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January / February 2011
by Carl GainesIllustration by Asaf Hanuka
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’re still lagging behind the Northeast.”
“There is religiously driven stigma,” says Webb of A Brave New Day. “[As a result,] across the board people aren’t getting tested [for HIV].” They’re also not getting educated about the virus. Webb says churches are eager to do HIV/AIDS outreach in Africa, but they are unwilling to broach the topic at home.
The lack of participation by many religious groups, especially black churches, in the fight against AIDS is a source of frustration for Ruby Gray, a social worker for the past two years with GA Carmichael Family Health Center in Canton, Mississippi, who has worked in HIV prevention services for more than 20 years.
Despite the fact that through 2008, 70 percent of the AIDS diagnoses in Mississippi occurred in the black community, Gray says black churches often don’t want to even acknowledge the HIV/AIDS epidemic in the South. “It’s like everyone’s turning their heads and it’s not happening—but it is happening.”
She says much of the unwillingness on the part of black churches to get involved in HIV/AIDS education, prevention and treatment is based on the connection between the disease—and people’s sexual orientation. “The [stigma] is tied to the idea of MSMs,” says Gray, referring to men who have sex with men.
In the United States, HIV is too connected to gay people, sex workers and drug users, Webb says. It’s easier for people in the South to think about helping heterosexual people in Africa with the disease.
Gray spent five years trying to convince her church pastor to incorporate some mention of HIV into his sermons and to have someone come in to speak. He finally said yes and she says since then she hasn’t had any further problems getting HIV/AIDS messaging and materials into her church.
Davis in Greenville also knows how difficult it can be to get black churches to talk about HIV/AIDS. She does peer-to-peer outreach, speaking at churches and schools about HIV when they’ll let her in the door, which isn’t often.
“Churches don’t want to participate,” she says. Davis recalls once being invited by a congregant to speak at a nondenominational church in the area, only to show up and have the pastor, who had approved the presentation, tell her there wasn’t time in the service for her talk.
Her beliefs about homosexuality and her feelings about how she became HIV positive show that, like many women in similar situations, Davis herself isn’t free from either stigma or discrimination.
Davis believes being gay is a choice—and she says she contracted HIV from a boyfriend who, unknown to her, also had sex with men.
“If a person wants to be gay, then be gay,” she says. “You get caught up in it, and it’s a hard habit to break—like cigarettes or drug addiction.” To underscore her point, Davis recounts the years she has spent, to no avail, trying to quit her own smoking habit.
She says of herself and other women who became HIV positive the way she did, “We didn’t have a choice, because we didn’t know.” She has made it her mission to change that for other Southern women—and men. Though her views on MSM are controversial (and may harm many MSM), the fact is she’s trying, in her own way, to move beyond issues of sexual orientation to help save lives—it’s a step more should take.
By doing so, she is a role model who shows that we don’t have to support or agree with people (whether on sexual orientation, HIV and immigration status or religious and political beliefs) to fight for their right to stay healthy. Even if that means we have to talk about sex and sexual orientation. In schools. In churches. At home.
Hiers agrees and suggests much of the solution to this nasty matrix of hard-to-overcome barriers rests on the shoulders of people living with HIV/AIDS who themselves demand heightened awareness, better education and improved access to care and services—despite stigma and discrimination.
Indeed, Hiers, Farfan and the two Davises are exemplary models of the kind of positive change that can happen, even in the most challenging of environments, when people with HIV and their advocates take matters into their own hands. Even if they have to use a candy bar every now and then to sugarcoat the bittersweet truth.
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Search: Bible Belt, conservative, HOPWA, ADAP, Social Security Disability Insurance, SSDI, Medicaid, health reform, poverty, Hurricane Katrina, Rita, BP Oil Spill, Sergio Farfan, Latinos, religion, discrimination
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