Chattanooga: Life with unspoken fear

For Gary Law, living with AIDS in Chattanooga can be lonely.

Unlike in his hometown north of Seattle, few people here know his status and most shy away when they find out, he said.

“It’s that, ‘Don’t ask, don’t tell,’ keep it hidden (atmosphere),” said Mr. Law, 53, who was diagnosed with HIV in 1989 and has had acquired immune deficiency syndrome since 1995. Mr. Law moved to Chattanooga with his partner in 2006.

“It’s kind of an unspoken fear,” he said. “Even in communities that are less conservative than this there’s still some stigma, so here I really notice it.”

The AIDS epidemic, which emerged in the United States in urban centers such as New York and San Francisco, is intensifying in the South and cultural taboos are part of the problem, health advocates say.

Women, particularly black women, increasingly are contracting the disease locally, reflecting national infection trends, local health officials said.

About 34 percent of newly infected people in 2006 were females and, of those females, 76 percent were black, said Tom Rucci, HIV/AIDS outreach coordinator the Chattanooga-Hamilton County Health Department.

Overall infection numbers also are rising locally. In 2002 there were 53 cases of HIV and AIDS reported in Hamilton County, compared to 62 in 2006, the most recent data available, he said.

As infection rates in the South continue to rise, funding for treatment and prevention is not keeping pace with the movement of the disease, state and local health officials say.

“As time has gone on and as the statistics show more people in the South are becoming infected, the money is not following the epidemic,” Mr. Rucci said.

The local health department’s federal funding for AIDS prevention and care has remained flat for the past seven years, he said. The local health department gets $279,000 annually for HIV/AIDS prevention and $186,300 per year for case management, he said.

The state’s annual federal funding for HIV/AIDS prevention actually has declined by about $190,000 since 2005 due to federal budget cuts, said Jeanece Seals, director of the Tennessee Department of Health’s HIV/AIDS and STD office.

In 2005, the South was receiving less total federal funding per person living with AIDS than any other region, according to the Southern States Manifesto, a July report from the Southern AIDS Coalition.

The Birmingham, Ala.-based coalition is a nonprofit organization of government representatives, corporations and community advocates addressing HIV/AIDS in the South.

Although the group’s 2002 report on the impact of AIDS in the South has led to increased funding to the region — including $6 million in new AIDS treatment funds for patients in Memphis and Nashville — funding levels still are lagging, Ms. Seals said.

A “CATASTROPHIC” SITUATION

Cases of HIV and AIDS in the South are even more of a challenge because of the region’s widespread poverty and high numbers of uninsured people, which delays HIV screening and treatment, according to the Southern States Manifesto.

Those issues, coupled with deeply entrenched stigmas that hinder outreach efforts and deter people from seeking medical treatments, have created a “catastrophic” situation in the South, the report said.

Although between 2001 and 2005, the number of deaths from AIDS decreased throughout the rest of the country, deaths from AIDS rose in the South, the report said. The report, an update of a similar release in 2002, used data from the U.S. Centers for Disease Control and Prevention.

More adults and young people live with and die from AIDS in the South now than in any other region of the country, the report said. Although the South has 36 percent of the nation’s population, the region accounted for more than half of all deaths from AIDS in the United States in 2005, the report said.

Chattanooga CARES, a nonprofit organization that provides financial assistance and medical treatments to people affected by HIV/AIDS, still faces roadblocks or censorship when trying to give presentations on HIV prevention in some Hamilton County public and private schools, said Jerry Evans, executive director of the group.

“Sometimes the South tends to have the stick-your-head-in-the-sand syndrome, where you don’t talk about it at all. ... It goes back to the idea that it can’t be me, this is a white gay man’s disease and therefore, if I’m not white and I’m not gay, then I don’t have anything to worry about,” he said.

Although the Hamilton County Board of Education fully supports getting information to students about HIV prevention, a school must consider getting parent consent and community feedback when presenting children with information that might be questionable for some, Board Chairman Kenny Smith said.

“The citizens of Hamilton County and the students of Hamilton County need to get as much information on all the subjects that we’re concerned with, and AIDS would be something everybody would be concerned about,” he said. “But we want to err on the side of precaution to make sure the whole community is aware of anything we would do and make sure all the groups were at the table before we do something that (could) offend.”

The Tennessee Department of Health is working to identify demographic groups and regions in the state with the most rapidly rising HIV infection rates to launch targeted prevention efforts.

But misconceptions and stigmas must be overcome for those efforts to be effective in slowing the spread of the disease, Mr. Rucci said.

Twenty-five percent of people with HIV don’t know they have the virus, and they cause between 60 percent and 80 percent of new infections, he said.

This month the U.S. Centers for Disease Control and Prevention increased its estimate of new HIV cases annually by 40 percent, up to more than 56,000 cases.

“CDC had a goal in 2000 to decrease the number of new infections by half,” Mr. Rucci said. “We aren’t even making a dent in it.”

Statewide, the number of reported HIV/AIDS cases has hovered around 1,000 per year for a number of years, state health officials said.

In Hamilton County, however, over the past five years HIV infection rates have risen fairly steadily except for a drop in 2005, Mr. Rucci said.

PREACHING PREVENTION, COMPASSION

Local health department officials have struggled to reach black and Hispanic communities that disproportionately are being affected by HIV and AIDS here, Mr. Rucci said. In an unusual partnership, some local churches serving those populations have been a vehicle for dispensing information in the face of a mounting epidemic, he said.

Reaching minority populations “is not as bad as it used to be,” Mr. Rucci said. “A lot of that is in thanks to some of the pastors who realize that they’re having too many funerals, that they’re burying too many people who are HIV positive and it is, in fact, in their churches and something needs to be done.”

Pastor Ron Cook of Rock Island Baptist Church in Avondale said he began preaching about HIV prevention and even discussing the benefits of condom use after the local health department informed him in 2006 of rising HIV infection rates in East Chattanooga ZIP codes and the disproportionate impact of HIV on black females. Other churches have begun to follow suit, he said.

“My people were wide-eyed when we began to have this conversation,” Mr. Cook said. “It’s always been difficult, I believe, within the church confines to talk openly about that subject. ... But if AIDS is rampant in our community, they need to be aware of it. That is what has driven this desire to speak openly.”

Although the east side of Chattanooga has less than 10 percent of the county’s population, the area had more than one-third of the reported cases of HIV and AIDS in 2006, according to a study by the local health department.

Small victories give Mr. Law hope that just his presence in Chattanooga may help spread acceptance.

He recalled when his massage therapist — a 30-something woman in Chattanooga — admitted that she’d been hesitant to work with him because he had AIDS. After months of seeing her, Mr. Law recounted, “She said, ‘I’m so glad right now that I’ve met you and what you’ve done for me in opening me up has been a good thing, and I’m thankful for it.’ That made me feel really good. ... As people get to know people that have different views, (they realize) we’re still all people.”