Overview: HIV/AIDS in the Deep South region of the United States

The HIV/AIDS epidemic in the Deep Southern states of the United States (U.S.) is, in ways, more similar to the epidemic in less wealthy nations than to other areas of the US. The U. S. Deep South is defined to include six states (Alabama, Georgia, Louisiana, Mississippi, North Carolina and South Carolina) with a shared history of actively promoting slavery and a strong agricultural and economic base in cotton and tobacco (Merriam Webster 2003). In the Deep South, like most less wealthy nations, the spread of HIV disease has never reached a plateau; rather this region has experienced the greatest proportional increases in HIV/AIDS rates each year since 1990 (Whetten & Nguyen, 2002). From 2000 to 2003, the number of newly reported AIDS cases increased 35.6% in the U.S. Deep South, while increasing 4.0% in the other Southern states and 5.2% nationally, excluding the Deep South states (CDC, 2001; CDC, 2003). Furthermore, as in less wealthy nations, a primary mode of HIV transmission in the Deep South is heterosexual sex (Kaiser Family Foundation 2006). For example, in North Carolina, heterosexual transmission represented 40% of new HIV infections (North Carolina Department of Health and Human Services, 2005). Onethird of new HIV infections are among women in the Deep South (CDC, 2001). Globally this percentage is 46 while in the US generally, women represent just over one-quarter of those infected (Kates & Carbaugh, 2006; UNAIDS, 2006). The majority of those infected in the Deep South live near or below the poverty line (Bozzette et al., 1998; Reif et al., in press). This region of the U.S. may have much to learn from other less wealthy nations and perhaps more to share with those nations than other regions of the US. This area of the country is culturally distinct from the rest of the US with a significantly stronger societal hierarchy that is difficult to transcend. The Deep South region is also currently characterized by the politically conservative nature of these states. HIV/AIDS-related health policies are often influenced by the conservative nature of the political and religious base in the Deep South. As just one example, most of the Deep South states allow only abstinence-based sexuality education in the schools. These are the same states with the highest rates of teen pregnancy and sexually transmitted diseases in the U.S. (Kaiser Family Foundation, 2006). The Deep South states are also characterized by having some of the highest levels of poverty, unemployment, and uninsured individuals in the U.S. (Kaiser Family Foundation, 2006; US Census Bureau, 2003). Moreover, the Deep South states perform poorly on most health indicators in comparison to other states. For example, the Deep South region leads the U.S. in infant mortality (Kaiser Family Foundation, 2006). In addition to having the greatest increases in new AIDS cases in recent years, the Deep South has some of the highest death rates from AIDS. All 6 Deep South states were among the 15 states with the highest AIDS death rates per 100,000 population in 2002 (Kaiser Family Foundation, 2006). The HIV/AIDS epidemic in the Deep South must be considered in the context of the conditions present in the region. Poverty and lack of insurance often compromise the ability of individuals in the Deep South states to secure adequate health care services. Furthermore, the tax-base of these state governments is simply less than that of most other states in the nation, limiting the ability of the Deep South states to provide adequate disease prevention and treatment. Issues of poverty, lack of health insurance, and inadequate health infrastructures are particularly relevant to prevention and treatment of HIV in the Deep South. Research regarding HIV/ AIDS in the Deep South region has revealed an epidemic with high proportions of HIV-infected individuals who are impoverished and rely on public AIDS Care, 2006; 18(Supplement 1): S1 S5