The South Carolina HIV/AIDS Council mobile testing van continues outreach and testing despite limited funding.
The South Carolina HIV/AIDS Council mobile testing van continues outreach and testing despite limited funding.

Credit: Lisa Desai for Public Health, Private Pain.

NEW YORK (WOMENSENEWS)–As part of a documentary team researching the impact of HIV/AIDS on black women in the rural South, I have learned these dire facts.

Eight of the 10 states with the most new cases of HIV infection and AIDS diagnoses are in the South.

African Americans account for 46 percent of all HIV diagnoses, and half of all rural AIDS cases.

Black women are disproportionately impacted at the national level (they make up 64 percent of new AIDS diagnoses) and face greater risk in southern states like South Carolina, which ranks fourth in the country for the number of African Americans living with AIDS.

Federal funding, however, is not following the epidemic and South Carolina is a particularly dire example of what that means.

In South Carolina, lawmakers cut the state’s prevention funds to zero in 2010. Now it is the only state in the country that does not fund prevention, despite the fact that the state has the highest rate of heterosexual transmission in the nation, with black women accounting for a quarter of HIV/AIDS cases.

In the rural South, poverty compounds high-risk behavior, making it difficult for people to afford and access health care. Pastors in Bible Belt states extol family values and can sometimes marginalize and even vilify those impacted by HIV.

In South Carolina, the revolving door of male incarceration creates potential for activities such as tattoo needle sharing and unprotected sex in prison. Men return home and resume their lives with wives and partners, sometimes without disclosing indiscretions.

Jobs, Not Health Care

South Carolina’s Gov. Nikki Haley, the party’s standard-bearer against President Barack Obama’s health care plan, spoke at the GOP national convention in Tampa, Fla. She hailed job creation as the solution to state unemployment and poverty.

Haley and other Republican detractors call "Obamacare," which decreases the number of uninsured Americans and expands Medicaid coverage, wasteful.

This kind of cold-shoulder policymaking doesn’t help fight HIV/AIDS. But the disease is also fuelled socially, by factors such as misconceptions about HIV transmission and a reticence among black women to focus on this problem.

Women who do not ask for explanation or negotiate condom use perpetuate a cycle of denial and stigma. Arguably black women do not see ourselves reflected in HIV awareness campaigns, so some of us do not get tested, do not stand before the mirror for fear of what we might see.

With medical care, HIV is no longer a death sentence. But in pockets of rural South Carolina, where jobs are scarce and there is only one doctor per 4,000 patients, the epidemic is devastating.

Wilhemina Dixon knows this devastation well.

A 64 year-old great-grandmother living in the dusty backroads of Barnwell, S.C., she spends her mornings in the field picking peas before the onslaught of the midday sun. Her odd jobs provide for her family of six and she takes pride in making an earnest living.

Afterwards, as she sits in the shade of her porch, far removed from the political machinations, I imagine Dixon thinks of her daughter Toni who died of AIDS last year and ponders the future of her granddaughter Dayshal, who was born with the virus.

New York Juxtaposition

Dixon’s travails in the South juxtapose with the resources I take for granted as a New Yorker. Here opportunities for HIV testing are numerous: local clinics, STD testing centers, church outreach.

Given the size of its HIV population and iconic setting for early gay rights and HIV/AIDS advocacy, New York City, with a population of 8.2 million, receives more funding for programs than South Carolina, with a population of 4.6 million.

In New York City, you’re a walk or a train ride away from support and care via public transportation. Without a car, travel is difficult in South Carolina. So whether someone goes to the doctor depends on medical need, but also access to a car and money for the fuel to get there.

In South Carolina HIV billboards or posters are nowhere to be seen.

Haley rejected matching funds for the AIDS Drug Assistance Program, which provides HIV medication to low-income patients. After the June 2012 Supreme Court decision upholding the Affordable Care Act, Haley vowed to refuse Medicaid expansion. She wants jobs, not health care, which she says would cost the state $1.1 billion annually for the half million citizens who could be covered.

These cuts to Medicaid and the AIDS Drug Assistance Program lower financial incentives for doctors to treat HIV and bar otherwise qualifying low-income enrollees from government HIV funds. And so the disease breeds in small towns like Barnwell, where people cannot afford medication or to disclose their positive status.

Cassandra Lizaire is a freelance writer based in New York City. Lizaire currently works as an associate producer on "Public Health, Private Pain," a documentary on the impact of HIV/AIDS on black women in the rural South.

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