Staying Alive in the Rural South

The disquieting silence around the HIV epidemic
deepsouth_candlelight2.jpg
(Lisa Biagiotti)

In Birmingham, Alabama, Baptist Rev. Michael Jordan's mission is to "save and deliver the homosexuals." A reformed compulsive gambler himself, he concedes, "I have taken a strong stand on homosexuality, and the stand is: it stinks in the nostrils of God. AIDS is God's curse to homosexual life. Some say that homosexuality isn't a sin. It is."

In a Mississippi classroom, high school teacher Sharon Morris is trying to teach sex education without acknowledging condoms, because in that district it's not legal.

The American South has 37 percent of the country's population, but 50 percent of the new HIV diagnoses. It has eight of the ten states with the highest infection rates. Why?

After learning about the disparities around populations most affected by AIDS in the rural Deep South, specifically as a leading cause of death among African American women, journalist and filmmaker Lisa Biagiotti travelled 13,000 miles throughout the region to learn more. She ended up spending two and a half years interviewing more than 400 people. The stories she heard, like those above, became part of the documentary deepsouth, which premiered this week in New York at the Human Rights Watch Festival.

As Biagiotti told me, "I thought that HIV was sort of 'under control' in this country." At the same time she began reporting in 2009, "Obama's team was holding town hall meetings across the country about the first HIV/AIDS strategy, which seemed late in the epidemic."

The subsequent implementation National HIV/AIDS Strategy, part of the Affordable Care Act, includes the 12-Cities Project, though Biagiotti says it still does not address rising rates of HIV infection in the rural South.

The problem, as she sees and presents it in the film, is more one of "broken social infrastructure" than on that AIDS-directed dollars alone can fix. It's overall poverty and access to health care, yes, but also cultures of discrimination against people who are HIV-positive, abstinence-only and otherwise inadequate education, and generally not talking about the epidemic. As she put it, "It's so quiet -- the opposite of urban HIV/AIDS activism of the 1980s and 90s."

HIVdiagnosismap.jpg
(AIDSVu, Emory University Rollins School of Public Health)

Dr. Bronwen Lichtenstein at the University of Alabama, who teaches a course called Sociology of HIV/AIDS, has been outspoken in deconstructing social stigma surrounding HIV in the rural South. She describes it involving not only the aforementioned homophobia and denial of the epidemic, but also deep-seated distrust of mainstream medicine among African American communities, as an echo of the Tuskegee experiments, that still manifests as reluctance toward HIV testing and treatment.

Biagiotti saw recurring themes among many people she interviewed. As she told me, "Their lives followed a pattern: some kind of sexual abuse or childhood trauma, then a period of sexual ambiguity, HIV infection, attempted suicide, and then isolation ... So many people told me similar stories, unbeknownst to them that there's anyone out there like them."

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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