13 hours ago
Living with HIV in the Rural South
Living with HIV can be challenging anywhere. But stigma can be devastatingly severe in small communities where privacy is more infringed, services can be limited and difficult to access, and the disease can be more deadly due to religious culture.
The rural South can seem to be littered with a church of every denomination at almost every intersection. Local legislation and governing bodies reflect highly conservative views. And the culture is permeated with religious ideologies even in people who aren't religious, because Southern culture is pervasively influenced by the strictest traditions of Christianity.
I'm not saying there's anything wrong with religion. But it should be a matter of choice, not coercion. In my opinion, Southern culture makes Christianity feel more coerced than chosen.
Religious people have been at war with LGBT people for years, and LGBT people are disproportionately affected by HIV. At the beginning of the AIDS epidemic in 1981, the then-mysterious disease seemed to only affect gay men. So it was stigmatized by the church.
This had a significant consequence. The fear of being judged or ostracized creates a perfect environment for the disease to flourish, thrive, and even spread because people are afraid to be tested. In small communities, privacy is usually heavily infringed upon and everyone knows everyone. So it only takes one person to reveal your HIV status. And disclosure of status can have devastating effects.
Being tested for HIV may seem like a small thing, but it's not. If you're afraid to get tested, you might contract the virus and not know until you're very sick. Sometimes it's too late. Stigma alone perpetuates the spread of HIV and AIDS, and it's a barrier to prevention efforts. That's how religion makes the virus more deadly.
But not all woes of rural communities are rooted in religion.
The sprawling distances common in such areas can create barriers to accessing health services. This is another factor contributing to health care gaps in rural communities. Not only are distances longer, transportation can be less reliable or even nonexistent. Many rural areas have little or no public transportation. Not everyone has family or other means to provide travel to basic necessities like groceries and doctor appointments. Telemedicine can help, but it can't fill all needs.
Rural isolation and loneliness can lead to mental health concerns. When you live with HIV, depression is common, partly because it's highly stigmatized. Loneliness intensifies the pain of depression.
I live in a rural community, but I have quick access to the amenities of a small city. I'm blessed to live where I can find health care with HIV expertise, but resources can be limited. Wraparound services often fall through the cracks of a sparsely funded health care system. Some rely on help like the Ryan White HIV/AIDS Program that provides assistance for low-income people living with HIV. Without this assistance, people would die.
Many rural areas have rising numbers of new HIV diagnoses, due to intravenous drug use. Needle exchange programs can help prevent HIV transmission and eliminate the risk of a community outbreak, as they have in the past. But many of these communities have religious objections to free needle exchanges. They claim to feel responsible for contributing to the drug problem by supplying clean needles. But they don't realize the greater danger is contracting HIV.
In 2014-2015, in Scott County, Indiana, there was an HIV outbreak among drug-injecting populations. A temporary needle exchange program was established and the outbreak was curbed, showing needle exchanges work. But the program was halted when the outbreak got under control. This allows for the continuation of HIV transmission. But why do anything about it until it makes the news, right?
Our HIV prevention system is broken, largely because of religious beliefs influencing legislation and policy pertaining to this disease. People will continue to contract and transmit HIV because of it. Regardless of geographical location.
But religious stigma is strongest in rural America, where there are greater numbers of new HIV cases. Religion isn't the only factor behind this. But you can change stigma and stereotypes before you can change the distance of a mile.
Rural areas will always have more miles to traverse with fewer reliable methods of transportation. They'll always be poorer and more vulnerable to HIV transmission. Some of these factors can't be changed. But harmful beliefs about HIV must change, or this disease will never be eliminated. Conservative, rural communities will continue to be hotbeds for HIV to thrive.
