We've known for a while that the epicenter of AIDS and HIV has moved from the urban centers of New York and San Francisco to southern states. But it's always a shock when you see the lists come out. The CDC's latest HIV Surveillance Reports is startling: Four of the top five metro areas with the highest infection rates are in the south: Atlanta, New Orleans, Baton Rouge and Miami.
In Atlanta, where I live, infection rates have climbed every year for the last 8 years, prompting activist Devin-Barrington Ward to tell Al Jazeera, "Atlanta is like New York was in the '80s in the need to develop a public health response to a serious [HIV] epidemic."
What makes the south such a haven for HIV? Demographics certainly contribute to the problem. Compared with other races and ethnicities, African Americans account for a higher proportion of new HIV diagnoses. Since the South has a higher proportion of the U.S. black population, it makes sense that we would have higher infection rates here. And in fact, the CDC put out a press release with one of the most shocking predictions of HIV in America I've ever seen:
Half of black gay men projected to be diagnosed with HIV in their lifetime.
But there's something bigger than demography at work: Southern propriety.
I do not have the privilege of saying I'm from the South, only the honor of living in it. I've had plenty of chances to move but I've stayed for 30 years. I'm too enamored by the Southern trait of minding your manners.
I remember my first experience with Southern "indirectness." I was in a hot stuffy class waiting for the teacher. I was about to blurt out "I'm hot, somebody open up a window" when I heard a guy say, "Is anyone else warm? A breeze would certainly be a welcome addition."
The sideways, indirect way of speaking is one of the most charming things about the south. There are famous examples of southern indirectness, like describing the civil war as the 'recent unpleasantness' or bad weather described as "The weather of northern aggression."
Getting to the point is not in keeping with southern tradition.
It's a charming way to interact socially, but it's a potentially deadly way to interact sexually. I remember when I first moved to Atlanta I met a guy who was so hot wilted flowers stood at attention when he walked by. We ended up in bed and in the middle of making out he said, "Why don't you let me warm up your backside." YES, I said, thinking I could really use a massage. So I flipped over on my stomach, closed my eyes, and waited expectantly for his magic hands to relax my aching back.
Well, it wasn't exactly his hands he tried to lay on me and it wasn't exactly my back he was trying to loosen. I jumped so high I nearly hit the roof. "WTF are you doing!" I yelled, scrambling out from underneath him. He was genuinely confused because in his mind he was being crystal clear about his intentions.
I suspect that the southern trait of indirectness contributes greatly to the spread of HIV here. If a guy feels the need to use a euphemism for intercourse how in the world is he going to ask about your HIV status?
One of the most effective ways to stop the spread of HIV is to know if your potential sex partner has it. Sexual behavior changes dramatically with that knowledge. It'll either prevent you from having sex with him in the first place, or severely limit what risks you're willing to take.
But unless he volunteers it, the only way to know if your potential sex partner has HIV is to ask, something southerners find exceedingly difficult to do.
Recently I asked readers to my sex advice column, "Who is the least likely to ask if you have HIV?"
"Southerners," was the unanimous answer. "I grew up in Kentucky, Louisiana and Georgia," a guy named Brad said, in a typical response. "And I can't recall anyone ever asking me. Then I moved to New York. Where I can hardly recall anyone not asking."
Southerners are indirect because they place great value on kindness. They do not believe in offending people and being explicit is often perceived as offensive. There's a tradition here -- if you can't be kind, be vague.
The problem is, you can't be vague with a plague. You have to be what Southerners find abhorrent: Blunt and direct.
In Gone With The Wind, when Aunt Pittypat learns the Northern army had entered Georgia, she practically had to be carried into her house. "Yankees in Georgia!" she exclaimed. "However did they get in?!"
The same could be asked of HIV in the south. However did it get in? The answer is simple but I have to mind my manners and find a polite way of stating it.