Until his death in March, bluesman "Big" Jack Johnson of Clarksdale, Miss., crisscrossed the troubled terrain of the Mississippi Delta, singing of broken homes and broken hearts.
His songs touched on all the timeless blues themes of poverty, abuse, abandonment and longing. Johnson also took on a newer heartache HIV/AIDS that is sweeping through the Delta and much of the rest of the South. And he confronted it head-on.
"Hello, little schoolgirl," Johnson sang, "You better keep your dress tail down. I hear there's a lot of AIDS out here, and it's spreading all around."
When the song was released in 1991, many people still regarded HIV/AIDS as chiefly a problem of gay enclaves in big cities. A new county-level map of HIV infection data, by researchers at Emory University's Rollins School of Public Health in Atlanta, along with an analysis of the data by USA TODAY, shows how deeply in three decades HIV also has become entrenched in America's heartland, especially the South.
HIV is tightly entwined with poverty. Southern counties that have the greatest rates of HIV infection are among the poorest in the nation, USA TODAY's analysis shows. Elsewhere in the USA, counties with the highest rates of HIV-infected people had, on average, one in seven people living in poverty, earning roughly $22,350 for a family of four. In the South's most HIV-stricken counties, about one of every five people live below the federal poverty line.
Jonathan Mermin, director of HIV/AIDS prevention at the federal Centers for Disease Control and Prevention, says the agency's research supports the link between HIV and poverty. "People with household incomes of less than $10,000 a year were 10 times more likely to have HIV than people whose household incomes are greater than $50,000."
What's more, the South's HIV-infection rates were statistically higher than the rest of the nation's, and the epidemic disproportionately affects minorities, especially blacks. In Mississippi, blacks account for 37% of the population but 76% of new cases of HIV.
"If we don't get a handle on where the epidemic is growing fastest, we're going to have an explosion," says Patrick Packer, executive director of the Southern AIDS Coalition and CEO of AIDS Alabama in Birmingham.
Tiny Rolling Fork, Miss., a rural farming community (population 2,011) has an HIV infection rate of at least 249 cases for every 100,000 people, putting it in the same category as San Francisco and New York.
Fourteen miles from the Mississippi River, Rolling Fork is typical of many Southern communities on AIDS, the data show. About 35% of county residents live below the federal poverty line. The majority of the population is African-American. Unemployment hovers at about 10%.
"Automation has done away with farm jobs," Mayor James Denson says.
Denson expressed surprise that the HIV rate has soared in his community. "I was unaware that it was so high," he says. "It's invisible."
Michael Baker, one of three doctors in the community, sees things differently.
"Those numbers don't surprise me," he says. "There are still some out there who refuse to be tested. That may just be the tip of the iceberg, unfortunately."
Baker says the community's high level of poverty goes hand-in-hand with a lack of education.
"Sharkey and Issaquena (Rolling Fork's two neighboring counties) are probably the two poorest counties in the poorest state in the union," he says. "Education is not a high priority for these people. A lot of them don't graduate high school. If they do, that's all they do. They have to work."
AIDS activist Cedric Sturdevant, 46, of Jackson, Miss., who was diagnosed with HIV in 2006, says misinformation about HIV helps fuel Mississippi's epidemic.
"Most people still think it's a gay man's disease," Sturdevant says.
He says other factors play a role. "Mississippi, being a Bible Belt state, is homophobic," he says. "You don't want people to know you're homosexual, if that's the case. If you're heterosexual and you get infected, you don't want people to put you in the category of being homosexual."
The shame attached to HIV also contributes to its spread by discouraging people especially young black gay men, who are at especially high risk of infection from getting tested or seeking treatment, he says. "People don't want to get into care because they're afraid their families will find out" and reject them.
HIV's links with poverty, 1A
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