Non-metro cases of AIDS are most concentrated in the Southeast. In states shaded orange, more than 25% of all AIDS cases are in non-metro communities.
Source: Centers for Disease Control [1]
Source: Centers for Disease Control [1]
AIDS isn't just a danger for your gay uncle living in Gotham. It came to rural America years ago. Between 1993-2003, rates of AIDS infection actually increased more in rural areas than in large U.S. cities. And unless ways can be found to combat the stigmas associated with the disease, especially in the South, rural Americans will account for more and more AIDS victims.
The Rural Center for AIDS/STD Prevention [2] found that between 1993 and 2003, "AIDS cases in rural areas of the U.S. increased by 202% [3], compared to an increase of only 147% in large U.S. cities." Minnesota's Department of Health reports that there were 325 new cases of AIDS last year, "the highest number of new cases since the mid 1990's [4] "; 14% of them are rural.
Further, the Centers for Disease Control announced this month that its national estimates of the spread of AIDS and HIV have been far too low [5]. The federal health agency underestimated the extent of the disease by 40%: CDC had estimated that in 2006 there were 40,000 new cases of AIDS and the human immunodeficiency virus (HIV) that causes it. But at an International AIDS conference in Mexico City in early August, the CDC reported that actual infections for 2006 were 56,300.
Rates of new AIDS cases are increasing fastest among African-American men in the South [6]. And several studies have disclosed that rural African-American men are far less likely to use condoms, to seek treatment or to provide health officials with information that might contain the spread of HIV.
One of the most powerful such studies, also from the Rural Center for AIDS/STD Prevention, showed that the association of AIDS with "deviance" -- specifically homosexual sex and intravenous drug use -- had created barriers to AIDS prevention, detection, and treatment in the rural South [7]. "The stigma context of the Deep South may be fueling the HIV/STI epidemics in the region," wrote Bronwen Lichtenstein, "since these epidemics are more severe in the Southeast than in any other region of the United States."
Respondents in an Alabama telephone survey: over 50 percent said they would delay seeking medical care for sexually transmitted infections because of stigma; one third would not seek treatment at all.
Source: Rural Center for AIDS/STD Prevention [7]
Lichtenstein and research partners showed how a dangerous combination of mistrust and stigmatization had not only kept men with HIV from obtaining treatment -- it had put rural African-American women at special risk for AIDS. Their study found that in the Deep South, particularly, African-American men were reluctant to seek treatment or to disclose their sex partners; further, men infected with AIDS tended to blame their own disease on "allegedly 'dirty' or 'promiscuous' women" as the stigma associated with homosexual sex in parts of the rural South remains extreme. Lichtenstein stresses that in some rural communities, the perils of being "outed" as a homosexual male are real. Still, the researchers insist that failure of African-American men to report their own risky behaviors has presented a cruel impediment to women's health.
In Georgia, HIV/AIDS is now the leading cause of death for black women ages 25 to 44. So reports Craig Schneider in a recent story for the Atlanta Journal Constitution. Schneider writes that in Georgia "HIV/AIDS has assumed a new face [8]," younger, female, and more rural. And there are many more of these faces. AIDS cases in Georgia increased 27% between 2004 and 2007.
In its surveillance concentrating on rural AIDS, the CDC found that Georgia had the third highest number of non-metro AIDS cases (behind North Carolina and Florida) in 2006, followed by South Carolina and Mississippi. Georgia had the highest number of non-AIDS HIV cases in rural communities (363) of any state in the nation.
Schneider's story also emphasizes the disproportionately high rate of infection among African-Americans. "By 2006, 71 percent of those living with HIV/AIDS in Georgia were black"; African-Americans make up only about 30 percent of the state's population. "In 2006, 76% of Georgians newly diagnosed with HIV were African-American."
Cathalene Teahan, of the Georgia AIDS Coalition, told Schneider that informing young people of the risks of AIDS had become harder throughout Georgia, as in many school districts, authorities have mandated that sex education focus on abstinence alone. "No one can use the word condom now," Teahan said.
Lola Thomas, executive director of the AIDS Alliance of Northwest Georgia, alleged that rural municipalities in Georgia still ignore AIDS as a local concern. "Most government people here see it as a city problem," she said. She acknowledged that because there are few gathering places for gay men in the rural South, reaching this population is extremely difficult; Thomas admits her organization has nearly given up that effort. Instead, the Alliance, based in Cartersville, is concentrating on "emergency assistance, financial help, transportation and counseling for clients."
There are many important and sobering resources available through the Rural AIDS/STD Prevention website. One monograph reports that "33-55 % of sexually active HIV-infected rural persons continue to engage in unsafe sex [9]."