When Robin Webb lived in New York City, he was treated by HIV specialists and had access to counseling and nutritional programs. Now he lives in Mississippi, where few of those services exist.
Mississippi is just one of several mostly rural states across the South with a dearth of resources for HIV and AIDS patients.
"Here, there's no support group, no case management. There's no daily reinforcement," said Webb, 52, who has been HIV-positive for two decades.
Activists and the health care providers cite a need for more federal and state funding for outreach and drug assistance programs, as well as transportation for patients who have to travel from small towns to get care. That's the message they'll deliver when a top White House aide holds a rare community discussion Monday in Jackson.
Jeffrey S. Crowley, director of the White House's Office of National AIDS Policy, said the meeting will highlight two realities of the national epidemic — the significant number of cases in the South, and how the disease disproportionately affects minorities.
The spread of the disease in the South has been attributed to numerous factors, including poverty and a social stigma that discourages many from getting tested or seeking treatment.
Patrick Packer, executive director of the Southern AIDS Coalition and a moderator for the discussion, wants to pose this question: "Why is it that the South is not getting its fair share of federal money based on the epidemic?"
Highest percentage of deaths
The South leads the nation in the percentage of AIDS-related deaths. Yet, the region ranks last when it comes to overall federal dollars spent on an HIV-infected person at $6,565 a year, according to the coalition.
Forty-six percent of new AIDS cases in 2007 were in the South, according to the latest figures from the U.S. Centers for Disease Control and Prevention. Twenty-five percent of the new cases were in the Northeast, and 17 percent in the West, two regions with the nation's largest metropolitan areas that have for many years received most of the federal money.
However, the South stands to get more funding.
President Barack Obama signed the $2.2 billion Ryan White HIV/AIDS extension act last month, which continued funding for rural areas, putting the South second in federal money behind the northern region. Activists said it's still not enough to keep pace with the new cases.
Debbie Konkle-Parker, a nurse practitioner in Jackson, said the act also added federal money to the South in 2006, but didn't put rural areas on the same level as big cities.
"The inequities were pretty huge," she said. "People were spending (Ryan White) money in New York City to do journal writing conferences, and in Mississippi, we couldn't even get people to the clinics."
Konkle-Parker said Mississippi has about eight public clinics to treat the majority of the 9,000 HIV patients in the state.
The current economic crunch has exacerbated the situation. Some states, like Kentucky, have cut funding for HIV/AIDS programs. The state had been contributing $250,000 a year prior to 2007, but now almost no state money is set aside for the AIDS Drug Assistance program, said Sigga Jagne, a program manager for the Kentucky Department of Health.
There are 1,277 enrolled in Kentucky's program with 100 more on a waiting list, she said. Arkansas and Tennessee also now have waiting lists for the program, which is mostly federally funded but receives some state money. Packer said funding cuts have led to the waiting lists.
"We're already disproportionately impacted by poverty and high rates of umemployment. It's important for people who are HIV positive to be provided with life-sustaining drugs," Jagne said.