The Mississippi Department of Health, which until now has offered free HIV and sexually transmitted infection (STI) testing, will begin charging a $25 fee for most of these tests. The move comes in the poorest state, amidst big budget cuts and one of the worst HIV/ STI epidemics in the country.
The HIV epidemic in Mississippi is concentrated in certain areas and populations; those hardest hit are African-American men who have sex with men.
In Jackson, the state capital, which has about 170,000 residents, more than 3,600 people are living with HIV and most of them are black men. In fact, 40% of gay and bisexual men in the city are living with HIV, which is the highest rate in the country. On top of that, the southeastern United States has the highest rates of people living with HIV who don't yet know they're infected.
Before Treatment Comes Testing
Of course, before treatment, you need testing, and the state of Mississippi has just made it harder for many of its residents to get that. Mississippi has the highest poverty rates in the country with 22% of its residents living below the poverty level in 2015. The new $25 price tag will put STI and HIV testing out of reach for many of them. And, we have to remember that the Centers for Disease Control and Prevention tells sexually active gay and bisexual men that they should consider getting tested every three to six months. Deja Abdul-Haqq, director of organizational development for My Brother's Keeper, told the Clarion Ledger: "Twenty-five dollars is not easy for everybody to come by. We have families that have to choose between taking their meds and buying food. This is another hurdle for people when it comes to knowing about their health. It's ridiculous."
Abdul-Haqq's agency provides social services in Jackson and was recently featured in a New York Times article about the HIV epidemic in the South. The author of that article, Linda Villarosa, writes: "... 35 years of neglect, compounded by poverty and inadequate local health care infrastructure, have left too many black gay and bisexual men falling through a series of safety nets." That is just what is happening in Mississippi.
Even those working in HIV-prevention in Mississippi acknowledge that the health department is in an impossible position given the funding cuts it is facing. Kenyon Farrow, U.S. and global health policy director for the Treatment Action Group told the Clarion-Ledger, "I understand the constraints that the Health Department is under, but there is no way, at this point, to talk about the epidemic in Mississippi as anything but a real crisis that continues to linger in the background." Farrow points out, moreover, that this could have been avoided if the governor of Mississippi had chosen to participate in the Medicaid expansion program offered under the Affordable Care Act, which would have provided "hundreds of millions of dollars to state health services."
Some organizations in the state will still provide free testing -- such as the Southern AIDS Coalition in Hattiesburg -- but many residents of the state will find them too far away to be practical.
Syphilis Also on the Rise
Mississippi is also battling a growing epidemic of other STIs, including syphilis. There were 290 diagnosed cases of syphilis in 2013, but that number almost tripled to 821 cases in 2016. While syphilis is treatable if diagnosed, people who have the infection are at increased risk of contracting HIV.
Widespread testing and treatment is the key to stopping the spread of these diseases. Once detected, STIs such as syphilis and gonorrhea can be cured with antibiotics while other STIs can be managed. For those infected with HIV, treatment means a drug regimen that can suppress the virus to the point where it is undetectable in their blood. This likely means a longer and healthier life for the individual -- and it makes it much less likely they will transmit the virus to someone else. Treatment is prevention.