To mark National Women and Girls HIV/AIDS Awareness Day on March 10, amfAR looks at the issues faced by women with HIV in the southern United States. The South accounts for 37% of the nation’s population, but 50% of new HIV infections. According to the Centers for Disease Control and Prevention (CDC), the region has some of the highest rates of HIV among women in the nation and more AIDS diagnoses among women than all other areas of the U.S. combined.
amfAR talked to Kathie Hiers—CEO of AIDS Alabama, president of the National AIDS Housing Coalition, member of the Presidential Advisory Council on HIV/AIDS (PACHA), and co-chair of the Federal AIDS Policy Partnership (FAPP)—about the factors fueling the high rates of HIV and AIDS among southern women. Click here for more information on National Women and Girls HIV/AIDS Awareness Day and events happening near you.
Kathie Hiers is CEO of AIDS Alabama, president of the National AIDS Housing Coalition, member of the Presidential Advisory Council on HIV/AIDS (PACHA), and co-chair of the Federal AIDS Policy Partnership (FAPP).amfAR: What factors contribute the high rate of HIV and of AIDS among women in the South?
Kathie: In many ways, the South is the perfect storm for HIV. We have more people who are not in healthcare, don’t have insurance, and are very poor. We have a horrible education system with no money to do HIV education, and we a have huge push for abstinence only education. In many schools, you can’t even say the “C” word, which is condom. In others, you can only mention condoms if students ask about them specifically.
In Alabama, we have a law that says if you are teaching sexual health, you have to say that homosexuality is not accepted by society and is illegal—which isn’t true. So there is a law that you have to say something that’s not true. And so 32 years into this epidemic, a lot of people don’t understand the basic modes of transmission or that if you have HIV, you need to take HIV medication to stay healthy, and not just after you are very sick.
We have very high levels of stigma against homosexuality. The stigma around HIV has gotten better in urban areas, but remains worse in rural areas, causing people to not go to healthcare facilities to get tested. Sixty-four percent of HIV cases in rural areas in the U.S. are in the South.
Also, a lot of women are not aware that they are at risk. I see the same story over and over. A woman thinks she’s in a monogamous relationship or marriage. She gets sick and doesn’t know what’s wrong, so she goes to the hospital and gets diagnosed and usually finds out that she already has AIDS.
amfAR: Nearly 75% of women newly diagnosed with HIV in the South are black, and nationally African American women are twenty times more likely to be infected with HIV than white women. What factors contribute to their higher HIV rate?
Kathie: First, if you look at the economic status of blacks in the South, in general, they’re incomes are lower than whites, and that causes a higher risk of HIV. And I think the stigma against homosexuality in the region causes so much pain in young gay black men, that some do try to live double lives. They often have a girlfriend and self- identify as heterosexual, but at same time, they’re having sex with other men.
I get mad when people blame them though. What we should get mad at is the prejudice and stigma that doesn’t allow them to live their lives.
But more black men are coming out publicly as gay, and that is helping. We also need to continue doing outreach in black churches. Black churches are such a dominant part of the community, and many of them have no room for homosexuality. We have one person on staff at AIDS Alabama who does nothing but that outreach, and we’re seeing more churches become more welcoming.
amfAR: According to the Census Bureau, 10 of the country’s 12 poorest states are southern and nationally adult women are more likely to be poor than adult men. How does poverty affect HIV risk and how is it a factor for women in the South?
Kathie: With poverty comes so many things that increase HIV risk. There is the lack of healthcare. There is also the lack of stable housing. Risky behaviors are drastically increased when a person does not have stable housing. And having stable housing may be the most important factor in treatment success for people who have HIV. This is especially an issue for women because if they don’t have a place for their children to sleep and food for them to eat, their own health takes a backburner. And in rural areas, there usually aren’t any shelters for women and children, but there are some men’s shelters. As a result, women tend to stay homeless longer than men.
amfAR: Many of the 26 states that opted out of the federally funded Medicaid expansion provided for under the Affordable Care Act are southern, and every state in the deep South except Arkansas has opted out. How has this fact and the implementation of the Affordable Care Act impacted HIV care?
Kathie: We’re trying to get people signed up on Affordable Care Act insurance marketplaces, but unfortunately about 80% of people living with HIV in Alabama fall into the Medicaid gap, so because we opted out of that coverage, they cannot get care. The people we talk to are just devastated when they find out they don’t make enough money to enroll in insurance under the act.
Because of this, many HIV-positive people still have to get care under the Ryan White Care Act and AIDS Drug Assistance Programs, which don’t have enough resources. And a lot of poor HIV-positive people use hospitals for primary care, but the Affordable Care took away payments for indigent care in hospitals, because at the time they thought Medicaid expansion would cover those people. It’s absolute madness when our state governments refuse free medical care when we are the area that needs it the most.
amfAR: Are there any other factors that contribute to the high HIV rates among women in the South?
Kathie: Domestic violence and sexual abuse also play a huge role in what’s going on with women in the South. Researchers in Tuscaloosa and Montgomery were trying to put together a study about women with HIV and the intersection with domestic violence. Over 90% of the women they interviewed had experienced intimate partner violence, so they couldn’t find a control group, and they had to give up the study.