It’s a killer that has faded in the public conscience as other more sensational illnesses — such as Ebola — have transfixed the world. But the HIV epidemic is persisting, particularly in the Bible Belt. Each year, about 50,000 new HIV cases are identified nationwide, and more than 658,000 people have already died from AIDS. State and federal statistics paint a grim picture for the South:
• The South — defined broadly by the Centers for Disease Control and Prevention as the District of Columbia and 16 states, including Georgia — ranks first in the nation for its rate of new HIV cases. In 2013 — the most recent year for which statistics were available — the South had a rate of 20.5 HIV infections per 100,000 residents. The Northeast placed second at 15.9 followed by the West, 10.8, and the Midwest, 9. Spread mainly through having sex and sharing needles with people infected with HIV, the virus infected more people in the South than in any other region every year between 2009 and 2013. In 2013, the South was home to 24,323 new HIV diagnoses.
• In 2013, Georgia ranked second among the 50 states in its rate of new HIV diagnoses at 36.7 with an estimated 3,011 new cases, behind Maryland, which had a 43.7 rate. New HIV cases were documented in at least 43 Georgia counties in 2013. The year before, there were 39,102 Georgians living with HIV or AIDS. Also in 2012, 613 Georgians died from HIV/AIDS. Meanwhile, the state’s prison system is housing 803 inmates with HIV.
• The Atlanta-Sandy Springs-Roswell area ranked fifth among metropolitan areas in the nation in 2013 for its rate of new HIV diagnoses at 34.7. There were 1,919 new HIV cases identified in that area that year. In 2012, there were an estimated 26,020 people living with HIV in the Atlanta region.
HIV IN GEORGIA: BY THE NUMBERS
» MAP: View our interactive map detailing HIV rates in each Georgia county for 2013
» CHART: See how the number of new HIV cases diagnosed in 2013 compares with the HIV rate per county
The South’s struggle with HIV is “a public health emergency,” said Dr. Patrick Sullivan, an epidemiology professor at Emory University. He and other experts cited numerous reasons for it, especially poverty. The region is home to the nation’s largest number of people living in poverty. Many lack health insurance. At the same time, people with HIV and AIDS are now living longer than ever in the U.S. because of better treatments.
Citing taxpayer costs, political leaders in Georgia and many other Southern states are refusing to expand Medicaid — a health insurance program for the poor — under Obamacare. Sullivan said a recent study he worked on in Atlanta showed gay men without health insurance were about twice as likely to contract HIV.
“Any programs that expand the availability of healthcare are a critical part of the answer to how we can get a better handle on the HIV epidemic in the South,” said Sullivan, a former CDC official and now the principal scientist for aidsvu.org, which tracks HIV in the U.S.
Among other obstacle to stopping the spread of HIV in the South, Sullivan said, is the lack of “comprehensive” sex education in some public school systems. Some schools are offering sex education, Sullivan said, that primarily emphasizes abstinence without giving students all the information they need to avoid getting HIV. Supporters of that abstinence-focused approach say students should learn the safest way to avoid HIV is to abstain from sex until marriage.
Meanwhile, some people who should get tested or treated for HIV are not because of the stigma surrounding gay sex, drug use and HIV in a largely conservative and deeply religious swath of the country, experts said. Fearing they will be judged, they avoid health clinics. That stigma is particularly powerful among black gay males with HIV, their families and their churches, said Dr. Patrick O’Neal, the Georgia Department of Public Health’s point person for fighting the spread of the virus.
“What I hear is that they feel essentially… thrown out of their families,” said O’Neal, director of health protection for the state agency, “if, in fact, their families know that they are gay or know… they are not gay but for various reasons — very often for money — they may be having sex with other men.”
This is significant as blacks are disproportionately affected by the virus in Georgia. For example, in 2013, blacks accounted for 66 percent of people living with HIV in the state, though they comprised only 31 percent of Georgia’s population. In contrast, 56 percent of those infected with HIV nationwide were black in 2013.
Yarborough, who is black, remembers struggling with fears about how people would perceive him after he was told he had AIDS. He recalled how he would get off the bus three stops past his doctor’s office so he wouldn’t be seen going there. And when he took his AIDS medication, he would do so in private. Yarborough’s family has been supportive, though he has heard horror stories about other families rejecting loved ones with AIDS.
“When people found out, they were like, ‘Yes, we are cool with it,’” he said of his experience with the illness. “For me personally, it was… the stigma that was in my head.”
Like Yarborough, Mona Bennett is fighting HIV on the front lines. She is the associate director of the Atlanta Harm Reduction Coalition, a nonprofit that operates a free, twice-a-week needle exchange program in a gritty Atlanta neighborhood called the Bluff. As of the end of December of 2013, intravenous drug use alone accounted for an estimated 10 percent of HIV infections in Georgia, or 5,438, state Public Health Department records show.
Bennett’s coalition exchanges thousands of needles a week and its customers come from across Georgia, including rural areas of the state such Blairsville, located near the North Carolina border. She has a ready answer for critics who say such programs perpetuate drug use.
“Drug users are gonna use drugs,” said Bennett, whose organization also provides HIV testing and counseling. “People who want to have sex are gonna have sex. So why not let people do what they are gonna do anyway more safely?”
Yarborough recalled how his body started to deteriorate in the days before he got his AIDS diagnosis in 2010. Suffering from bronchitis, he would run out of breath walking to his mailbox. He had thrush – an infection in his mouth – and was struggling with digestive problems. And then he collapsed in the shower one day. He didn’t want to go to the hospital because he was afraid of what he would learn. Yarborough finally went after his mother insisted.
His heart sank when his doctor told him he had AIDS. But his troubles weren’t over. Within that same year, Yarborough learned he was also suffering from Kaposi’s sarcoma, a cancer that causes abnormal tissue made of cancer and blood cells to grow under the skin. The disease moves quickly in AIDS patients.
At one point, Yarborough was undergoing chemotherapy and taking 11 pills to treat all of his medical problems. Now he is down to one pill a day — Stribild — and can go for months without seeing a doctor. Yarborough, who is exercising and watching his diet, said he now feels “like a normal person.” He is about to get his GED diploma and is studying business and finance at Atlanta Job Corps.
In some ways, Yarborough sees his illness as a blessing. It has forced him to take care of himself. It has given him a new outlook on life. And it has opened doors for him as an activist combating HIV. He is now creating a nonprofit organization called HYPE to Empower, which is aimed at helping young people with HIV.
“HIV has matured the hell out of me,” he said. “HIV gave me a sense of life. It gave me a sense of purpose.”