2006 Awards

In 1997, Karen Morris thought she had cancer.

Having lost close to 60 pounds in a matter of months, she knew something was wrong. Living in Wilmington, Del., at the time, she visited her gynecologist, who found a fibroid tumor on her uterus.

The doctor took a biopsy of the growth and, almost as an afterthought, asked Morris if she wanted an HIV test.

“Sure,” she answered with little concern.

“Since 1991,” she says today, “I'd had one steady boyfriend, so HIV and AIDS were not something I'd ever worried about.”

Two weeks after her doctor's appointment, the results came back. The biopsy was negative. The HIV test was positive.

Two weeks later, Morris began a regimen of medications she takes to this day. At 55, she is happy and as healthy as a person living with HIV for nearly a decade can hope to be.

With self-deprecating humor and an honest, up-front attitude, she makes even the most awkward conversations seem casual.

To meet Morris, it is impossible to know she is HIV positive.

That, in essence, is her message. Don't assume your partner is safe because she appears healthy. Looks can not only be deceiving. They can be deadly.

Sometime in 1996, while she and her boyfriend were on the “outs,” Morris met up with an old friend.

That night she had unprotected sex with someone she trusted, a man who looked healthy, a man she thought was safe.

The stigma of HIV had begun to lift, due to a decade of education, prevention and awareness programs. By the time of her diagnosis in 1997, it seemed everyone understood they couldn't catch AIDS from water fountains, toilet seats or by holding hands.

That was until she came down south in 2001, specifically to Calhoun County, to take care of her ailing parents. Suddenly people were afraid to touch, hug or even sit near someone who was HIV positive.

“It was like stepping back in time ... like being in the 1800s,” she says, sitting in the hard plastic chairs of an exam room at the Health Services Center, an HIV/AIDS clinic in Hobson City. “They didn't want to say the word, let alone be around someone with the disease.

“It was like how people used to treat lepers.”

Today, Morris' virus is under control. Since moving to Anniston, she has become an advocate for the clinic, visiting area schools, churches and jails in the 14 counties it serves.

“The South is frighteningly uneducated, and people are dying because of it,” Morris says as multiple red AIDS bracelets slide up and down her wrists. “Nobody wants to believe HIV or AIDS could be in the South … in Alabama.

“But it is here. AIDS is everywhere.”

The South is no more immune to the crisis of HIV/AIDS than any other part of the country or the world.

In recent years, the disease has changed course, attacking the rural poor and heterosexual, and it's slowly decimating the black population - both male and female.

Although blacks represent only 12 percent of the U.S. population, they account for 50 percent of newly reported AIDS cases. In Alabama, blacks represent 26 percent of the population but account for 70 percent of new infections, according to AIDS in Alabama, a Birmingham-based advocacy group.

Twenty-five years into this epidemic, scientists and researchers have made tremendous strides in unlocking the mystery of AIDS on a molecular level, but the reason it continues to fester within the rural landscape of the South are no less complex.

And yet the root causes can be reduced to the lowest common denominators - poverty, drugs, hopelessness and a lack of access to basic sex education.

The virus once known as “gay-related immunodeficiency disease” has steadily become both color and gender blind. The so-called “face” of AIDS has taken on a new, horrible identity, especially in the South where the numbers of HIV/AIDS cases are continuing to increase.

“Want to know what HIV looks like?” says Tom Robertson, HIV coordinator for the Calhoun County Health Department. “If you've ever had unprotected sex … then just look in the mirror. It might look just like you.”

Ground Zero

According to the Centers for Disease Control, more than 1 million people in the United States live with HIV/AIDS, with approximately 40,000 new cases diagnosed each year.

Despite representing little more than one-third of the U.S. population, the South (designated by 17 states from Texas to Delaware) accounts for 46 percent of all new AIDS cases diagnosed each year, according to the CDC.

While the number of new AIDS cases in the United States remained relatively stable between 2000-2004 - increasing less than 1 percent - new cases in the South increased by 9 percent.

“The South is the new Ground Zero for the AIDS epidemic,” says Kathy Hiers, chief executive officer for AIDS Alabama. “And yet most people have no idea just how bad it is or how much worse it could get.”

According to the Alabama Department of Health, currently there are 14,415 reported cases of HIV/AIDS in Alabama. The most combined cases are in Jefferson County, with 4,189.

