HIV on the Rise in the Deep South

Georgia native Rick Westbrook was a high school graduate back in 1981 when he first heard about HIV and the AIDS virus. He didn't know it then, but years later he would become one of the statistics. Thirty years after the epidemic began, HIV is on the rise again in the South among black men who have sex with men.

Westbrook decided to get tested after getting out of a relationship and after finding out that his partner hadn't been faithful. Back then, Westbrook went to AID Atlanta's Mercy Mobile unit to get tested. "You had to wait two weeks to get the results," he recalled.

He took those long two weeks to prepare himself for the possible results. In the early days of the virus, Westbrook said, "People were dropping like flies. They'd find out they were positive and a month later they were dead."

"I was OK with it," Westbrook said of the possibility that he could be positive. "I went home and told my mother and tried to reassure her. I told her I'd probably live for five years, and that I'm OK with it."

Westbrook said that while his mother shared her son's resolve, he was sure she grieved, but refused to show it to him.

He found out he was HIV positive two days before his 30th birthday, and he has been positive for 18 years now.

At just 30 years old, HIV positive, and single, Westbrook wondered if he'd ever be able to find someone to share his life. "It wasn't a problem to find people to have sex with safely," Westbrook noted. But, he knew some day he would want more than just sex.

A year later, Westbrook was set up on a blind date with a man named John. The date went well, and other dates between the two soon followed. When the relationship reached the point where it was about to get physical, Westbrook prepared to tell John about his HIV positive status, only to discover that he already knew. Some friends had already given the news to John before Westbrook had the chance.

In the beginning, Westbrook said he thought John would just be a "booty call," but three homes and several animal children later, the two are still together. John is HIV-negative, and they have been together for 17 years.

"Everything seemed to mesh more than with any other relationship," Westbrook said of their relationship. "John understood the HIV positive status and it didn't scare him."

Rick and John are known as pillars of the community because of the work the two of them do with AIDS and HIV. Westbrook currently works with Positive Impact's Mister Program. Only in his second month on the job, the Mister Program is a nonprofit community outreach program for gay and bisexual men.

Westbrook is well known around Atlanta as one of the East Point Possums and as Sister Rapture Divine Cox, one of the members of The Order of the Flaming Sugarbakers, an order of 21st century nuns dedicated to the manifestation of cosmic joy through freedom of expression, charitable acts, community outreach, and social activism.

Outreach Efforts Fall on Deaf Ears

Westbrook performs his community outreach duties on behalf of Positive Impact by visiting the local Atlanta bars and clubs and talking to the men about safe sex. He asks them to fill out short surveys to learn more about their habits and needs.

But since taking on the role, Westbrook said he has been pretty discouraged by the results of the surveys and some men's refusal to accept the condoms or safe sex advice he gives out.

"In my opinion, especially if you look up the stats on the CDC (Centers for Disease Control), I think you're going to see a huge resurgence of HIV," Westbrook noted.

Part of the problem, said Westbrook, is the misleading ad HIV drug advertisements in the local LGBT publications featuring handsome hunky models that are supposed to be HIV positive.

"Folks think HIV is like diabetes, and they are not concerned if they end up being positive," he said.

"The virus mutates. There are different strains," Westbrook added. "These young kids don't realize where we've come from. Yes, HIV/AIDS is manageable, but those ads don't show you sitting on the toilet after the meds have kicked in and you're either free flowing or it's (stool) hard as a brick."

Westbrook said he is out there every day trying to educate people, especially gay men, about the importance of safe sex. He admitted he could be a little brazen when he is trying to get his message across.

"I've been very fortunate to be honored as an AIDS activist, and if I tell you take a condom, you better take it," Westbrook advised.

He is on a mission to stop new HIV infections among young people. "We have just got to get them to think," said Westbrook.

Westbrook is not surprised by the recent CDC statistics regarding black gay and bisexual men, which indicate that there are more new infections (52%) among young black men who have sex with men 13-29 years old than any other racial or ethnic group of MSM in 2006.

"The black community is so hidden and chastised through the church, it makes me wonder if I'm reaching them," he said of his work. Westbrook said that those in the Hispanic community are equally unresponsive to his message, even though he has offered to get Spanish-speaking interpreters.

But organizations like Positive Impact, AID Atlanta, and Jerusalem House offer various support groups and assistance to help those come to terms with being HIV positive.

