From the outside, Bluefield, West Virginia, doesn't look much different from any other run-of-the-mill Appalachian town in a region that has seen better days, but is still clawing and scratching to survive. But of all of the towns in West Virginia, Bluefield has the highest percentage of black residents, with nearly one in four of African-American descent. One in four might not sound like a lot, but in a state where only 3.4% of the population is black, Bluefield is about as black as it gets. This southern region of West Virginia in which Bluefield is located is the state's most impoverished -- and the one with the greatest gaps between residents' health care needs and the services available to them. And in few areas is this health care gap more pronounced than in the prevention, detection and treatment of HIV.
Within two minutes of meeting Darryl Cannady, I knew I liked him, and I also knew that there were probably a lot of people in this world who did not. Catch him in a rare moment when he's not talking and carrying on, and there really isn't anything about the man that will strike you as remarkable. A middle-aged black man with a thin mustache, salt and pepper hair that's heavy on the salt and, more often than not, a t-shirt tucked into a pair of dad jeans, Cannady's unassuming looks belie a flamboyance and tenacity that become evident the moment he opens his mouth.
With a voice that sounds like Harvey Fierstein gargling gravel, a razor sharp wit and little-to-no filter, Cannady has no qualms about launching into diatribes against opponents large and small, a character trait that comes out when he discusses how the state of West Virginia stopped funding the HIV service provider and advocacy group he founded, South Central Educational Development, Inc. (SCED) in 2010.
But somehow, some way, despite the loss of this funding, Cannady has managed to keep his organization running. As the only HIV service provider in West Virginia south of Charleston, he and the communities he serves have no other option.
"We need dedicated housing down here," Cannady told me while stirring a big pot of curried chicken in the basement of the old church that serves as SCED's headquarters. "We need a dedicated AIDS clinic down here. Right now there's only one infectious disease doc in all of southern West Virginia, and he's leaving in January with nobody to take his place."
At first I thought that I must have misheard him. But Patti Crawford, the director of rural outreach at the West Virginia School of Osteopathic Medicine, assured me that I hadn't: Southern West Virginia wouldn't have an infectious disease doctor at the start of 2016.
"Normally, when a physician leaves an area, there's a mechanism for referral, so they can say, 'well, I'm leaving, but I can offer these suggestions.'" Patti said. "The only suggestion they have now is to go up to the Ryan White Clinic in Charleston, which is 100 miles away. And, there are some people who go all the way up there for care, but there are plenty who won't. There have been discussions about them opening up a clinic down here, but when they talk about opening up a clinic they're talking about once a month. That's just not going to cut it."
Like many sections of rural America, southern West Virginia's biggest obstacle between its HIV-positive residents and the care they needed is lack of accessibility. The vast majority of West Virginia is rural, but the southern part of the state is unique in the degree to which it is isolated from medical facilities that employ infectious disease doctors.
"If you're in Morgantown, you're fine," said Steve Webb, the treasurer of SCED, as he tried to explain the topography of health care in West Virginia. "[West Virginia University] is there, it's the cherry on top of the pie. If you're in Huntington, you're okay because you're on the border of Kentucky and Ohio and because Marshall's there. If you're in the Eastern Panhandle, you're a couple hours from DC. If you're in the Northern Panhandle, you're an hour or two away from Pittsburgh. But here, you're not close to anything. And, even if you were close, we don't have the transportation capabilities or infrastructure."
For now, it doesn't appear as if help and resources for HIV prevention and treatment are coming to southern West Virginia, and the epidemiological reports that are being released are all but useless since there haven't been any surveillance or outreach efforts in the area for the better part of a decade. When I asked Christine Teague, who serves as the director of the Charleston Area Medical Center's Ryan White HIV Program, why it is that the most southern and black region of West Virginia is being more or less ignored by the state government, her reply was startlingly blunt and bleak.
"The numbers are just not high enough," she told me over coffee at a small cafe by the state capitol. "I think [HIV] will continue to spread throughout that population, and it's just not going to be addressed. The problem we have is that, despite the disproportional impact, we have such a small black population that they get lost in the shuffle."
What does that disproportional impact look like? For black men in West Virginia it means a rate of HIV/AIDS that is over seven times greater than the rate for white men. For black women in West Virginia the rate is over 31 times greater than for white women.
Significantly, in 2012, West Virginia's all-cause death rate per 1,000 black people living with HIV, a good indicator of the quality of and access to care in a region, was 28.9 -- the highest of any state.
Here's what that means: A greater percentage of blacks in West Virginia who have been diagnosed with HIV are dying than anywhere else in the U.S. and people don't seem to care. How many more black West Virginians have to die preventable deaths before people do?
Drew Gibson is a social worker and freelance writer based out of Cincinnati, Ohio. He does his best to split his time and efforts between his work as a case manager for people living with HIV/AIDS in Northern Kentucky and the maintenance of his blog, "Virally Suppressed," which covers a multitude of issues related to inequity and social justice. You can follow him on Twitter at @SuppressThis.
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