A link between violent childhoods, poverty, secrecy and risky behavior could be contributing to the spread of HIV in the largely rural South, according to Kate Whetten. An assistant professor in the Terry Sanford Institute of Public Policy and the Center for Health Policy, Law & Management at Duke University, Whetten is the author of "You're the First One I've Told: New Faces of HIV in the South."

In the South, Whetten said, "We have more females infected, and we look like less-wealthy countries in Africa." HIV is much more prevalent among very poor and African-American Southerners, she said. While HIV-positive people in both urban and rural areas are subject to stigma, Whetten said, many rural residents do not have access to the kind of support that city-dwellers use to cope.

"We did a random draw of 25 people and interviewed them for eight hours over three months. We asked them about their childhood, their families, their dreams, and then we got into HIV and their relationships," Whetten said. "One of the most striking things we found were the high levels of chaos and trauma in the lives of these people when they were growing up. It was pretty extreme violence, rape of both men and women, lots of violence between parents and lots of fathers abusing their sons. Kids who are sexually abused are more likely to engage in high-risk sexual behavior, a predictor of HIV."

One impediment to prevention in the South, Whetten said, is that "all prevention messages for the most part are developed in urban areas. When the messages are seen by people here, they don't see themselves like the people in the posters and on the commercials. We have to spend the money in the South to develop culturally appropriate prevention messages. ... In 20 years, we could either have a chronic disease that's fairly contained that's not spreading as quickly, or we could have a lot of people dying in rural areas."

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