Addressing HIV in the southern United States is a public health and human rights obligation for state and federal governments, argues Megan McLemore, J.D., LL.M., senior researcher at the Human Rights Watch, in a presentation at the 20th International AIDS Conference (AIDS 2014) in Melbourne, Australia.
The U.S. South consists of the 17 federally defined southern states and the District of Columbia, and is home to 37% of the U.S. population. While African Americans make up about 13% of the U.S. population, 57% of all African Americans live in the South.
According to McLemore, the HIV risk factors in the South (which severely impact minorities) include:
- Highest rates of poverty.
- The most prisoners.
- The most uninsured patients.
- The weakest safety net programs.
- Failure to invest in HIV programs.
- Abstinence-based education.
- Hostility toward LGBT individuals.
- Criminalization of HIV exposure.
- Few needle exchange programs.
Because of these factors, which create what McLemore calls "an environment of risk," the South has the highest HIV infection rates, particularly among individuals aged 13-29; 44.6% of the country's AIDS cases; the highest number of AIDS deaths; and the top 10 cities with the highest AIDS diagnosis rates.
The statistics become even more alarming when looking into the rates among minorities. African Americans account for 46% of people living with HIV in the U.S. and a staggering 55%-60% of people living with HIV in the South.
Moreover, rates of new HIV infections among black MSM (men who have sex with men) are four times greater than that of white MSM. Rates of new HIV infections among black women are 14 times greater than white women. Meanwhile, half of new HIV infections among Latinos in the U.S. are in the South.
Therefore, McLemore argues that, based on international law regarding human rights and public health, the U.S. is obligated to provide the following protections for U.S. Southerners:
- The right to health.
- The right to disease prevention and information.
- The right to treatment and services.
- The right to be free from racial discrimination.
- The right to equal access to public health services.
By framing the debate in human rights terms, and pressing for changes in policy and law enforcement, Human Rights Watch has been able to bring about changes on issues such as segregation of HIV-positive prisoners in Alabama and South Carolina, the use of condoms as evidence against sex workers in New Orleans, and access to clean syringes for drug users in North Carolina. However, there are still many disparities among people living with HIV in the South, and more work needs to be done to tackle these issues. Improved access to health care and housing remain particularly difficult to address.