HIV Plaguing Rural Carolinas

HIV is an increasingly disturbing problem in rural eastern Carolina counties, home to the states' poorest and least-educated residents. Many rural people with HIV face stark poverty, lack of health care coverage, waiting lists for life-saving HIV medications, and stigma.

In South Carolina, African-Americans, who comprise about 30 percent of the population, make up almost 80 percent of the more than 17,000 of reported HIV/AIDS cases. In North Carolina, which is 22 percent African-American, blacks make up slightly more than 70 percent of about 22,000 cases.

According to Linda Ashley, who directs a clinic serving York, Lancaster and Chester counties in South Carolina, in 1997 fewer than 20 percent of her clients were female. Now 49 percent, or 140, of her clients are female. In North Carolina, the proportion of black women with HIV jumped 50 percent between 1990 and 2000. Women now make up more than 27 percent of the state's HIV cases. "In most cases, she's heterosexual, she has a child, and she makes her decisions on how she can take care of her children," Ashley said. That means sometimes choosing between medicine and food.

The corridor between Columbia and Charleston has some of South Carolina's highest rates of HIV infection and is one of the poorest areas. "We average eight new cases a month. That's high for a rural area. For that eight, there's another eight out there. It's like a pyramid," said health care worker Cathy Johnson, who works in Orangeburg, Bamberg and Calhoun counties. Some theorize that HIV infections spread south along Interstate 95. By 1999, the Carolinas, Florida and Mississippi had the most HIV infections in communities with fewer than 50,000 people, according to a North Carolina report.

Many women with HIV return to the Carolinas to die. Trish Barlett, a social worker for Duke University's AIDS clinic, estimates that almost half of Duke's clients were infected elsewhere and came home once they got sick. Health care workers despair over the lack of help from the state and federal government. "I am beginning to see some churches talk about it," Ashley said. "But in the mainstream South? In small communities? I don't know. I wouldn't stake a lot of money on it."

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