It is important to understand the distinction between HIV and AIDS. Simply put, HIV (Human Immunodeficiency virus) is the virus that causes AIDS (Acquired Immunodeficiency Syndrome).

AIDS is a syndrome defined by a series of opportunistic infections, like skin cancers and rare forms of pneumonia. Due to advances in medical treatments, someone can be HIV positive without ever contracting AIDS.

Calhoun County ranks right up there with 265 total cases of HIV and AIDS. These statistics reflect the epidemic's growing strength throughout the South.

The numbers have been steadily increasing, up from 84 reported AIDS cases in Calhoun County in 1996, to 149 in 2002, to 180 in 2006.

At first glance, these numbers don't appear frightening in a county with a population of a little more than 120,000. But AIDS is as much a disease about potential as reality.

The CDC estimates that for every one “known” HIV positive person, there are five who are unaware they are infected. All told, the CDC estimates there are 252,000 to 312,000 people in the United States who do not know they are HIV positive.

With that in mind, Calhoun County could easily have nearly 1,000 people infected with HIV - a “significant number,” Robertson says.

“The weird thing about AIDS is that it's real easy to look at in terms of people I'm not,” he says. “If it's gay ... Well, I'm straight. If it's in big cities ... Well, I'm in a small town. If I'm black ... Well, it's a white disease.”

“Everybody surrounding me is at risk, but not me. I don't have to change my behavior. Wrong.”

In 25 years, AIDS - now a global pandemic - has killed more than 20 million people and infected 65 million more, making it one of the most destructive epidemics in recorded history. By way of comparison, the Black Death killed 34 million in the 14th century.

In 2005 alone, AIDS claimed the lives of between 2.8 million and 3.6 million people worldwide; about 570,000 were children.

When confronted by such numbers, it's important to maintain perspective. The death of one person is a tragedy, but the death of untold millions is more than a statistic, says Jennifer Morgan, spokeswoman for the CDC in Atlanta.

“We have seen a rate of decrease of infection in many groups,” she says, “causing some to become immune to the data. But we need to always remember that there are people behind those numbers.”

In the South, where accepted social stigmas and prejudices can pollute both hearts and minds, AIDS has found its new prey.

“This is becoming a disease of the disenfranchised,” says Barbara Hanna, medical director for the Hobson City HIV/AIDS clinic, many of whose 500-plus clients live on the fringe of poverty. “We are the underbelly of society and this is where the disenfranchised live.”

One reason for the increase of AIDS in the South is based on a positive - there are now drugs that allow the disease to be more manageable. Contracting HIV is no longer a death sentence, although there is no cure.

If caught in time, HIV is a manageable disease where patients, assuming they respond to the medications, can live 15 to 20 years.

“People act like there's a cure,” Morris says. “One pill won't make this thing magically go away.

“With HIV, your whole life changes ... everything.”

Silence = Death

The fear and paranoia surrounding the early years of AIDS became an urban legend that was whispered in high-school locker rooms and college keg parties.

As the story goes, a promiscuous young man, after a wild night with a strange girl, awakens to find a haunting message written in lipstick on his
bathroom mirror:

Welcome to the wonderful world of AIDS.

The legend was society's way of scaring people into changing certain at-risk behaviors - unprotected sex and sharing “dirty” needles, the main way the CDC determined HIV was spread, along with mother-to-baby transmission, namely through breastfeeding.

For a while AIDS, or at least open discussions about AIDS, was everywhere, from the classrooms to the nightly news. Temporarily, the approach seemed to work.

As education and information about HIV infection spread, the number of new AIDS cases, which had increased rapidly during the 1980s, peaked in 1992 with 78,000 in the United States before stabilizing around 1998.

If tested early, when the infection can be monitored and treated with proper medications, HIV-positive patients can live 15 to 20 years without contracting AIDS-defining illnesses. Long-term survival rates among those with AIDS are improving.

From 1981 to 1992, the percentage of people living two years after an AIDS diagnosis was 44 percent, the CDC reports. That figure improved to 64 percent from 1993-95 and 85 percent from 96-2004, according to the CDC.

Trouble is, people often aren't tested until they get sick. It can take as many as 10 years before “symptoms” appear. As the immune system worsens, a variety of complications start to take over.

For many people, the first signs of infection are large lymph nodes or “swollen glands” that may be enlarged for more than three months. Other symptoms often experienced months to years before the onset of AIDS include a lack of energy, weight loss, frequent fevers and sweats, and persistent or frequent yeast infections.

