Why the South Is the Epicenter of the AIDS Crisis in America

The epicenter of the AIDS epidemic in America is Atlanta and the southeast, and among the hardest hit populations are gay and bisexual black men. According to the CDC, half of them will be diagnosed with HIV in their lifetimes if current trends continue. Pulitzer Center grantees William Brangham, Jon Cohen, and Jason Kane report on this topic in the second installment of their PBS NewsHour series "The End of AIDS?"


Gwen Ifill: Tonight, we continue our series "The End of AIDS." Yesterday, we looked at San Francisco and at one of the nation’s most ambitious plans to curtail AIDS. Tonight, we turn to a city where the struggle is much more difficult. Atlanta, Georgia, and much of the Southeast is, by some measures, the epicenter of America’s AIDS crisis. And, as correspondent William Brangham and producer Jason Kane report, the barriers to stemming the epidemic there are enormous. This report was supported by the Pulitzer Center on Crisis Reporting.

William Brangham: The alarm bells rarely stop in the inpatient and isolation wards at Grady Memorial Hospital. Here in Atlanta, just down the street from the CDC, in 2016, in the age of lifesaving antiretroviral drugs, hundreds of people are still dying every year from AIDS.

Dr. Carlos del Rio, Emory Center for AIDS Research: The epidemic of HIV in America is forgotten, but not gone. People have forgotten it exists. I think I have a better chance of winning the lottery than I have of ending AIDS in where we are today, right?

William Brangham: The Southeastern U.S. is the epicenter of America’s epidemic. These states make up 44 percent of people living with HIV, and they make up half of all new HIV diagnoses.

Dr. Carlos del Rio: It’s almost like the South is a different country. It really is about poverty, the social determinants of health, racism. It’s really a bunch of different things.

William Brangham: Carlos Del Rio is one of Atlanta’s leading HIV doctors. He co-directs the Emory Center for AIDS Research, and sees patients at Grady.Often, he says, patients have no idea of their HIV status until it’s nearly too late.

Dr. Carlos del Rio: Half those people we diagnose here already have AIDS. In other words, they have been infected for five, six, 10 years.

William Brangham: Russell Martin was one of them. Black gay men are one of the hardest-hit populations here in the Southeast. Martin thought he was perfectly healthy, until one day he came down with a fever.

Russell Martin: I’m just thinking it was a cold. I have asthma, so I’m prone to having pneumonia, so I’m like, OK, maybe it’s just pneumonia.

William Brangham: By the time he checked into Grady, he was so sick that doctors induced a near-coma in a desperate attempt to save him. He woke up to learn that he had HIV, it had progressed to AIDS, and that he had nearly died. It’s not that Martin didn’t know about HIV or wasn’t being careful. In fact, he once worked at an HIV clinic and got tested regularly.

Russell Martin: I got routine checks until I got into a relationship. And it was once I was in a relationship, I didn’t do it.

William Brangham: Because you thought, “I’m in a monogamous relationship, I don’t need to be tested.”

Russell Martin: That’s true. That’s what I was thinking.

William Brangham: While Martin is currently on treatment and doing well, he’s become further evidence for an alarming projection. According to a recent analysis that was done by the CDC here in Atlanta, if current trends persist, half of gay and bisexual black men will be diagnosed with HIV in their lifetimes, half. Fulton County Commissioner Joan Garner has been helping lead the push to change the course of the epidemic here in Atlanta. She started after hearing that few cities in the country have higher rates of HIV.

Joan Garner: Fulton County Commissioner: The information has been out there. Research is out there. Treatments — treatment is out there. And I was just floored when I heard that, and I said, we have got to do something about this.

John Eaves: Fulton County Chairman: We certainly have some new leadership.

William Brangham: Two years ago, Garner and council Chair John Eaves assembled the Fulton County Task Force on HIV/AIDS. Fulton County makes up the bulk of the city of Atlanta.

Woman: This really shouldn’t be a conversation anymore. This is low-hanging fruit. We swing the gate literally from one end to the other.

William Brangham: Like San Francisco, which we reported on earlier, they are one of the first local governments in the U.S. to formalize a plan for ending AIDS. The exact budget and timeline of their work is yet to be determined.

Dr. Melanie Thompson, Fulton County Task Force on HIV/AIDS: There are a lot of people who are working on this, not necessarily working together.

William Brangham: Dr. Melanie Thompson is helping lead the task force. She says it’s unbelievable to her that it’s taken this long to get started.

Dr. Melanie Thompson: It’s horrifying. I mean, frankly, we have had a smoldering epidemic here for a long time. But when you get a little bit of political will, it goes a long way, and that is something that we have never had here.

