For much of mainstream America, the HIV/AIDS epidemic is sometimes seen from a distance, a story for the history books or the developing world. But for marginalized communities across the country, particularly in the U.S. South, the HIV/AIDS crisis continues unabated.
The South is at the heart of the current HIV/AIDS epidemic in the United States, with more people living with HIV and dying of AIDS than in any region in the country. Nine out of the ten U.S. states with the highest AIDS-fatality rates are in the South, and the death rate from AIDS in the region is nearly twice the national average.
According to the Centers for Disease Control, Louisiana ranks third in the nation for estimated HIV case rates. Louisiana’s two largest cities, Baton Rouge and New Orleans, have the second and third-highest rates of new HIV infections for metropolitan areas in the nation. In New Orleans, 40 percent of people with HIV are not receiving treatment.
Despite these startling statistics, for years the epidemic has gone seemingly unnoticed. At both the federal and state levels, this Southern health crisis has been neglected, invisibilized, and often exacerbated by laws and policies that isolate, stigmatize, and criminalize many of the groups most in need of assistance.
Moreover, at every level of the epidemic, racial and ethnic minorities bear the overwhelming burden of the disease. The toll of the epidemic on African-American communities in Louisiana has been devastating. African Americans comprise approximately 32 percent of Louisiana’s general population, but they represent some 75 percent of the new cases of HIV infection. For women of color in the South, particularly Black women, HIV infection rates are skyrocketing and reaching levels similar to those of sub-Saharan Africa. Among women in Louisiana, 81 percent of newly diagnosed HIV infections were among African Americans.
In New Orleans, those of us working on the ground with the city’s most marginalized populations bear witness to the devastating impact of state laws and policies that keep our communities barred from the resources they need to survive. We’re seeing how the long-standing socio-economic conditions that plague Louisiana — poverty, sexism, racism, classism, homophobia, and a lack of access to health care — combine with conservative state laws and policies to fuel the HIV/AIDS epidemic. This deadly combination means that people living with the disease in the South are at a far greater risk of dying from AIDS than those living in other regions.
Louisiana itself fails at almost every level of HIV preventative care, ignoring proven strategies that would help to address the uncontrolled epidemic and the extremely high death rate. This is exemplified through several state and city policies:
–  the lack of HIV/AIDS education and comprehensive sex education for youth, and the continued promotion of abstinence-only based sex education,
–  the criminalization of HIV exposure,
–  the creation and hyper-enforcement of drug war laws and policies that drive Louisiana’s world record-breaking high incarceration rates,
–  the criminalization and over-policing of sex work, and
–  the criminalization of proven harm reduction programs such as sterile needle exchanges for injection drug users.
On the ground, we see how shame, stigma, and the laws themselves combine to keep our state’s most marginalized populations at risk. The LGBTQIA community, especially transgender women of color, face barriers in accessing HIV prevention and treatment care, and suffer high rates of sexual violence, discrimination, police harassment, and stigmatization. The mass criminalization of sex workers, transgender women, and injection drug users means that these vulnerable populations are funneled into our prison systems, many of which are notorious for failing to protect state inmates against sexual assaults and other forms of harm.
Not only do our local criminal justice policies continue to work against HIV prevention strategies, decisions made at the state level are keeping us from care: Louisiana Governor Bobby Jindal’s decision not expand the federal Medicaid program in Louisiana means that it’s even harder for low-income women of color and transgender women to get the HIV care they need.
If we’re going to address this health crisis and save lives, Louisiana must abandon harmful laws and policies that undermine human rights and endanger public health. Louisiana needs to embrace proven, evidence-based approaches to public health, such as legalizing and funding clean needle exchange programs (which have saved millions of lives across the world), implementing policies protecting sex workers and sexual minorities, carrying out state-wide drug policy reforms to reduce the state’s booming prison population, and addressing the social determinants that make poor women, African-American women, and transgender women vulnerable to high infection rates (this means providing living wage jobs, affordable housing, gender-sensitive care, job training, and funding programs that address gender-based violence and provide mental health services.)
The time for change is now.
Desiree Evans is the Policy and Communications Director at Women With a Vision. This was originally posted at the blog of Louisiana Progress, a nonpartisan organization dedicated to promoting public policy that moves Louisiana ahead without leaving some of its people behind.