AIDS fight progress threatened by millennials, South

A rising number of new HIV infections in southern states and among millennials threatens to reverse years of progress in combating AIDS, the incurable disease caused by HIV, health officials said in advance of World AIDS Day on Saturday.

The rural and suburban communities of the South have become the epicenter of the pandemic, a radical shift from cities such as New York and Los Angeles, which defined the fight against HIV/AIDS in the 1980s and 1990s.

According to federal data, about 44 percent of the 1.2 million people living with HIV in the U.S. are concentrated in the 16 states that make up the South, an area already overburdened by the leading causes of illness — heart disease, obesity and diabetes — compared with the rest of the U.S. Of the 40,000 HIV diagnoses last year, 52 percent were in the South.

“Lack of insurance, lack of Medicaid expansion, access [to health care]” all contribute to high rates of HIV infection, said Mardrequs Harris of the Southern AIDS Coalition, a public health advocacy nonprofit. The opioid epidemic and a rise in the number of injection drug users also have increased rates of infection.

Georgia, Florida and Louisiana lead the U.S. with the highest rates of new diagnoses, and of the 10 cities with the highest rates of people living with HIV, three are in Florida, two are in Louisiana and one is in Georgia.

Those states are also among the five with the highest rates of uninsured residents. Georgia and Florida, which opted out of expanding Medicaid coverage for poor residents under the Affordable Care Act, have about a 12 percent uninsured rate, according to the latest data from the Kaiser Family Foundation. Louisiana, which expanded Medicaid in 2016, has an 11 percent uninsured rate.

“Poverty is an issue, lack of education and lack of people who have the ability to educate” worsen the problem, Mr. Harris said.

Based in Birmingham, Alabama, Mr. Harris has lived all his life in the South, including in Memphis, Tennessee; Atlanta; and the District of Columbia. He describes even big Southern cities as small communities where discrimination, racism and fear loom large against infected people.

“Southerners have to fight through a lot of layers just to even be OK with being themselves sometimes,” he said.

Jesse Milan Jr., CEO of AIDS United, a nonprofit policy and advocacy group, said a lack of knowledge about HIV, misunderstanding and prejudice press upon every aspect of life in the South.

“So much of it has to do with the ongoing foundation of stigma and discrimination around HIV,” he said. “Stories that we hear are heartbreaking, that they’re still occurring in 2018, from landlords to people being afraid to disclose their status even in their own faith community.”

Mr. Milan, who has been living with HIV for 30 years, said that while there is more access to medications such as anti-retroviral therapies and pre-exposure prophylaxis (PreP), there is still a lack of understanding or even knowledge of these therapies among the people in policy.

“We still have to educate our legislators. We still have to educate our governors, our mayors and, of course, even our president about what are the needs that can change this trajectory in this epidemic,” he said.

The human immunodeficiency virus, or HIV, weakens the immune system, making the infected person vulnerable to a host of diseases, especially AIDS, which grew into an epidemic among gay men in the U.S. in the 1980s. The virus can transferred from person to person via bodily fluids during unprotected sexual intercourse, the sharing of intravenous needles and blood transfusions.

Gay and bisexual men are still the group most at risk for contracting HIV, but new diagnoses among gay Hispanic men have increased by 14 percent from 2011 to 2015 and by 4 percent among gay black men.

’Inherited the trauma’

Young people also are among the most affected: In 2016, almost 25,000 HIV cases were diagnosed among 20- to 39-year-olds.

D.C. native Gregory Meredith was 17 when he received a positive diagnosis for HIV in 2015. It was the fall of his senior year of high school, and he didn’t know what life he could have moving forward.

“It was a lot. It was depressing, kind of stressful,” he said.

“Living as an HIV-positive man, it has its ups and downs. … Some days I can wake up and just take my medicine and not even think about it,” he said. On more difficult days, he said, “I get a little bit, not discouraged, just a flashback of how I accumulated it and everything.”

After graduating from high school, Mr. Meredith started working for the D.C. Department of Health in the division for HIV and sexually transmitted diseases. Through this, he was connected with a new movement called ECHO (Engaging Communities around HIV Organizing), made up of young people living with HIV and advocating for more awareness and open conversations about HIV/AIDS.

“Once I got into the work, my diagnosis did — it pushed me more to advocate,” he said. “I felt like I could help some other young person that maybe, living with HIV, that was like me — finding out in high school, not knowing what life was going to be like.”

New diagnosis rates in the District of Columbia have declined 73 percent over the past 10 years, thanks to an effort of increased testing, scaled up needle-exchange programs and wider access to medical care and medication services for those living with HIV. Yet progress has stalled between 2016 and 2017.

ECHO founder Louis Ortiz-Fonseca, director of LGBTQ health and rights at the nonprofit Advocates for Youth, said he was inspired to start the program after conversations with young people revealed they harbored a lot of misunderstandings and stigma about HIV.

“Some young people I’ve talked to, it’s like they inherited the trauma and stigma that adults in their life carry,” he said. “Some of them have the same fears and stereotypes around HIV that people had in 1985.”

ECHO and Advocates for Youth are launching social media campaigns and a series on YouTube to facilitate more frank conversations about HIV, sex and relationships among LGBTQ youths. The goal is to access areas that are harder to reach in Southern states and communities where young people are struggling with identity and getting accurate information.

The YouTube series, called “Kiki’s With Louie” (Kiki’s is LGBTQ slang for “gossip”) was screened this month in the District. Mr. Ortiz-Fonseca, as the host, said he was overwhelmed by the response from the crowd.

“I certainly didn’t anticipate some of the feedback that folks provided, that this is something they would show students in their classrooms, their parents and other family members to create opportunities around conversations, around topics that are taboo,” he said.

* (Correction: An earlier version of this article cited HIV diagnosis data by metropolitan area for girls and adolescents. The new numbers reflect total diagnosis rates of HIV.)