HIV quietly sweeps through rural South

Poor black heterosexuals keep conditions a secret for fear of being ostracized

March 28, 2004|By Dahleen Glanton | Dahleen Glanton,CHICAGO TRIBUNE

LAMAR, S.C. - The middle-age couple living in a trailer park in this small farming community have kept a secret from their friends and neighbors for more than five years: Both are infected with HIV, the virus that causes AIDS.

Deborah Grant and her boyfriend, Larry Frazier, both 45, represent an emerging face of HIV and AIDS in America. They are African-American, poor, heterosexual and they live in the rural South.

In a striking parallel to the AIDS epidemic in Africa, HIV is sweeping through black communities in the South, where stigma, inadequate medical care and poverty hamper efforts to educate and prevent its spread. Many rural residents refuse to go to public clinics - often the only option for health care - to be tested or treated, fearing they will become targets of discrimination and gossip.

Those who have tested positive often live in a secret society, sharing their stories only with others who have the virus. Or, like Grant and Frazier, they live in fear their secret will be exposed.

"If we came out, we wouldn't have any friends," said Grant, a former heroin addict who was diagnosed with HIV in 1998, two years after she returned home to the South from Washington. "Nobody here wants to talk about AIDS. It's like the plague. If they knew we had HIV, we could never enter their doorway again."

After coming back home, Grant was in and out of the hospital with pneumonia. Two years passed before a doctor suggested she take an HIV test. In the meantime, she said, she likely transmitted the virus to Frazier. Though her relatives initially shunned her - some would not speak to her or sit at the dinner table with her - most have become more accepting since she learned more about HIV and shared the facts with them.

But Frazier, once a South Carolina middleweight boxing champion and a former Marine, has told only his brother.

"The first time I heard about AIDS was when Rock Hudson got it, and I always thought it was a gay disease," Frazier said. "People here are very uneducated, and nobody would want to be around me if they knew. I can't even tell my mother. She is 71, and it would probably kill her."

AIDS is a leading cause of death for African-Americans ages 25 to 44, according to the Centers for Disease Control and Prevention. In 2002, the last year for which numbers are available, 21,000 new cases were reported among African-Americans, half of the new adult AIDS cases that year. More than two-thirds of women with AIDS between 1999 and 2002 were black.

While AIDS has declined or leveled off elsewhere in the U.S., cases are rising in the South, according to a report last year by the Southern AIDS Coalition, which is made up of health officials in 14 states. The South represents 38 percent of the U.S. population, and 40 percent of the people estimated to be living with AIDS reside in the region. An estimated 46 percent of new cases occur in the South, according to figures from several sources, including the CDC.

African-Americans make up 19 percent of the region's population, yet more than half the people with AIDS in the South are black. About 22 percent of people with AIDS in the South are black women.

"This is definitely an epidemic in the South," said Dr. Gene Copello, executive director of the AIDS Institute and co-chairman of the Southern AIDS Coalition. "For a long time, the numbers were not large enough to gain attention. But that is changing. The policies that were developed in the 1980s need to be reviewed and changed to apply to the current epidemic. People of color make up the majority of cases in some areas of the country, and racial issues must be addressed."

The CDC, however, said the numbers from the South should be kept in perspective.

"In the South, we have seen more cases in rural areas than in rural areas in other parts of the country, but most HIV remains in large cities and in midsized cities," said Dr. Robert Janssen, director of the CDC's Division of HIV/AIDS Prevention. "In the rural South, you see more heterosexual transmission of HIV among African-American women, but it is not like the numbers have completely flipped over. The HIV epidemic in the U.S. still predominantly occurs with men who have sex with men."

In the rural South, where many people struggle every day to make ends meet, medical issues often take a back seat to social issues.

In addition, some African-Americans have a profound distrust of the public health system, largely because of the Tuskegee Syphilis Study, which has come to symbolize medical racism. From 1932 to 1972, the federal government supported experiments in which black men in rural Alabama were denied treatment for syphilis.

While intravenous drug use is a factor in spreading HIV to black women in urban areas, the virus most often is transmitted to women in the South through heterosexual sex.

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