With World AIDS Day 2016 now a recent memory we can celebrate the fact that HIV/AIDS is no longer a death sentence in much of the world, and we are starting to see a decrease in HIV rates across a large part of the country.

The glaring exception to that is the southern United States, an area with about one-third of the population of the United States, but with nearly half of all HIV cases in the nation. According to a 2014 U.S. Census Department report on the rate of new HIV infections 18 of the top 25 cities were in the South with Memphis ranking in at number 7 and the Nashville Metropolitan area ranking 22nd.

The situation is so extreme that living in the South has now been added as a risk factor for contracting HIV along side more common risk factors, such as being a gay and bisexual male, being an African American regardless of gender, a young gay and bisexual man, and being a transgendered woman. While HIV is still disproportionately effecting all of these groups, African American communities are among the hardest hit especially among gay and bisexual African American men, African American women, and African American transwomen.

The causes of the HIV epidemic in the South are multifaceted, encompassing social, religious, and cultural issues, and while many of those are similar throughout the region, that does not mean that there is a one size fits all solution. Part of the issue, though, seems to arise from the messaging surrounding the epidemic, as well as stigma

For many people, the horrors of the AIDS epidemic of the 80’s are still fresh in their mind, and they can tell you stories of watching friends pass on a weekly basis. For a younger generation, born since the late 1980s, HIV/AIDS has always existed, and with that so have messages about the dangers of the virus. These messages, specifically targeted at populations that have historically been the hardest hit by the virus, especially among gay and bisexual men, has led to an increase in AIDS Fatigue in those communities.

These communities have become desensitized to the messages around the virus, because they cannot remember a time before people were infected and when there were not lifesaving medications. They also don’t remember when people were dying of related diseases that were

once uncommon or non life threatening. This is a generation that is no longer living with the specter of death that haunted the gay bars, as friends and acquaintances stopped showing up.

Besides AIDS fatigue, messaging around the virus has also had other unintended consequences. Prevention methods have, for the longest time, focused primarily on condoms in an effort to decrease the spread of the virus. With condoms being shoved into their hands, pockets, and faces, gay men are starting to revolt against this constant force to try and influence one of the most intimate parts of their lives.

Because of this, there is a growing amount of ‘condom fatigue’ among gay and bisexual men, who are choosing to have raw sex. These are not men who believe that they are immune to STDs or HIV, and they are not unaware of the risk involved in having sex without condoms. Instead they are often men who are choosing when and how they have sex and who, in many ways, are rebelling against an aggressive campaign to try and stop a natural urge that most people have.

Another facet of this growing HIV epidemic in the South is the stigma that is attached to HIV, which continues to persist to this day. The stigma in the South is similar in many ways to the stigma faced in many parts of the country, stemming from a fear of being discovered as having HIV, as well as a fear of being tested or even associated with places that serve those with HIV.

But the stigma in the South is also felt on deeper level, being intimately tied to the South’s Bible Belt culture. In an area where sex is often a taboo subject, vital discussions of sex often do not happen to the detriment of the community. The role that the churched plays in the life of many southerners, and the impact of church ideology on the shape of discussions about sex, leaves many without vital information and this is putting communities at an increased risk for the virus.

Stigma also presents itself in the form of making many unable or afraid to admit that they are gay or bisexual, and because of this they are participating in risker sex behaviors, while also having sex with a female partner. This stigma means that these men and their partners not getting tested until they have become very sick, and because of this the HIV epidemic in the south is also becoming an AIDS epidemic, with Atlanta having the AIDS rate of a third world nation.

But, while the HIV rate in the south is eclipsing the rest of the nation, hope is not lost that things can be changed. Prevention efforts can now include newer messaging, including information about PrEP and its effectiveness in helping prevent HIV. Stigma can be addressed in a variety of ways, such as reaching out to community members, including churches, and having an open dialogue about the reality of living with HIV. And organizations tasked with fighting the epidemic need to understand that testing may have to occur in nontraditional settings.

AIDS is an epidemic that can come to an end, and there is an ambitious movement to end the transmission of HIV. While the South has a long journey ahead of it, in terms of its efforts to combat and defeat this epidemic, there is still hope that, by adapting to the new realities we face in the fight, we can still prevail over the trends.

 

 

 

Photo by Stephen Bloodworth

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