"We've got to keep talking before the virus mutates and we're back where we started and people are dropping like flies," Westbrook said.

Salina Cranor of the CDC news media team told EDGE that the CDC published the first multi-year estimates from its national HIV incidence surveillance in the online scientific journal PLoS One. According to the journal, this new analysis found that overall, the annual number of new HIV infections in the United States was relatively stable at approximately 50,000 new infections each year between 2006 and 2009.

But HIV infections increased among young men who have sex with men (MSM) between 2006 and 2009, driven by alarming increases among young, black MSM -- the only subpopulation to experience a sustained increase during the time period. Gay and bisexual men remain the population most heavily affected by HIV in the U.S. This is compounded by stats revealing that the estimated 35,962 new AIDS diagnoses in the 50 states in 2007, 46% were in the South.

Testing is Up, But Condom Use is Down

When Westbrook found out that he was positive, he turned to Nursing Mobile, a division of St. Joseph's Hospital, for support and care. "At that time, wherever you found out you were positive is who took care of you," he recalled. As is with the case with some agencies that rely on funding, Nursing Mobile lost funding and his case was transferred to an Emory University study.

Another group offering support in Atlanta is the Grady Health System Infectious Disease Program. Westbrook said they offer several support groups where people can go for meetings to talk about their feelings and to meet others.

While the statistics are alarming, Westbrook said it is not hard to meet other people. There are some who will only date others who are positive and others have no preference. But Westbrook said he knows many couples where only one partner is positive.

Another long-term HIV positive survivor Luke Versher, a field organizer with AIDS Action in Mississippi, agrees.

"I've been positive 23 years," Versher said. "I can only date positive people. I don't find it hard to find other positive people."

Versher is originally from Chicago, but he currently resides in Jackson, Mississippi. He has used online gay dating sites to meet other men. On many of the sites, Versher noted that many people will say they are negative when they are actually positive.

But, for Versher he said he chooses to date others who are positive, although he has dated some who were negative.

He found out he was positive while in Chicago in 1988 and moved to Mississippi in 2004. It was there, in Hattiesburg, that Versher said he found the best facility to help and offer him support. Versher said of the Hattiesburg Family Health Center's South East Mississippi Rural Health Initiative, "They have wonderful services." Versher said he still drives a little over an hour to go to the facility.

Versher feels that the Center should be a model for the state, "because they deal with the whole person, not just the HIV," he noted. The Center works with various other agencies and connects them to the ones who can give them various types of assistance from physical health, mental health, and drug treatments. "The agencies in Hattiesburg work together."

An advocate himself, Versher is hoping to make a difference in Mississippi. AIDS Action In Mississippi is a statewide grass roots organization dedicated to advocating for the rights of all people infected and affected by HIV/AIDS.

Versher has been working to get long-term housing in Mississippi for those with HIV/AIDS. He staged a demonstration in front of the capitol in March. Unfortunately, Versher said he got no response from the legislature. "They have ignored the issue for far too long," he said of the state's housing needs.

Ignoring the issues and the statistics surrounding teenage pregnancies and sexually transmitted diseases has not done any good he said. "We're number one in HIV/AIDS cases, number one in teenage birth and we lead the nation in the number of syphilis and gonorrhea cases," Versher noted.

In Mississippi, he also has seen a rise in the younger African-American gay population. "I believe a lot of this is that there is a stigma associated with HIV and that's the reason folks don't get tested or hide their illness," Versher added. Last year, Versher said there were five people in their 20's that were positive and not taking their medicines because they didn't want anyone to know that they were positive. "People are afraid of the status, they are afraid of losing jobs and/or family members."

Resources Provided for Mixed-Status Couples

Although a rural state, Versher said there are networks for HIV positive folks. In his work he has found many relationships where both are HIV positive and cases where only one is positive. According to Versher, in Mississippi there are 9,215 people who are positive.

"I had one couple, his partner found out he was positive. He said he wouldn't leave him if he had cancer or any other illness, so why leave because he had HIV," he recalled.

Similar to the state of Georgia, in Alabama the couples generally make up one HIV positive partner and the other negative. Tyloria Y. Crenshaw, Executive Director of South Alabama Cares, said the agency does provide support to couples.

"What we are finding with gay and straight partnerships is that one partner is positive and the other is negative. We council the partners on practices to protect the health of both partners," Crenshaw wrote in an online interview. "One of our support group topics is called, "Safer, Hotter, Sex and You," and it is a real hit with our communities. Other areas of support include the health department which specifically does partner notification and counseling and the local community health center."