William Brangham: But the challenges are daunting, something the task force has been hearing about as they have traveled across the county, meeting with various groups, from gay, bisexual and transgender organizations to those who inject drugs. It’s estimated there are 3,000 HIV-positive people in the county who don’t know they’re infected, meaning they could unknowingly be spreading the virus to others.

Dr. Melanie Thompson: At a time when San Francisco is talking about getting to zero, and New York is talking about ending the epidemic, we still see increasing numbers of new HIV diagnoses in some of our population.

William Brangham: For those who do know their status, and want to start treatment, just getting there can be arduous. Claude Bowen’s difficult commute to the doctor isn’t uncommon in this sprawling city. He has no car and has to travel two hours to his appointments.

Claude Bowen: I take one bus to the train to another bus. If I come down here, I take a bus, the train, another train, then a bus.

William Brangham: And that’s just one way?

Claude Bowen: That’s one way.

William Brangham: If a bus or train is late, he will miss the next leg, and often his appointment will be canceled entirely. For these reasons and many others, an estimated 40 percent to 50 percent of people in Fulton County drop out of HIV care once they have started. For others, even basic information about treatment can be a struggle.

Derrick Langford: I’m going for like this Bohemian-type thing.

William Brangham: When 22-year-old Derrick Langford was diagnosed with HIV, he had no trouble opening up to friends and family. But he couldn’t figure out what to do next or where to go for medication or follow-up care.

Derrick Langford: So, it was pretty much me searching, looking, using Google a lot to find out where I needed to go. And the stress kind of made me very, very sick.

William Brangham: It’s often these kinds of barriers, not riskier behaviors, that drive these high rates of infection. In fact, gay black men don’t engage in higher-risk behaviors compared to, say, white gay men. Repeated studies have proven that. They often have fewer partners and use condoms more, says Wendy Armstrong. She’s medical director of the Ponce De Leon Center, Grady Hospital’s massive outpatient clinic for Atlanta’s HIV-positive community.

Dr. Wendy Armstrong, Ponce De Leon Center: There’s so much easy blame: Those people shouldn’t be doing those things. And that is not the situation at all. It is that it is such a prevalent disease in our population for a group of patients who don’t have easy access to care.

Daniel Driffin, Fulton County Task Force on HIV/AIDS: People living with HIV should be at all levels of engagement.

William Brangham: Daniel Driffin is a member of the task force. He’s HIV-positive himself, and he says the Achilles’ heel of the fight against HIV in the South is stigma. He says even he feels it.

Daniel Driffin: I thought I did something wrong, being that I’m now HIV-positive, on top of being black, on top of being gay, and in the South.

Man: So this is the South, the Bible Belt, and so when it comes to HIV, it’s like we’re doing something that’s immoral to what we have been taught as children.

William Brangham: While stigma about being gay has always been a problem in much of the U.S., Driffin says it’s particularly an issue in the black community. And he says it’s complicit in the rising rates of HIV infection.

Daniel Driffin: We see what happens when people do tell that they’re gay. We see what happens when people do say that they’re HIV-positive. They’re homeless the next morning, or the same day. You know, they’re being assaulted.

Man: A local man could be facing federal hate crimes charges.

William Brangham: He points to a recent case where a man walked into his girlfriend’s house, discovered her son in bed with another man, and threw boiling water onto them.

Daniel Driffin: He boiled a pot of water on the stove, took the pot of water and poured it all over them. And, literally, they were in the hospital for four months.

William Brangham: Melanie Thompson says, while all these impediments are finally being acknowledged and talked about openly, the region still has major hurdles to overcome them. One example, among many, funding. Georgia was one of the states that didn’t expand Medicaid under the Affordable Care Act, so it’s got much less money to care for its poor HIV-positive patients.

Dr. Melanie Thompson: Many of my friends ask me, you know, why are you working in Atlanta? Why don’t you go work in Africa, or Asia, or whatever? Everybody works internationally. And I feel like we have a Third World epidemic, in some ways, here, that’s difficult to address.

William Brangham: Three years after nearly dying of AIDS, Russell Martin is a testament to the power of successful HIV treatment, and to what many hope Atlanta will do more of. He’s now studying law and looking towards graduation. The virus is fully suppressed in his blood. He’s trying daily to get healthier still. For the PBS NewsHour, I’m William Brangham in Atlanta, Georgia.

Gwen Ifill: Tomorrow night, our reporting continues with a look at New York, the state with more HIV-positive people than any other in the U.S. You can follow our series online as well. Here’s what you will find there:

William Brangham: On the NewsHour's Web site, you will find more reporting from our series on HIV/AIDS. There, you can see stories from people we met around the world. You can read more about the effort to find a cure and see all the video reports broadcast on air, The End of AIDS, at