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HIV/AIDS: South struggles against rising problem. Not enough funding, doctors, education to fight growing problem
 
 
  By Dahleen Glanton | Chicago Tribune correspondent
April 13, 2009
 
HENDERSON, N.C. - Sheila Holt moved to this small town from New Jersey two years ago to take care of her ailing mother. But as a former heroin addict with HIV, she found that rebuilding her life in the South was harder than she had imagined.
 
She was shocked that the wealth of services, such as housing, transportation and medications, available to her as an HIV patient in Newark were lacking in Henderson. In the North, she said, people talked openly about the disease without fear of reprisal. In the South, she could not sit at the dinner table with her family or talk to her neighbors about the disease without the risk of being shunned.
 
With no job and few housing options in this rural area, she lived for months in the basement of her mother's home, slipping upstairs only when her stepfather was at work. She eventually qualified for Medicaid, which pays for the 10 medications she takes every day. And she receives a disability check that helps cover the rent for her sparsely furnished apartment, tucked away on the backside of a public housing complex.
 
In the eyes of many, including her stepfather-a part-time minister-HIV and AIDS are a sin, she said.
 
"People are scared in the South. They don't really understand that this is a disease," said Holt, 44, who has begun to speak out about HIV prevention to students and other women. "They are either too religious to open up or they don't want the stigma."
 
It is an attitude that health-care professionals have battled for almost a decade while HIV/AIDS skyrocketed in rural Southern communities, particularly among African-Americans. With too few doctors, staggering poverty and a history of inadequate AIDS education programs, the South is now home to half of the 1.1 million people living with HIV/AIDS in the United States, according to the Southern AIDS Coalition, which is composed of health professionals.
 
The Obama administration said last week that it would refocus attention on HIV/AIDS in America, spending $45 million over five years on television and radio ads, transit signs and other efforts to promote education and prevention.
 
A new study by the Trust for America's Health found that during the economic downturn, Midwestern and Southern states are receiving the least federal funding from the U.S. Centers for Disease Control and Prevention to spend on public health, including AIDS. Illinois, for example, received $16.66 per person in 2008, compared with $52.78 per person in Alaska. And with most states facing severe budget shortfalls, health professionals fear public health could take a hard hit.
 
"Some states have significantly less money to engage in disease prevention in their communities and either the state will have to make up the difference, which is hard to do in these economic times, or there will be harsh outcomes," said Jeff Levi, executive director for the trust. "Without equitable spending across the country, where you live will determine how well you live."
 
Levi said reasons for the CDC funding disparities include lack of money available to the CDC and states failing to aggressively apply for all available funds.
 
In 2006, the federal government revamped the formula for distributing Ryan White Program funds, which significantly increased the allocation of HIV/AIDS money to the South. But health-care workers said they still are catching up from years of underfunding and are struggling to provide the level of medical and support services to their primarily low-income patients as those in other regions receive. As a result, they said, many patients in the South lack adequate housing, transportation and access to some medications.
 
"Certainly the $30 million shifted to the South helped, but we still have bigger problems," said Kathie Hiers, former co-chair of the Southern AIDS Coalition. "There needs to be a better level of parity between the states. The money should follow the epidemic, but the way it stands now, the cities get way more per person than the rural areas."
 
The CDC said urban areas, particularly in the Northeast, continue to experience the greatest impact from AIDS. The Northeast had the highest AIDS case rate per 100,000 in 2007 at 16.4, followed by the South at 15.1. The South, however, accounted for 46.4 percent of new AIDS cases in 2007 and has the greatest number of people estimated to be living with AIDS, according to a Kaiser Family Foundation analysis of CDC data.
 
"While the South has faced a higher burden of AIDS, the bulk of the available data do not suggest that the epidemic in the South is worsening," said Dr. Richard Wolitski, acting director of the CDC's Division of HIV/AIDS Prevention.
 
Dr. Michelle Ogle, director of the Northern Outreach Clinic in Henderson, has struggled to serve patients with limited resources. The recession has exacerbated the problem, as people who are uninsured and barely making ends meet often place their medical needs on hold for daily survival.
 
Ogle has spent eight years working with HIV and AIDS patients in this town of about 16,000. Her small clinic, nestled out of sight in the rear of a medical complex, is the only such facility in a 50-mile radius and serves 50 to 100 patients a month from surrounding counties.
 
"We are not just fighting HIV, we are fighting a culture," Ogle said. "What is disturbing is that we have women who don't feel comfortable insisting that men use condoms because they are afraid he will leave and maybe he is paying some bills. They are victims of poor education, low self-esteem and they don't feel empowered."
 
In the 12 years since she contracted HIV through unprotected sex, Jo Lee Cooper, one of Ogle's patients, has begun to talk openly about the disease, but it was not always that way. She used to laugh with her co-workers about people who had AIDS. One day, she showed up for work to find that someone had posted copies of her medical records in the bathroom stalls and public areas of the factory.
 
"You get up in the morning and the last thing you do before closing the door to go to work is put on a mask. The laughter was my mask," said Cooper, 44, "Now I'm not ashamed of it. I know I made mistakes but I'm human, and that's something I have to live with."
 
It was harder for her husband, Michael Cooper, 50, to accept because it brought attention to the fact that he too has HIV and was not ready to go public. Recently, after years of what he called "hiding in the bottle," he gave up drinking and faced reality.
 
"I don't know whether I gave it to her or she gave it to me," said Michael Cooper. "It caused some problems for us in the past but now it doesn't matter. This is my sermon now, and I'm taking better care of myself."
 
 
 
 
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