2005 New Cases: 1,806*

Black: 63%
White: 28%
Latino: 7%

Children
College Students
Women

Adolfo Aguilar
Outreach Worker, Chatham Social Health Council
Coleen Cunningham
Chief of Pediatric Infectious Diseases, Duke University Medical Center
Milford Evans
Benefits Advocate
Gerrod Henderson
HIV Positive teenager
Peter Leone, M.D
Medical Director, HIV/STD Prevention & Care Branch
Jonathan Perry
HIV Positive
Fred Wiggins
HIV Positive
Del Williams, Ph.D
Manager, Epidemiology & Special Studies HIV/STD Prevention & Care Branch

HIV/AIDS on Campus
HIV/AIDS & Kids
HIV/AIDS & Latinos
HIV/AIDS & Women

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*NC Department of Health and Human Services

What are some of the trends we're seeing in HIV/AIDS cases in North Carolina?
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It's not unique to just North Carolina. The south in general is continuing to see the swell in HIV/AIDS reports.

The rise that we're seeing, or the increase that we're seeing, doesn't really appear to be happening in any one geographic area or any one demographic area. In North Carolina, HIV/AIDS cases are still primarily reported from our minority community. Minorities make up approximately 25 percent of the state's population, but the proportion of new HIV/AIDS reports we see, we see around 75 percent of those reports are from 25 percent of the population. That hasn't changed in the last ten years unfortunately. That trend is still there.

Over 50 percent of the new cases reported are found among six counties. We'll put it that way, and they're primarily our urban counties such as Mecklenburg, Wake, Durham, Forsyth.

We see some slightly different trends that have emerged, and that is that in eastern North Carolina, some of our smaller population counties do have a rather inequitable burden of HIV, new HIV or AIDS cases that have been diagnosed and reported from those counties in the last three to four years.

There are significant barriers to an individual being able to access quality health care - or even health care in general - quality or not quality. There are areas where there's very limited public transportation available. Someone may be unable to get from home to the health department or to their physician for treatment or for testing because they don't have a car, and in some of those counties it may be an all day job if you have to find someone to take you from home to the health department at the other end of the county.

The idea of having easy and ready access to health care is something that many of us take for granted, but unfortunately a lot of our citizens in North Carolina do not have that available to them.

The other reason is socioeconomic status. That particular area of the state that I've described is one of the areas where we've seen a significant downturn in the state's economy - that has been statewide - but in those areas if we're dealing with some of the small manufacturing textile areas which have gone out of business or have had their business transferred elsewhere and put a lot of people out of work, one of the things that happens is that if you don't have money for all of your necessities, you try to prioritize and generally food's going to come first. Health care may come last.

We have individuals who maybe now are in medical care and are feeling healthy and are able to hold down a job as a result of HIV medications and are feeling much more like going on with what are sort of the normal life processes - having friends, spending time with those friends, and occasionally having sex. We have some areas where we have identified very tight what we call sexual networks which are fairly easily defined as a group of people who know each other. And in some of our areas, in some of the counties, many of these sexual networks seem to be associated with the use of crack cocaine, and one of the things that does tend to occur is that when we see individuals who are using substances that lower inhibitions, interesting things start to happen. Some folks will also trade sex for drugs, so there is an increase of prostitution, both male and female, in some of those areas.

With the advent of the highly active antiretrovirals, with there being some options available to people now who are HIV infected for something that does approximate more of a normal lifestyle than there used to be available for those folks, there's not as much resistance to being tested for HIV. There's no longer the mindset of well, there's nothing that can be done if I'm HIV positive, so why do I even have to worry about being tested. That's not the case now. There are medications that are very effective.

HIV/AIDS in African Americans
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Some of the very tight sexual networks that I mentioned earlier are African American sexual networks. Again, the instances of individuals who have difficulty reaching good health care many times is also an issue of socioeconomic status, and the unfortunate reality in North Carolina is that our African American community does have overall, at least on average, a lower earning capacity than the white population or the majority population. Many more of the individuals living in poverty are African American, and many of the areas we were talking about that have the highest rates are our counties where the African American population is also the highest proportion of that county.

HIV/AIDS in Latinos
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At present the increase in Hispanic HIV cases is pretty much matching what we're seeing as the increase in proportion of our population that is Hispanic. What we don't know for sure, and what we're concerned about, is that we're setting ourselves up for a repeat of what we're seeing in the African American community where many of our Hispanic communities have difficulty in reaching health care. Many of our Hispanic communities don't have access to providers where Spanish is available or Spanish interpreters are readily available.

We see people who are living, if not in poverty, on the edge of poverty and all the pieces are there for us to see a continued increase in HIV cases for our Hispanic community.

Is enough being done to stop HIV/AIDS?
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If we take the approach that if you don't stop it you're not doing enough, then I guess the answer would have to be no, we're not doing enough. But I try to look at it in terms of what I've seen as additional programs that have been created to try to intervene in the spread of disease. I think that we have a strong partnership that has been developed over the years with people who are HIV positive. The other thing that we need to insure is that we really are very straightforward in what puts people at risk and in knowing how to protect yourself from becoming infected.

I'm not sure how we would go about doing an awful lot more with the limited funding that we have. One has to understand that for the prevention efforts that we undertake, a large part of our funding comes from the federal government, from the Centers for Disease Control and Prevention, and we have learned over time that involvement of the communities that are at risk is going to be critical to utilizing that prevention funding and making the information available to people at risk.

One of the things that has been recommended that we have embraced is the so-called prevention for positives approach to HIV prevention, which means that given that we have individuals we know that are HIV positive that may be in a position to continue to have sex or share needles if they're injecting drug users, to get them involved in helping us with our prevention, and in doing so insuring that they take an active role in trying to prevent the spread of the disease from them to someone they're having any sort of relationship with.

Is the HIV/AIDS crisis over?
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No. It's not over. I think we're, we're learning more faster now than we were in the mid-1990s, but it is.. Other folks have described this as a chronic disease, and it is. I think we're reaching a point where we will have folks who are infected and who live with the virus for perhaps what would be a regular life span. We don't know that yet. We do know that we've seen dramatic increases in survivability for folks who are able to receive the highly active antiretroviral therapies.