Why we must respond to the HIV crisis among African Americans in the South

These numbers are even more staggering when you look at HIV rates among young black men who have sex with men (MSM). There were more new HIV infections that occurred among young black gay men and other men that have sex with men (aged 13–29) than any other age and racial group of MSM. Also, new HIV infections among young black MSM increased by 48 percent from 2006-2009.

A close look at how the epidemic has affected our community in the South will reveal that black men and women are hit hardest here. The Southern States Strategy Initiative (SASI) commissioned and released a report which was compiled by the Duke Center for Health Policy and Inequalities Research last month on HIV/AIDS in the American South.

The report pays particular attention to states in the Deep South:  Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and eastern Texas. These states collectively shoulder an unprecedented share of the epidemic.

In the Deep South, 35 percent of all new U.S. infections come from the region, though it makes up just 22 percent of the country’s population. Despite these numbers, the region lags behind the rest of the nation in HIV/AIDS funding.

Failure to act in an impactful way could lead to a worsening of poor health outcomes for people living with HIV in the South, including death. Nine of the ten states with the highest rates of death due to HIV in the country are in the South.

A number of factors point to why the South has become such a perfect storm for high HIV rates in African-American communities, among them: inadequate healthcare, poverty, economic distress, and stigma. And while these facts are discouraging, there have been significant medical advancements in the last few years that may shed light as we look toward an eventual end to the epidemic.  

Antiretrovirals, medicines currently licensed to treat HIV infection, may be one of our best tools, not just for HIV positive people, but HIV negative people as well. Several scientific studies over the past few years have indicated that antiretrovirals, such as pre-exposure prophylaxis, would be an effective tool in our fight against HIV.

Pre-exposure prophylaxis or PrEP is an HIV prevention strategy where HIV-negative people take antiretroviral drugs before possible exposure to HIV, which would lower the risk of infection. This method coupled with regular HIV testing, counseling, risk reduction education, provision of condoms, and support is one of the most promising approaches to HIV prevention in the last decade.

More research has to be done, particularly to see how such approaches would impact African-Americans in the South, and to examine cost effectiveness and other considerations, but such evidence provides hope. It will also be imperative to ensure that African-American communities work along researchers to help continue to build bridges and heal the historical legacy of mistrust between African-Americans and medical researchers.

HIV testing efforts have to continue to be expanded and sustained, in addition to access to HIV care and treatment for those who test positive. Other demonstrated methods of reducing HIV rates have to be built upon such as syringe exchange programs, access to HIV testing and counseling, expanded and sustained STD testing and treatment programs, access to care and treatment for HIV positive people, and access to male and female condoms.

Furthermore, issues such as housing, stigma (particularly related to criminal laws targeting individuals that are HIV positive) economic distress, and overall access to health care also have to be addressed in a robust way.

And finally, full implementation of meaningful health care reform would go a long way to ensure increased access to healthcare for people living with HIV, and reducing disparities in access across race, class, and regional lines.

As we mark today as National Black HIV/AIDS Awareness Day and consider our steps forward, it is imperative that the South not be forgotten.  The HIV/AIDS epidemic in this country cannot be adequately addressed without engaging the South, particularly our black Southern brothers and sisters.

Charles Stephens, an Atlanta native, is committed to HIV prevention, advocacy, and justice. He is also the Southern Regional Organizer for AIDS United.