Washington Blade - August 17, 2007
Elizabeth Perry

A report revised in 2006 by the Center for AIDS Prevention Studies and the AIDS Research Institute, University of San Francisco, found 60 percent of the rural AIDS cases throughout the U.S. involved gay sex, while transmission through intravenous drug use accounted for 20 percent. The report cited statistics from the Centers for Disease Control & Prevention, which said 68 percent of all rural AIDS cases in the nation were found in the South.

"In 2000, the rate of new AIDS diagnoses was three times higher for the South than for other rural areas in the U.S.," it said. "In certain areas of the South, the rate of HIV/AIDS diagnoses is almost as high in rural areas as it is in urban areas."

Ann Verdine-Lewis, director of education for the Tidewater AIDS Task Force in Norfolk, Va., and Brian O'Dell, Tidewater's program director, said they have seen an increase in HIV cases among black and Latino migrant workers on the "down-low" on the Eastern Shore and other rural areas of the state. These are straight-identified men in heterosexual relationships who also have sex with men.

The national report said blacks represent half of all rural AIDS cases, Caucasians, 37 percent, Latinos, 9 percent and Native American/Alaska Natives, 2 percent.

The report didn't include any figures for transgender persons infected with HIV in rural populations, but Verdine-Lewis said they too are an at-risk population.

She also said rural gays looking to connect with each other often have to drive more than an hour to get to the nearest gay bar, so they hold hotel parties and solicit sex on the Internet. Lewis said the task force has an online outreach to combat Internet solicitation and provide education and contacts for services.

"Volunteers log onto Internet sites frequented by at-risk populations," she said. "We go into live chats, identify ourselves as educators and ask if anyone wants to know more."

The report cited geographical isolation, lack of funding for HIV/AIDS prevention programs and the stigma that is still associated with sexual orientation and HIV as factors that can make it difficult for people in far-flung areas to access services. Lewis said the few support groups available to gays, lesbians, bisexuals and transgender individuals tend to lump them in together.

"The issues are different between the groups," she said. "What one faces as a lesbian is not what a gay man or a transgender person faces. I don't know how open a transgender [person] would be sharing their experiences with a non-transgender person. There is also the fear of being recognized at meetings and not being welcomed at church on Sunday morning."

Crystal Rivera is a caseworker for the Tidewater task force who arranges medical referrals for patients to see infectious disease specialists, dentists and mental health counselors. She also teaches life skills such as budgeting to people with HIV/AIDS. She does not have clients on the Eastern Shore, but knows it is a community where HIV and AIDS are not talked about openly.

Rivera said the pace of education has been slow and that she has met people who do not know that touching an infected person cannot spread HIV or that HIV status cannot be determined by someone's appearance.

"A lot of young males, 19 to 21, don't know how to use a condom and won't tell you they don't know," Rivera said. "Men need to educate other men by showing them. The face of AIDS has changed. There are people who are 45 and have been living with AIDS for 11 or 12 years. We don't see a lot of wasting away and dying now, but young people don't know about the side effects of the medications, either."

Other difficulties include limited public transportation, having to travel hours between neighboring towns for medical care and social services and having no medical insurance. The report said rural areas have fewer health care providers who specialize in HIV/AIDS, so patients with the disease are less likely than their urban-dwelling counterparts to get antiretroviral therapy.

"[The state government] sees a greater need in the cities," O'Dell said. "Even in the rural areas, the people who are infected will drive to Norfolk. Even if they have a doctor close by, they won't go to them because they are afraid someone will see them."

O'Dell said his agency sometimes goes to the Eastern Shore to offer its services, knowing there is no funding available for the trips. He said the $5 million in grant money the Task Force receives from the Ryan White Act is specific to metro areas, such as Norfolk, Hampton Roads, Richmond and Northern Virginia. He said these areas get more Title I funding under Ryan White because they have a higher rate of AIDS cases.

All other areas of the state get Title II funding, because they are less populated and have few cases. He said most of the funding in Tidewater's budget goes toward primary medical care, case management, medications, medical co-pays, mental health and emergency financial assistance.

One way the rural communities on the Eastern Shore are reaching out to at-risk populations is through area churches. Lewis said the task force recently partnered with a church in Virginia Beach for a youth event about HIV and other sexually transmitted diseases. She also gets calls asking for speakers at Bible studies and church events.

"The virus is spreading so rapidly, now the church folks are affected," she said. "In the past it was happening 'over there,' but now it's their city, their brother, their uncle. Their eyes have been opened and they can no longer ignore it."

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