Denise Meadows remembers the first time she realized HIV was a problem in Alabama. As the executive director at Hobson City’s Health Services Center, Meadows oversees the treatment of more than 500 HIV patients across five clinics and 14 counties in northeastern Alabama.
Every week, she saw them: men, women, mothers, fathers, grandmothers, grandfathers. Some were black, others white. Some were humble. Some were well-educated community leaders. Others had never left Calhoun County.
“You’d just be shocked at the diversity of the people,” Meadows said. “I realized there are people that looked just like me, just like you.”
The area’s high poverty levels, coupled with the stigma that comes with being HIV-positive, has made Alabama a hotbed for the HIV/AIDS epidemic.
In 2010, the Kaiser Foundation ranked Alabama 15th nationally in number of HIV deaths, with 153. In 2011, it ranked Alabama 14th nationally in HIV diagnosis rate, with 20.9 people diagnosed for every 100,000 people.
Despite the region’s large number of cases, Alabama receives a disproportionately small amount of federal funding for HIV/AIDS programs. According to data from the Henry J. Kaiser Family Foundation, Alabama received $42.6 million — 1.4 percent of federal HIV/AIDS funding — in the 2013 fiscal year, ranking it 20th in the nation.
“The rates are the highest in the most conservative places,” Meadows said. “People aren’t talking about it, and they may not know their status. Really, HIV is an indicator of other societal issues.
“If you don’t have insurance, and you don’t have something wrong, you’re not going to get up to go to the doctor,” Meadows continued, “because you don’t know how you’re going to pay for it, you don’t know where you’re going to get the gas money.”
One program where Alabama receives a smaller amount of federal funding is Housing Opportunities for Persons with AIDS, or HOPWA. It is the only federal program designed to provide safe, stable housing for low-income HIV/AIDS patients.
On June 10, the U.S. House of Representatives failed to pass an amendment that would have increased HOPWA funding by $29.1 million. Instead, the funding will be cut to $305.5 million from its 2014 level of $330 million.
Rep. Bradley Byrne, R-Mobile, was one of two members of Alabama’s House delegation who voted for the amendment. Byrne said he voted for it because of his district’s high number of HIV cases; Mobile County ranks second in the state with 1,926 prevalent HIV cases and 3,022 total cases through March 31, 2014.
Byrne said federal and state legislators should do a better job of addressing the issue.
“I don’t know if it’s a money issue, but I think we could do a better job,” Byrne said. “You would think we could make better decisions to avoid the behaviors that make you more susceptible to AIDS.”
Kathie Hiers, CEO of AIDS Alabama, described the cut in funding to HOPWA as potentially devastating for Alabama. In the 2014 fiscal year, Alabama saw roughly $4 million in funding from competitive and formula-based grants, ranking Alabama 16th among the states. Hiers said Alabama’s funding will be cut roughly $150,000 during the 2015 fiscal year, which will only aggravate what is already an issue of too little HOPWA funding in the state.
The program allocates money to states and cities based on two grants. In one grant program, which represents 10 percent of the total funding, programs compete for money. In 2014, the state of Alabama received two of these grants for roughly $2 million. If Alabama had not received those grants, it would be ranked 24th in the nation in total HOPWA funding.
The remaining 90 percent of the fund is formula-based. Under the formula, 75 percent of funding is based on the cumulative number of AIDS cases in each state since 1981. The formula excludes HIV cases which, due to advances in medicine, have increased in number as opposed to AIDS. A person diagnosed with HIV will progress to AIDS once they receive certain types of infections or their white blood cell numbers fall below a certain level.
The remaining 25 percent is based on new AIDS cases per year. Only the largest 30 metropolitan areas benefit from this funding; states as a whole are ineligible to receive it. The program’s formula, Hiers said, coupled with the fact the AIDS epidemic did not hit the southeastern U.S. until roughly four years after the initial epidemic, disenfranchises Southern states, which have more rural populations than they do urban ones.
Hiers has been trying to lobby HOPWA officials for 10 years to change the way they allocate their funds based on the number of total living HIV/AIDS cases for each state, which could potentially see Alabama gain up to twice as much funding per year.
“It’s unfair for the South,” Hiers said of the way funding is allocated throughout the U.S. “It’s absolutely crazy for them not to count HIV. The South in general has newer epidemics.”
Ultimately, however, Meadows said the key to slowing the spread of HIV/AIDS in Alabama is to address the myths and stigmas that surround the disease.
“We can’t make positive change affecting this population without improving several other social factors,” Meadows said. “There’s no cure, but it can definitely be treated.”