A map of the Southeast showing the prevalence of people living with an HIV or AIDS diagnosis in 2010. Map courtesy of AIDSVu, Emory University, Rollins School of Public Health.
According to the Centers for Disease Control, African Americans account for 75 percent of Alabama’s HIV cases, but only about 25 percent of the state’s population. In many neighborhoods, HIV is a disease spoken about in whispers. People are scared to get tested, and scared to be seen going to a clinic. In order to combat stigma and increase awareness, doctors and academics are going to an unlikely place — the church — in an attempt to break down some barriers. Ashley Cleek traveled down to the Black Belt to see how it’s going.
Highway 5 runs from Birmingham’s industrial outskirts into Alabama’s rural heart. Trucks heavy with pine timber speed down the road. A patchwork of houses flick past some fly American flags from sturdy porch posts – others are nothing but a brick chimney in an empty plot.
“This is Black Belt, this is the Bible Belt,” says Isaac, 49, who asked that we not use his real name. “It was kind of challenging being an African American and gay.”
Isaac grew up in Selma, as the youngest of five. In 1990, he tested positive for HIV. At the same time, his eldest brother moved home, also sick with AIDS.
Isaac’s brother died of complications related to the disease in 1995, but publicly, Isaac’s family told another story.
“When you say AIDS, it’s like ‘Oooooh, you know, he got that disease from doing immoral, sexual things.'” Isaac explains. “So, Mom said, ‘Just say he has cancer.’ And to this day, everybody thinks he died of cancer, but actually he died of AIDS. And I can say that today and be at peace with that.”
It took a long time for Isaac to talk openly about his positive status, but now he travels the Black Belt, holding workshops about HIV.
However, he says, there are some places he still doesn’t feel comfortable speaking out.
“Do I speak in Selma? No.” Isaac pauses. “Am I still fearful? Yes. Unfortunately, here in Selma, there are certain places like ‘the church.'”
According to Isaac, churches in the Black Belt actively ignore the growth of HIV in black communities.
And it’s a serious problem.
A report from the Alabama Department of Public Health shows several counties in the Black Belt have HIV rates three times the national average, and almost 20 percent of people living with HIV in Alabama don’t know they have the disease.
Some of the highest infection rates fall along the Civil Rights trial.
Dr. Laurie Dill, the medical director of Medical AIDS Outreach in Montgomery, a clinic providing comprehensive care to patients with HIV and AIDS throughout central and south Alabama, points to a map in the hallway, showing the number of people in each county living with HIV in 2010.
“That’s the Selma to Montgomery March. Plus the Tuskeegee Institute,” says Dr. Dill.
Alabama’s middle, where the counties pulse red, is the new, rural heartbeat of the AIDS epidemic.
“There is a synergy of plagues that put people at risk for HIV,” Dr. Dill explains. “One of them is racism, one of them is poverty, one is poor education one is rural access, one is stigma, one is domestic violence.”
In Lowndes County, these conditions create a perfect storm. It’s one of the poorest regions in the country. The population is majority African American. There are few jobs. Inadequate education. No public transportation, and little medical care. For example, within the 725 miles that make up Lowndes, there is only one doctor.
HIV, Dill explains, has become a disease of the disenfranchised.
“Let me pull out a map of where our churches are…” Dr. Pamela Payne Fosters whispers and she roots around in her desk.
Dr. Foster works at the University of Alabama’s School of Rural Medicine and has been researching HIV in the South since the early 2000s. Over and over she has heard her HIV patients in the Black Belt repeat a similar fear.
“When they tell the pastor, ‘I am HIV positive,’ that that information will spread throughout the congregation,” Foster says. “They feel it should be confidential, but they say, ‘If you want to keep a secret don’t tell anybody in the church.’ You know, if people know they won’t want to sit by them.”
To combat this attitude, Dr. Foster decided she had to get churches involved. She had heard about a program in Ghana, where churches taught an anti-stigma HIV workshop and thought it could work in the Black Belt. It took a year and a half, but Dr. Foster convinced 12 churches across the Black Belt to enroll 20 members of their congregation in an HIV and anti-stigma education program.
One congregation that joined was Snow Hill Christian Church in the tiny town of Mount Willing. For over three decades, Snow Hill has been led by Reverend Dale Braxton. He grew up in the county during the Civil Rights movement.
“The church was the center focus of our way of being. Every Sunday we find ourselves in Church,” Rev. Braxton says. “It’s like a community center, everything you needed was at the church.”
In the late 80’s, Braxton was called to the beside of a young man who was dying of AIDS. It shocked him and made him vigilant. Braxton does not shy away from talking about HIV and safe-sex, even though some congregants have told him they disapprove.
“I try to let them know that if you have no vision you’ll perish, without knowledge you will perish,” Braxton says, referencing the Bible. “It’s like any silent killer — diabetes, obesity, hypertension — HIV and AIDS can be a silent killer if we keep it to ourselves and not learn about it.”
A few years ago when the NAACP launched an awareness campaign, Braxton realized he had to do something. For the past three years, he’s preached a yearly sermon dedicated to AIDS awareness.
The church slowly crowds with about 100 people. Men in pressed white linen shirts shake hands, as families hugging young children scoot down the pews. Braxton rises to the pulpit, as young and old pull worn Bibles from their bags and follow along.
Braxton is direct. He says HIV and AIDS has become a community crisis, and they must talk about it.
“It is an epidemic, church. It is said, that Lowndes County has a high rate of people infected by HIV. And if that be the case then we got problems.” Braxton’s voice cracks with emotion. “Somebody say, ‘We got problems.'”
The church echoes Braxton’s call.
The congregation looks tense and focused. Some look down at their Bibles.
Others mutter Amen under their breath and raise their hands in praise. But after the service, when I ask people in the parking lot about HIV in their community, no one agrees to talk.
Braxton plans to hold an HIV class at the end of this month and talk to teens about getting tested, and it’s important. The Alabama Department of Public Health reports that, for some counties in the Black Belt, the numbers keep rising and getting younger.
Remember Isaac? He recently met a 15-year-old boy from a town in the Black Belt, who had just been diagnosed with HIV.