Lingering stigma helps Aids epidemic ravage US South
The American South has been quietly ravaged by HIV/Aids, even as the rest of the US has made great advances in treatment and prevention. As Michael Maher reports, the conservative region's reluctance to speak publicly about the epidemic has hampered its ability to fight it.
About this time every year, the Reverend Patricia Starr runs a Christmas drive for HIV-positive children in the small town of Clover in the state of South Carolina.
A few years ago, she recalls, one boy asked her for a telescope so he could look up to heaven, where he expected to be soon.
Four months after receiving the Christmas gift he was dead, another HIV/Aids victim for Clover's graveyards.
''The cemeteries keep getting larger,'' says Ms Starr. ''They keep pushing the woods back and making more graves.''
In the American South, HIV/Aids remains a silent epidemic.
In no other part of the US are the death rates from the disease as high. Poverty, religion, culture and neglect have all played their role in keeping it this way.
And it's the South's African-American population which has suffered most.
The graveyards of Clover, a town with a population of about 5,100, tell of the toll that HIV/Aids has exacted.
Not one of the headstones bears a reference to the disease.
In the past, poignant markers were sometimes left on the graves of those taken by the smallpox or influenza epidemics.
Aids victims' graves in the South bear no such inscriptions.
In a plot on the fringes of Clover, Ms Starr's sister, brother and niece are buried alongside one another. They and five other members of her extended family died of Aids.
As she walks among the headstones, she points to others who have died the same way but whose families dare not acknowledge it.
Such is the stigma attached to HIV/Aids in the South.
''I think we're still going downhill. Until we open our eyes and really talk about it, it's not going to get better,'' says Ms Starr, a Pentecostal preacher who has taken to handing out condoms at her church.
An epidemic ignored
Statistics from the Centers for Disease Control and Prevention (CDC) underline Ms Starr's fears:
- Death rates for Americans living with HIV are highest in the South
- Eight of the 10 states with the highest percentage of African-Americans with Aids are in the South
- In all those states, the majority of people who have Aids are African-American
- Six of the 10 states with the highest percentage of women with Aids are in the South
When the world's attention turned to the scourge of Aids in sub-Saharan Africa, the disease was still spreading in the states of the Old Confederacy, says Andrew Skerritt, author of Ashamed to Die: Silence, Denial, and the Aids Epidemic in the South.
"I was in South Africa last year," Mr Skerritt says. "You see a lot of banners about Aids and these banners were in your face.
"They didn't mince words. In the years of going to Clover I've never seen a billboard addressing Aids.
"To me that is telling. You see billboards about strip clubs on the highways. You never see a billboard about Aids."
Mr Skerritt argues the innate conservatism of the region known as the Bible Belt, combined with poverty and lack of education among African-Americans, have hampered efforts to rein in the epidemic.
He says Ms Starr is "one in a million", pointing out that most pastors would never promote condom use because they see it as "giving people a licence to have sex".
He also contrasts the vigour and success of campaigns in the rest of the US with the South's reluctance to act.
In New York City, for example, the gay community loudly and defiantly demanded a public prevention effort as early as the 1980s.
He says: "Even as other regions in America devised programmes to stem the flow of Aids, Southerners remained bound by denial.
"A conspiracy of hypocrisy, shame, false morality, cowardice and political opportunism conspired to keep Aids, 'God's curse on homosexuals', off the public policy list of priorities."
For the health workers on the frontline of the epidemic, it's an unending struggle to obtain funding and to encourage those at risk to come forward for testing.
At the Catawba Care clinic, which treats about 450 HIV-positive patients from Clover and surrounding districts, director of preventative services Monica Adamian says that local and state authorities have at last begun to take the epidemic seriously.
But the battle against the disease's stigma has been far less successful, she says.
"People are embarrassed to just walk through the door because they don't want someone else to see them," she says.
"They're scared that they're going to be shunned by everyone if they come up infected."