HIV Is Coming to An Unprepared Rural America

Williamson, West Virginia.

Rural America has many problems facing it ranging from economic decline to scarce access to medical facilities to a mindset that in some that embraces ignorance and bigotry.  Now, as a column in the New York Times makes clear, some parts of rural America, including much of neighboring West Virginia is about to face an HIV crisis that it is ill prepared to deal with largely due to closed mindedness, the stigma attached to being gay and/or HIV positive and lack of access to progressive testing and medical treatment. Much of the increase in HIV positive residents come from drug use and shared needles yet, rather adopting policies that might reverse the trend, many localities are shuttering programs that might stem increased infections. Here are highlights from a very troubling column:

While there are still about a million people living with H.I.V. in the United States, in some of America’s largest cities, the news about H.I.V. and AIDS is surprisingly positive.

“New H.I.V. Diagnoses Fall to Historic Lows,” the New York City Department of Health announced on Nov. 22, reporting that the largest city in the United States had fewer new diagnoses of H.I.V. in 2018 than during any year since statistics were first kept in 2001. This was just a few weeks after Philadelphia’s Department of Public Health reported a 14 percent drop in the number of newly diagnosed H.I.V. infections overall, and a drop of more than one-third among black men who have sex with men — an especially vulnerable population.

San Francisco and Chicago have also seen their rates of new H.I.V. infections falling.

[I]n much of rural America, an opposite trend is emerging. There have of course always been cases of H.I.V. in sparsely populated parts of the country, but in these places far from cities, the conditions that lead to H.I.V. transmission are now intensifying — and rural America is not ready for the coming crisis.

Indeed, in Appalachian West Virginia, the crisis has already arrived. A cluster of 80 new H.I.V. infections has been diagnosed since early last year in Cabell County.

Unlike large urban areas that have dealt with similar health and substance crises in the past, and that have networks of service providers and consumers in place, small rural health jurisdictions often lack the infrastructure to confront the crisis and have little history of dealing with comparable health issues, she explained.

[W]hen prescription highs can’t be sustained, people often turn to using — and sharing — needles to inject heroin and then fentanyl, leading to hepatitis C and H.I.V. This avoidable crisis has been exacerbated by unemployment, declining coal mining production and economic pressures on regional press to act as effectively as a watchdog.

At the same time, health care is relatively inaccessible. “It’s not so easy to get to the nearest town to see a doctor,” Dr. Judith Feinberg, professor of medicine at West Virginia University, explained, pointing to a lack of transportation and stigma as the biggest barriers to testing and care. People living with H.I.V. are stigmatized everywhere, but those who live in large cities can get tested while feeling relatively anonymous in a clinic in ways rural dwellers cannot.

[T]he C.D.C. released a list of 220 counties similarly vulnerable to such outbreaks among people who use intravenous drugs. The densest concentration of those counties is along the Appalachian Trail, with 28 of them in West Virginia — more than half of the state’s 55 counties.

“There is no way that doesn’t wind up as an H.I.V. outbreak in the state,” Ms. Young says. Yet unlike in places like New York — with its comprehensive sex education; efforts at queer- and trans-specific public health; embrace of public syringe exchanges; and what its health commissioner, Oxiris Barbot, describes as a “sex positive approach” — when it comes to confronting its H.I.V. epidemic, rural America is ill-prepared at best and antagonistic at worst.

[D]espite research showing that syringe programs are effective at limiting transmission of H.I.V. and encouraging people to enter drug treatment, two cities in West Virginia — Clarksburg and Charleston — have recently moved to close or limit their needle-exchange programs. Negative press, business worries and conservative approaches are among the reasons the programs have been reduced when they urgently need to be expanded (along with statewide testing and education about preventive H.I.V. medication).

While it’s true that people who are black, queer, transgender, homeless, incarcerated or poor, or who use injection drugs, are disproportionately affected by H.I.V. and AIDS, the misguided impression that members of these groups are the only ones affected has unfortunately contributed to the media’s choice to deprioritize coverage of H.I.V. and AIDS in recent years.

Meanwhile, the rural, heterosexual white Americans who have been the subject of countless national profiles because they’re imagined —  incorrectly — to represent all of President Trump’s supporters, are more at risk all the time. But while we’re bombarded by analyses of many aspects of their plight, we don’t hear about this crisis facing them.

[T]he new major terrain of the crisis right now is in rural America, and it can’t be ignored any longer.

Putin and the Russian Orthodox Church Turn HIV Into Heterosexual Epidemic

Throughout Russia's history the Russian Orthodox Church has typically been on the side of autocracy, has fought any and every progressive idea, and worried more than anything else about its own wealth and power.  Indeed, the Church opposed even small moderate changes that might have helped Russia avoid the horrific 1917 revolutions.  Now, Putin, like some of the most insidious tsars from Russia's past has allied himself with the Russian Orthodox Church to bolster his base of power .  In exchange for such support, Putin has given the Church free reign to push its archaic, anti-modernity, anti-knowledge based agendas.  Adding to the toxic mix has been the efforts of American Christofascists to export their anti-gay animus and contempt for modern democratic norms.  In Russia, this embrace of ignorance is fueling a HIV epidemic that is rapidly ravaging the heterosexual population.  Unlike other modern nations that are seeing their rate of increase of HIV cases drop, Russia is seeing explosive increases that rival those of sub-Saharan Africa, an area known for its lack of education and susceptibility to Christofascist propaganda.  A piece in Politico looks at the disaster taking place in Russia.  Here are excerpts:   

The Kremlin and its allies are pushing a socially conservative, hands-off, and often church-influenced approach to sexual and reproductive health, as well as drug policy. Fueling an epidemic, state policies and inaction have led to more cases than ever of Russians contracting or dying from HIV/AIDS.

At least 14,631 Russians died from AIDS-related symptoms in the first half of 2017—an increase of more than 13 percent from the year earlier. Russia now hosts the largest HIV epidemic in Eastern Europe and Central Asia, which, along with the Middle East and North Africa, make up the world’s only two regions where the rate of HIV cases is rising. “It’s explosive,” says Christopher Beyrer, an epidemiologist and professor at Johns Hopkins University who previously served as president of the International AIDS Society and helped run an anonymous HIV testing facility here in Moscow before pulling out due to Russian policy hostile to U.S. funding. “The policies that they have been sticking to in the Russian Federation and attempting to impose in countries they seek to control are clearly not evidence-based,” he adds, calling the shocking rise in HIV rates a clear “failure of policy and practice.” In January 2016, Russia registered its millionth HIV-positive person, a 26-year-old woman. Actual numbers are likely much higher, according to health experts. Across much of the world, including the United States, the rate of HIV is declining, thanks to strategic programs like clean needle exchanges, increased awareness and better access to antiretroviral therapy. In the U.S., for example, the annual number of overall HIV diagnoses decreased by 5 percent between 2011 and 2015, according to the Centers for Disease Control and Prevention. But that’s not the case in Russia: Here, the rate of HIV infections is rising faster than in sub-Saharan Africa, host to the world’s largest HIV epidemic, where an international effort has slashed the rate of new HIV infections. Russia’s growing HIV crisis is seemingly no match for the Orthodox Church, which preaches faith and family values as the cure-all for the virus. A burgeoning alliance between Russian President Vladimir Putin and the church in recent years has fueled an environment where sexual education in schools is forbidden, clean needle programs are shunned as sinful and attacks on women’s and gay rights are state-sanctioned. Further blocking access to health care and resources, Putin signed a controversial church-backed bill into law in 2013 that criminalized the dissemination of information about homosexuality to minors—or, in government terms, “propaganda of nontraditional sexual relations.” But it wasn’t just the Russian Orthodox Church: U.S. evangelical funding and influence have also fueled the conservative tide in Russia, says Dr. Breyer. “The [anti-gay law] language was in some cases lifted whole from legislation passed in Nigeria and Uganda,” he says, referring to the U.S. Christian right’s influence on anti-gay legislation in parts of Africa. Patriarch Kirill, head of the Russian Orthodox Church, who has deemed Putin’s presidency a “miracle from God,” has called for the “establishment of family values, ideals of chastity and marital fidelity” and a focus on “moral education”—not sexual education. The church’s presence on social issues is so suffocating that one researcher working on issues of HIV in Russia quipped that he saw “more Orthodox priests than condoms” at a recent HIV conference in Moscow. Despite the rising number of new HIV infections, Russia is not increasing the amount of HIV medication accessible to the public or ramping up health education efforts. Instead, parents are expected to educate their children at home on the risks of unsafe sex and drug use. HIV experts say that’s largely still not happening, and a generation of children are growing up without life-saving knowledge of HIV and its risks.

Meanwhile, top Russian officials cast doubt on the need to combat the disease. Deputy Director Tatyana Guzenkova of RISS, for example, has said that the HIV epidemic is merely an “information war” waged by the West on Russia.

In the past, most HIV positive Russians contracted the virus through intravenous drug use. That’s changing: The number of people contracting HIV from heterosexual sex will soon overtake new HIV infections from drug use, according to experts. And an increasing number of newly infected Russians—some 38 percent in 2015—are women. As Russia’s decades-long HIV crisis takes on a different shape, experts say more and more Russians like Ivanova—non drug-using Russians who are part of mainstream society—are becoming infected, although drug-use is still a leading factor fueling the country’s HIV epidemic.