January 20, 2011

January 20, 2011
Southern Discomfort Part 2

Welcome to another day in my life. Today is Thursday and I hope you are having a safe and great week so far. It is another busy week for Dab the AIDS Bear and me.

Yesterday, I started a blog about the problems with HIV and AIDS care in the South which I would like to continue today.

If one were to try to understand the HIV hot spots in America based on Ryan White appropriations, one would think HIV/AIDS was primarily an urban disease. But the truth is drastically different. And until funding gets shifted to areas hardest hit by HIV, we will continue to see an imbalance between need and resources.

Another critical component to the health care needs of low income HIV positive people is Medicaid.

As a result of the structure for distributing Ryan White funding, the bulk of money for HIV/AIDS care in the South comes from Medicaid, the U.S. government’s health care program for low income Americans (This is true in many other parts of the country, including those also covered by Ryan White funding). To date, four in 10 Americans with HIV have their health care covered by Medicaid.

However, Southern states in particular, in efforts to bring down costs and shorten budget deficits, are limiting their Medicaid contributions and the services that Medicaid covers. For example, the expenditure of $127 million from Congress in supplemental Medicaid dollars is being postponed by Mississippi Governor Haley Barbour until fiscal year 2012.

“I appreciate the leadership of both houses for agreeing that these additional funds should be saved and spent in fiscal year 2012 when we face a budget shortfall of more than $600 million,” says Barbour in an August 2010 statement.

Meanwhile, in December 2010, there were 828 people on AIDS Drug Assistance Program wait lists in Georgia and 477 people waiting in Louisiana. There were no wait lists in Mississippi.

Southern states already have relatively low Medicaid expenditures given their population sizes. In 2008, Alabama, with a population of 4.7 million people, paid $4.1 billion for the program, and Mississippi, with a population of 2.9 million, paid $3.8 billion. By comparison, New York, with a population of 19.2 million, paid the most of all states $47.6 billion.

Many see the Patient Protection and Affordable Care Act, a.k.a. the nation’s new health reform bill, as a bright spot, widening the net of HIV positive people eligible for services.

“I think that health care reform is going to help a lot,” Hiers says. “When health care reform kicks in, we figure that about 80 percent of HIV positive people [in the South] are going to get Medicaid.”

Personal poverty, tight fisted and impoverished state governments and conservative attitudes toward sex have created a perfect storm of inadequate HIV care for many Southerners, but Mother Nature herself has also played a big role. Hurricanes Katrina and Rita slammed into Louisiana and Mississippi in 2005, and the storms’ aftermaths continue to undermine both prevention and treatment efforts.

The storms destroyed infrastructure, much of which has still yet to be rebuilt, and this continues to make getting around difficult. Many people who were dislocated from their homes are still not settled into new ones. Medical records for countless people were washed away.

Adding insult to injury, the BP oil spill in 2010 further wrecked the Gulf Coast economy, making addressing the needs of those in the area even more challenging.

Sergio Farfan, cochair of the Louisiana Latino Health Coalition for HIV/AIDS Awareness, who lives in Baton Rouge, was one of the first to return to New Orleans, post Katrina, in an effort to rescue medical records. As the chaos surrounding the hurricane subsided, he says, Latinos streamed in to help clean up the devastation.

According to a 2006 study by Tulane University in New Orleans and the University of California at Berkeley, almost half of all reconstruction workers who came to New Orleans post Katrina were Latino and a quarter of them were undocumented. “The health needs for the Latino community, [including people with HIV], increased tremendously [after the hurricane],” Farfan says. The Mexican Consulate in New Orleans closed in 2002, but it reopened post-Katrina to deal with the increased need.

Farfan says that it can be particularly hard to reach the Latino population due to stigma surrounding HIV and that language barriers create more problems.

One of the main challenges with trying to do HIV/AIDS prevention and outreach work among Latinos in the South has been the lack of services in Spanish, Farfan says. And not everybody is coming from the same country, so there are small cultural differences that are important to acknowledge.

He also cites current immigration laws, which cause undocumented people to hide and which make them ineligible for free services from the state, as major challenges to effectively combating HIV among Latinos in the South.

But for all these factors poverty, lack of funds and services, squeamishness about sex, language and immigration barriers, walls of water and oil washing over parts of the region without a doubt, the largest obstacles in the South to fighting HIV/AIDS remain stigma and discrimination. Advocates acknowledge that the factors are far from unique to the South, but they run deep in the region and religion further entrenches them in the culture.

Hiers of AIDS Alabama tells the story of a board president at an AIDS service organization she ran in Mobile years ago. When he found out he was HIV positive, this man would drive several hours to Birmingham for medical care in order to avoid being seen in his neighborhood seeking treatment. His care lapsed, and he died.

“The stigma is still bad,” Hiers says. “The good news is that the death rate is going down, though we are still lagging behind the Northeast.”

This blog will conclude tomorrow. Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab