by Maggie Smith
North Carolina is among the 10 U.S. states with the highest rates of new HIV and AIDS diagnoses and HIV-related deaths, according to a study released this week by the Southern HIV/ AIDS Strategy Initiative (SASI). The analysis, which is based on data from 2009 from the Centers for Disease Control (CDC), also found that the South had the highest rates of both new HIV diagnoses and HIV-related deaths in the country.
Other findings in the report include:
— Nearly half of people living with HIV in the U.S. reside in the South
— 8 of the 10 states with the highest rates of new HIV and AIDS diagnoses are in the South, including North Carolina
— 9 out of the 10 states with the highest rates of HIV-related deaths are in the South, including North Carolina
— 99.5% of people on waiting lists for AIDS drug assistance programs live in the South
This analysis uses the U.S. Census definition for the South: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia and Washington, D.C.
HIV is an incurable and deadly virus that attacks the body's immune system. AIDS is the final stage of the HIV disease. More than 34 million people in the world live with HIV, more than 1 million in the U.S.
There are about 35,000 people are living with HIV/ AIDS in North Carolina. High rates of HIV in North Carolina are partly caused by the high proportion of rural areas in the state, said Carolyn McAllaster, the director of the project. Residents in rural areas often have limited access to medical facilities and reliable transportation, she said.
The Triangle has more resources to help HIV patients than rural parts of the state. Both Duke University and the University of North Carolina at Chapel Hill have infectious disease clinics, and the Duke AIDS Legal Assistance Project in Durham provides free legal assistance to low-income patients.
While limited access to services is a major barrier to treatment and prevention, the report also identifies social conservatism as another contributing factor to the disproportionate prevalence of HIV and AIDS in the South.
“Stigma is probably still one of the largest factors that impact people who are living with HIV and thinking about getting tested,” McAllaster said. “You would think in 2011 we would be past the stigma, but we’re really not.”
McAllaster said the stigma people associate with HIV or AIDS often prevents them from seeking help or even practicing prevention. Many people fear losing their families, jobs, and inclusion in their communities.
“I see it happen all the time,” said McAllaster, who is also director of the Duke AIDS Legal Assistance Project.
The report also identifies laws in some southern states that make HIV prevention challenging. In North Carolina, it is currently a misdemeanor for people infected with HIV or AIDS to have unprotected sex without notifying the other party, a crime that’s punishable by up to two years in prison.
It’s also illegal to purchase or carry a syringe without a prescription. It's also illegal to possess or distribute syringes that could be used for illegal substances. Injection drug users (IDUs) may be deterred from buying clean syringes from the pharmacy out of fear of being arrested.
“In North Carolina, we have a criminal justice solution to a public health problem,” said Robert Childs, executive director of the N.C. Harm Reduction Coalition. “It’s a big problem.”
Criminalizing syringes prevents syringe-exchange programs from operating legally, Childs said. Sharing needles is the third leading causes of new HIV and AIDS diagnoses in the United States, according to the CDC, and improperly discarded needles can lead to accidental pricking. Police are particularly vulnerable to being accidentally pricked by a used and potentially infected needle.
Currently, there are five needle exchange programs in the state that are operating illegally, according to the N.C. Harm Reduction Coalition. But that might change next year. State representatives Verla Insko, a Democrat from Orange County, and Pricey Harrison, a Democrats from Guilford County, pushed bill this year that would decriminalize the possession of syringes. The bill gained bipartisan support, Childs said, but stalled in a committee. The bill will be reintroduced next year, Childs said.
The fact that HIV and AIDS disproportionately affects people shoved to the margins of communities, such as drug users and minorities, might be the reason that relatively few people are talking about or paying attention to the epidemic, McAllaster said.
“Unfortunately, they're not communities that catch the public attention like the cancer community does,” said McAllaster.
The Duke AIDS Legal Assistance Project launched SASI, with a grant from the Ford Foundation, to raise awareness about the prevalence of HIV in the South, and to develop policy recommendations. McAllaster and a group of advocates are meeting with delegates in Washington, D.C., this week to share their research and to ask for financial resources.