Rural southern minorities new face of HIV/AIDS; states that failed to expand Medicaid hit hardest

AIDS was once thought to mainly affect middle-class, often white gay men living in urban areas. However, because states like New York offer free health care to uninsured or underinsured residents who are HIV positive, as opposed to limited and expensive care in the South, "today, the face of AIDS is black or Latino, poor, often rural—and Southern," Teresa Wiltz reports for Stateline. (Associated Press photo: Sterling Williams hammers in markers representing the 3,423 people in Shelby County, Tennessee, who have died from AIDS.)

"Southern states now have the highest rates of new HIV diagnoses, the largest percentage of people living with the disease, and the most people dying from it, according to Rainey Campbell, executive director of the Southern AIDS Coalition, a non-profit group serving the 16 Southern states and Washington, D.C.," Wiltz writes. "Fifty percent of all new HIV cases are in the South. The HIV infection rate among African-American and Latina women in the South now rivals that of sub-Saharan Africa. In some Southern states, black women account for more than 80 percent of new HIV diagnoses among women."

"States in the South have the least expansive Medicaid programs and the strictest eligibility requirements to qualify for assistance, which prevents people living with HIV/AIDS from getting care, according to a Southern AIDS Coalition report," Wiltz writes. "In the South, Campbell said, people living with HIV have to reach disability status before they qualify for aid. This is significant, because nationally the vast majority of HIV/AIDS patients rely on Medicaid for their health insurance, according to research conducted by the Morehouse College of Medicine." 

The nine deep South States with the highest rates of new HIV/AIDS diagnoses—Alabama, Georgia, Florida, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas—have all refused to expand Medicaid under federal health reform, Wiltz writes. "Those states also have the highest fatality rates from HIV in the country, according to the Southern AIDS Coalition."

A White House Council of Economic Advisers study found "that if the nine deep South States expanded Medicaid coverage, more than $65 billion in federal funding would flood those states, and an additional four million people would have insurance coverage," Wiltz writes. Campbell told Wiltz, “Jurisdictions throughout the South fail at nearly every level of HIV prevention and care, ignoring proven strategies that could help to address the uncontrolled epidemic and alarming death rate."

Part of the problem is the Southern attitude towards AIDS, Wiltz writes. "The escalating HIV rates are the result of a perfect storm of social factors including poverty, racism, persistent anti-gay attitudes, increasing homelessness and a lack of transportation in rural areas. In the South, AIDS still has the taint of the plague. Fear of being judged and ostracized keeps some people away from clinics and the care they need. Those who don’t know they’re infected will infect others, creating what the University of Alabama’s (Dr. Michael) Saag calls a 'silent epidemic.'” (Read more)