South Alabama Cares, formerly known as Mobile AIDS Support Services, is a community AIDS Resource. According to the group's website, CARES helps people with HIV connect with the information and resources they need. They offer a wide area of services for people with HIV and their families.

Like Mississippi and Georgia, Crenshaw said Alabama too has seen a great increase in the number of people seeking support and information.

"We have also seen a great increase in the number of people seeking HIV testing, which in turn has led to several newly diagnosed cases, as well as an increase in the number of people getting back into care," Crenshaw noted. "We see many more women coming in now. Many more couples and more families, including children."

Unlike Mississippi and Georgia, Crenshaw said that most of their clients who are seeking assistance and support are straight. "In the past many of our clients were from the LGBT community. I think now that community "gets it." They are very aware of their status and take steps to protect themselves and their partners."

"Those who are living with HIV are medically compliant, they take their meds, they keep their appointments and they do what they are supposed to do. The newly identified people in the community are not," she added. "They are young MSM, either black or white. They are young, heterosexual females who have many partners. They don't have stable housing, decent education and no life skills to cope with disease or negotiate safe sex in relationships.

According to Crenshaw, this reflects a changing face of the epidemic. "Particularly in the south where 50 percent of all people living with AIDS currently reside, there is a lack of education and lack of access to resources due to ignorance, transportation, poverty, and many other factors. As the epidemic has changed, those of us who are service providers have had to change the way we cope as well."

"This agency was established in 1987 and as the face of the epidemic has changed, so has our client population. While we still have a well-established relationship and an open door with the gay community, the majority of those we serve now are African American, heterosexual, and female," she added.

"Most are at 200% below the federal poverty level; have no insurance and are not permanently housed; when they come to us for services they are not just HIV positive, but at the level the CDC defines as AIDS," said Crenshaw. "Of those, 95% report heterosexual contact as their primary exposure category and the other five percent report intravenous drug use."

According to the Alabama Department of Public Health, there are 17,674 people living with AIDS in the state. There are 2,828 cases of HIV in Mobile County, which is the largest county that Crenshaw's agency serves. Even though Jefferson County, Alabama is the largest County in the state and has the highest number of cases, Mobile County has the highest percentage of cases based on population, she said.

Like the other agencies, CARES provides support services for people living with HIV/AIDS. Their services include case management, transportation, food bank and meals on wheels, dental assistance, gas vouchers, emergency financial assistance including utilities and rent; HOPWA (Housing Opportunities for People with AIDS), HPRP (Housing Prevention and Rapid Placement); transitional housing, emergency shelter; medication assistance, information and referral.

They also provide free and confidential HIV testing every day and free STD testing on the last Saturday of each month, plus a list of other support groups to meet the needs of their clients.

One of the oldest and largest HIV/AIDS service organizations (ASO) in the Mid-South and one of the most comprehensive in the Southern United States is Friends for Life, located in Memphis.

Conrad Pegues, a prevention specialist with Friends for Life said they too have also seen an increase especially among the African-American males and females seeking assistance.

According to their website, the demand for the services continues to increase, with the agency now serving over 2,500 persons; 45% of these being women with 488 children.

Pegues said that among gay men, 80 percent of the population is HIV positive; he cited a recent article attributes this to lack of condom use.

He too has become disheartened by the views of the young gay men, especially African American male youth. "The young black gay men are not worrying about getting it (HIV), and they believe they can just take a pill and be OK," said Pegues.

Pegues blames their lackadaisical attitudes on the lack of positive viable images in the community. Pegues say all they see and look up to are the porn stars, media images, rap music, and the things they hear in church.

And while many people believe that the women who are affected with HIV is due to men on the down low, Pegues said he has found that is not always the case. Often these men have multiple female partners.

So far, Pegues said that many times, when both partners are HIV positive they are usually same sex couples, and when one partner is positive and the other negative, it's usually a heterosexual couple.

Surprisingly, Pegues said he is seeing people that want to become HIV positive so that they are able to receive the various services.

But all the agencies agree that more education is key to breaking the cycle of the rising spread of HIV.

"For the past two months, I've been on a mission to find the best way to reach out the community," Westbrook said. "If I can get people to stop for just a second before they put it in, then just maybe I've done my job."