March 31, 2012

March 31, 2012
Why It's Harder in the South

Welcome to another day in my life. Today is Saturday and it is also the last day of March. Where did the month go so quickly? I hope you have had a safe and great March so far. It was an extremely busy month for Dab the AIDS Bear and me.

Any one living with HIV will tell you there life is harder than before being diagnosed with HIV. But those living in the south of the United States have it even harder. Did you know that? Well the blog today will let you know why.

Alabama, one of Alabama's oldest and most important HIV service organizations. Kathie Hiers and Amanda Shipp tell us what AIDS Alabama does, and why, in the more rural South, and client Janet Johnson tells us her personal story of struggle, survival, and growth.

Much of what they share with us will sound familiar. It is no surprise to find that people living with HIV often have other problems. Poverty, abusive childhoods, mental health issues, drug use, sex work, living on the street - a person living with any of these is already at higher than average risk for adding HIV to his or her list of problems, and someone living with more than one is in the cross hairs of the epidemic's gun sight. Like Harlem United, AIDS Alabama knows it can not work with a client's HIV without working with the whole client. It integrates housing, mental health/substance abuse, and medical case management for its clients. Integrated services just work better.

What is different about the South is the difficulty of linking people with HIV to the integrated services they need.

It is partly a problem of resources. Alabama has about three quarters the population of Massachusetts. It has just under half the gross domestic product. Southern state budgets are so tight, in part, because people earn less than in much of the North. Less income, less income tax revenues. Less revenue, less public services.

It is partly a problem of culture. It is hard to talk about HIV without talking about color and sexual behavior - two topics that are, if anything, even more charged in the South than in the rest of the country. Stigma kills, and not just by discouraging people from getting tested. It also kills by making it politically easier to balance those stressed state budgets by cutting HIV services. After all, some will say, "those people" would not have the virus if "those people" had not been doing what they should not do, so why should the state provide services to them? (The rational public policy answer to that question is, of course, that it costs the state so much less than not providing services will.)

And it is partly a problem, finally, of geography. Much of the South is rural, and it can be very difficult to find a country doctor who accepts Medicaid and sees enough HIV patients to have real expertise. It can be even harder to find support services, sixty miles from the nearest city with a community health center. AIDS Alabama client Janet tells us she acquired her drug use problem and her HIV in the city. Then she took them to her boyfriend's remote home town, did not have access to the services she needed, deteriorated there, and lost her born positive twelve year old son. It was not until she returned to the same city where she had slipped into drug use and become positive that she found the services she needed to help her turn her life around.

Resources, culture, geography: all these make dealing with HIV in the South uniquely difficult. Twenty five years ago, we thought the HIV epidemic was going to explode in men who have sex with men. We were right. Ten years ago, we thought the next explosion would be among poor women of color. We were right. The next explosion is coming in the South.

Our grim prediction from 2010 is coming true: HIV is exploding in the South. Baton Rouge now leads the nation in new AIDS diagnoses per capita. In the age of effective drugs to control HIV, there is no excuse for letting people with HIV progress to full blown AIDS. Treatment deferred is treatment denied.

Now you know the rest of the story about HIV treatment and prevention disparity in the South.

Hope you have a great Saturday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab