The unspeakable truth
By SHELBY OPPEL
© St. Petersburg Times, published February 12, 2001
MARIANNA -- In the big cities of the United States, AIDS no longer carries the stigma it did when the first case was discovered 20 years ago. People talk of "managing" the disease with powerful drug cocktails that prolong lives. The world's attention has turned to Africa, where millions are dying from the uncontrolled spread.
But in a rural county west of Tallahassee, a church pastor wonders aloud if you can catch it "out in the air."
AIDS is far from manageable in Jackson County.
Four out of 100 HIV tests come back positive, twice the state average. Yet it is the numbers that health workers here don't know that scare them most.
More than half of the people who tested positive for HIV in the county last year had full-blown AIDS, having delayed the diagnosis out of fear or ignorance, or both. Because it can take as long as 12 years for the virus to develop, those new victims presumably have been infecting others for years.
They aren't the gay white men whom the disease struck first in bigger cities, but black grandfathers, white farmers' wives, men just released from prisons, Mexican migrant workers and junior college students from other Panhandle towns. The older ones are often too afraid or ashamed to get help. The younger ones, among whom the disease is spreading fastest, aren't scared enough.
AIDS took longer to arrive in Jackson County, home to an abundance of peanut farms and prisons, and other out-of-the-way pockets of America. To many in Jackson County, it is a gay disease, or something that happens to movie stars.
Here, in the notch of rolling farmland where Florida meets Alabama and Georgia, the stigma hasn't budged. The fear is still fear, thicker and more pervasive in a place where visitors turn heads, the bars don't serve hard liquor and almost every social event is a covered-dish supper.
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Matilda McNair's big, blunt-edged voice fills up the wood-paneled meeting room at Buckhorn Missionary Baptist Church, a black parish in Greenwood, where 11 people have shown up on a cold Wednesday evening to hear her talk about AIDS.
The virus that causes AIDS is spread by sharing infected needles or from a mother to her baby, McNair says. Or through vaginal, anal or oral sex.
White lace curtains flutter in the window. Two elderly women in crocheted hats purse their lips and blink, slowly.
McNair works for BASIC, Bay AIDS Services and Information Coalition, a Panama City-based group that is often the only resource for people with HIV and AIDS in six central Panhandle counties, including Jackson.
McNair barrels on, leading the mostly female audience through "A Christian Response to AIDS," printed by the state Department of Health. New listeners continue to arrive, including a few men, and fill up the long metal folding tables.
Any questions? Only the Rev. William Harvey, 69, asks his aloud.
"So you don't have to worry about just getting it out in the air? You've got to get it from somebody?" he asks.
"I heard that there are people who have it, and they start going out into the community and . . . "
The gray-haired preacher pauses, his voice trailing into a sheepish grin.
"And they're not telling people (they have AIDS). Is that happening?"
Yes, McNair tells him, that is happening.
Not only in Jackson County, but in big cities and small towns across the country, AIDS is spreading fastest among blacks. Health officials estimate that one in 50 blacks in Florida is infected with HIV, the virus that causes AIDS, compared with one in 127 Hispanics and one in 286 whites.
Blacks account for 56 percent of new AIDS cases reported last year, though they constitute only 13 percent of the state's population. At the BASIC clinic in Jackson County, blacks account for 56 percent of HIV and AIDS cases. The county of 49,000 people is 30 percent black.
Blacks in Jackson County aren't more likely to contract HIV or AIDS than their urban peers, but small-town life creates additional challenges to coping with the disease, regardless of the victim's skin color. Where everybody knows everybody, a visit to the local AIDS clinic gets noticed -- and talked about -- if such a clinic exists.
Churches, black churches in particular, are among the toughest places in Jackson County for AIDS prevention workers such as McNair to gain entry. The language of AIDS -- homosexuality, bisexuality, drug use -- remains off-limits in many sanctuaries, so the words that could prevent the disease also go unheard.
Women account for 22 percent of cumulative AIDS cases reported in Florida through December 2000, and black women are almost three-quarters of that group. Yet "AIDS" is still a synonym for "gay" in many households, and reason enough to show a relative the door.
"Even if you're not homosexual, it's just 'get out,' " said Harvey Williams, who works with McNair. "This is a cold county."