Over time, those once-frequent conversations about AIDS were slowly muted. Anti-retroviral “cocktails” made the disease more manageable, helping HIV-infected people live longer (NBA superstar Earvin “Magic” Johnson was diagnosed in 1992 and is still alive). And somehow the fear of AIDS abated, resurrecting the same old myths along the way.

“Kids today don't even know who Magic Johnson is,” Robertson says.

But AIDS didn't go away because Americans stopped talking about it. It just changed course.

“Back when everybody was dying, there was terror and panic, people wanted to do whatever it took to stop this thing,” Hanna says. “But since we put a Band-Aid on the problem, people stopped being afraid.

“We've become complacent, especially in the South. And now it's catching up with us.”

Lifting the veil

The generation of students who recently graduated from high school was born around 1988. They don't know of a world without AIDS. And if things don't change, they likely never will.

Part of Robertson's job as Calhoun County HIV coordinator is to visit area schools to educate students about the disease. He often leaves those classrooms and auditoriums feeling both amazed and ashamed.

“Some still think it is spread by mosquitoes,” Robertson says, “In 25 years of this epidemic, we're still answering the same questions. And it's not the ignorance of the South. It's the lack of information.”

Students are taught math - all day, every day, and they still don't understand math, he says. They are taught English - all day, every day, and they still don't understand English.

“We teach HIV education one time in the ninth grade for 55 minutes in a health class and are appalled by what they don't know,” Robertson says.

HIV in the South is like a frog in boiling water. Dump it in there when it's already hot and he'll hop right out. But put him in a cool pot of water and slowly turn up the heat - and it'll sit there until it burns alive, Robertson says.

“And that's exactly what we've done with HIV,” he says. “We've turned the heat up 'til we're comfortable with it. And a lot of people will be left to die.”

Most students Robertson talks to still believe AIDS is a gay disease or a big-city disease. The reason the misconceptions about HIV/AIDS still exist is because often they aren't being taught anything different.

“What do we do with drugs? We talk to 'em,” Robertson says. “What do we do about drinking and driving? We talk to them.

“What do we do about HIV? Nothing.”

Turn the page

Ed Roland understands the pain of stigmas. As a gay white man born and raised in Piedmont, its stain has saturated every facet of his life.

When Roland tested positive for HIV three days after Christmas 1993, he could have easily surrendered to anger and bitterness that he says are as destructive as the disease itself.

For a while he hid his diagnosis, revealing it only to his partner and his cousin, both of whom had tested positive. He refused to even tell his parents for fear they'd reject him.

“People in the South aren't exactly open-minded about that kind of stuff,” rubbing his hands on paint-splattered jeans. “Things have gotten better, but they're still not great.”

When his partner died of a massive heart attack in 2000, Roland's outlook changed. Always confident that he'd live “to a 120, no matter what the doctors thought 'cause there was no way that thing was gonna beat me,” the 38-year-old Roland began to share his story as an advocate for the Health Services Center in Hobson City.

And the honesty cost him dearly, though not with his parents. They were more understanding than others.

“When I started telling people, I lost a lot of friends,” says Roland, whose current partner is HIV negative. “And it wasn't just gay friends. It was straight friends, white friends and black friends.”

But Roland refused to stop talking.

“I want ... I need ... people to know about this disease,” he says. “I wouldn't wish it on my worst enemy.”

Karen Morris has been talking, too, trying to educate people on the truth about AIDS. She repeats it over and over again to people from all walks of life from across the state. But the message, to her at least, seems to be falling on deaf ears.

“People just don't wanna hear it,” she says in a tone of white-knuckled frustration. “It didn't take us 25 years to become educated about cancer or tuberculosis. But after 25 years of AIDS, we still have this incredible attitude of ignorance.”

AIDS is more than a local bully. It's a global monster that feeds on the poor and the uneducated. AIDS could kill 31 million people in India and 18 million in China by 2025 according to projections by the United Nations' population research. And in Africa, where it likely began, the AIDS death toll could reach 100 million.

Entire countries are being depopulated, and few are talking about the crisis because it's “over there…” or it's happening to “them.” Unless the world lifts the veil of stigma it's hiding beneath, no one is safe. In the South, as well as across America, we must be united in this global struggle for survival.

“In my life, I've probably told 300 people they were HIV positive,” Robertson says. “Not all were gay white men, not all were anything - except human beings.”