U.S. South Faces HIV/AIDS Crisis

Stigma plays a central role in the South's disproportionate HIV/AIDS burden, according to CDC. Though it comprises just slightly more than one-third of the U.S. population, the South has one-half of all new HIV cases and the highest AIDS death rate.

HIV testing lags in the South, said Carolyn McAllaster, director of the Southern HIV/AIDS Strategy Initiative.

"We see sad cases here all the time of people who present with blindness or meningitis or pneumonia, and that's the way they get diagnosed with HIV/AIDS. In an ideal world, they should have been diagnosed years before that," concurred J. Michael Kilby, professor of medicine and chief of infectious diseases at the Medical University of South Carolina.

Further, a significant number of people who are diagnosed with HIV do not receive treatment. Southern patients often live far from specialized HIV practices and lack transportation to get there. One in four South Carolinians with HIV live in rural areas, as do four in 10 HIV-positive Mississippians -- by far the highest percentage in the United States.

"HIV is clearly a disease of poverty. And there is a lot of poverty in the South," said Michael Saag, director of the Center for AIDS Research at the University of Alabama-Birmingham.

Religion, homophobia, and a hesitance to talk about sex or sexuality in the South also are factors, particularly among African Americans. A 2011 study by the Florida Department of Health estimated that one in five gay black men in that state were HIV-infected. According to researchers, Southern blacks are especially likely to see homosexuality as immoral.

"In the African-American community, men who are gay are more likely to hide their sexual activity," said Saag. "So it's more common for the virus to spread from gay men to heterosexual women."

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