But the taboos haven't kept AIDS out of Buckhorn Missionary Baptist Church. Most congregants don't know it, but more than one of them has the AIDS virus, and others have relatives who have died from the disease. As McNair speaks, some of them sit quietly in the wood-paneled meeting room, not far from the elderly women in their crocheted hats.
* * *
Until recently, BASIC's limited budget allowed for only two prevention workers to cover six central Panhandle counties, from Panama City in Bay County west to Jackson County. Then last year, state lawmakers passed legislation sponsored by former state Rep. Rudy Bradley, a St. Petersburg Republican, that set aside $10-million for grants aimed at improving disease prevention and treatment among racial and ethnic minorities.
BASIC applied for and received $117,000 of that money, which is paying for the first full-time AIDS prevention effort in Jackson County. McNair, who is white, and Williams, who is black, are leading the fight.
They grew up two decades apart in Jackson County, but only Williams left, bound for the Army and jobs in New Jersey and South Florida. He returned five years ago so his 84-year-old mother could grow old at home, alongside the Rottweiler and tabby cat he named Hammer and Nails.
McNair, a 28-year-old single mother, is more garrulous, more likely to block the path of giggling freshmen at Chipola Junior College in Marianna with free condoms and a bright brown-eyed stare.
At a grimy strip of subsidized housing not far from the college, Williams, 49, is cooler. Wearing the baggy jeans and cocked-back cap of a younger man, he easily wheedles his way behind the paint-chipped doors, where young mothers stand in slippers amid marijuana smoke on a weekday afternoon.
The state grant that pays McNair and Williams requires they give 80 new HIV tests each month. They logged in 11 at the college. No. 12 just opened a bottom-floor apartment in a skirt slit up to her waist.
"I practiced safe sex," the woman, 20, tells Williams. "Until I got pregnant."
Williams persuades her to sign the consent forms and to take from him a plastic stick with a cotton swab attached to one end. She squeezes the swab between her cheek and gum, allowing her saliva to soak in. In two weeks, when the results are back from the state lab in Jacksonville, she'll know.
Williams and McNair represent only a fraction of the roughly $160-million allocated by federal and state lawmakers annually to fight AIDS in Florida. The vast majority is sent from Washington, D.C., and pays for drugs for and the care of those who know they are sick.
But first, somebody has to tell them, and Williams is grateful for the chance. After he moved back to Jackson County, he heard friends up North had tested positive for HIV. He got scared but declines to elaborate. Ultimately, he tested negative.
"There is no reason," he tells the young mother inside the dim apartment, "for another person to die."
* * *
At the eighth annual Retrovirus Conference last week in Chicago, federal researchers reported that 30 percent of young gay black men in the United States are infected with the AIDS virus, according to a study of six large cities. Recent studies in San Francisco and New York City, among gay men who grew up in an era of widespread publicity and prevention efforts, found similar trends.
The drug cocktails that have helped thousands of HIV-infected people stave off AIDS, slowing the rate of new cases in the mid 1990s, are taking their toxic toll. In a shift, federal health officials last week recommended that drug treatment be delayed as long as possible because of the often severe side effects.
Just last month, Florida logged a sobering milestone: the state's 100,000th reported case of HIV or AIDS. The number of deaths increased in 1999, after three years of declines.
"This is not a time to let our guard down," said Tom Liberti, chief of the state Bureau of HIV/AIDS, a division of the Department of Health.
In Jackson County, McNair and Williams are struggling to get the guard up. In the church meeting room, McNair has another question.
"How can my church respond to people with AIDS?"
Finally, someone besides the preacher answers. Jean Neal, the only white church member in the audience, is HIV positive.
Neal, 51, learned she had HIV in 1997. She believes she caught it from a boyfriend who later died of AIDS in prison. She met her husband, who is black, in a BASIC support group. He, too, is HIV positive.
"Have more love and compassion, not persecute them," she says, her eyes moving from McNair to the pastor and back again. "If God's people can't love that person, that person's in real bad shape."
The Rev. Williams meets her eyes for a long moment and smiles.
"Amen," he says.
- Times researcher Kitty Bennett contributed to this report.
* * *
Florida experienced an increase in deaths from HIV or AIDS in 1999, after three years of declines.
Source: Florida Department of Health, Bureau of HIV/AIDS
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