HIV in an unexpected place: A quiet epidemic in SW Georgia

This is the ninth in a series of articles about health care in Southwest Georgia, an area of the state that has great health needs and challenges, but also some innovative approaches to such problems. The series is the product of a collaboration between Georgia Health News and the health and medical journalism graduate program at UGA Grady College of Journalism and Mass Communication, a partnership made possible by the Ford Foundation and Grady College.

Slideshow: Faces of the Rural Model Clinic

It’s not a date you forget – the day you were diagnosed with HIV. For Adolphus Major, that milestone was Oct. 28, 1999.


He’d had digestive problems for some time, but when he was working in Miami he got so sick that he had to be hospitalized. Two days later, the doctor told him the bad news.

Major had AIDS.

On that day, the long-awaited arrival of the year 2000 was only a little more than two months away. But the doctor told Major he wouldn’t live long enough to celebrate.

Major did not believe it.

“I said, ‘OK, that’s how you feel. I’ve never died before so I don’t know how this dying thing is supposed to be, but it does not feel like I’m about to die.’ ”

Major found a new doctor, one with what he called a “more positive outlook.” Bolstered by faith in God and support from his church and family, Major turned his health around, and in 2007 he moved back to his hometown of Albany, the main city in Southwest Georgia. Today, he works in the city for Georgia Public Health District 8-2. He’s the lead client advocate for New Beginnings, a regional support program for people with HIV.

Adolphus - action
Adolphus Major puts together packets at a Public Health office.

Not everyone in his hometown is so lucky.

Albany is the county seat of Dougherty County, home to roughly 91,300 Georgians. Although there are shopping malls and tidy suburban neighborhoods on the outskirts of the city, much of the Southwest Health District is rural, and the economic focus is agriculture, with big farms and small ones.

This is not the urban landscape that most people associate with burgeoning HIV outbreaks.

“People just feel like it’s not going to happen to them in the smaller town,” said Major, who also serves as co-chairman of the Georgia Prevention and Care Council (GPACC), which brings together people from throughout the state. People think HIV infection is just “not happening here,” he said.

But it is.

In 2015, Health District 8-2 averaged three new diagnoses a month, mostly residents of Dougherty County, said Jackie Jenkins, epidemiology director for the district. As of 2014, Dougherty also has the second-highest HIV diagnosis rate in the state among reporting counties at 63.9 people per 100,000, according to data collected by the CDC.

The only Georgia county where HIV is spreading faster than in Dougherty is the big urban/suburban county of Fulton, where the rate is 68.8 people per 100,000 and a new clinic now offers free pre-exposure prophylaxis (PrEP) in hopes of slowing new infections.

District 8-2 can’t afford a prevention program like that.

Elijah Miranda, HIV program director for the district, said he would love to make lifesaving PrEP available to Albany-area residents, many of whom live in poverty; he just doesn’t know when that can be done and who will pay for it.

The Rural Model Clinic, which provides both HIV-related and primary care to infected patients, received $944,652 from the national Ryan White HIV/AIDS Program in 2014. The clinic holds fundraising events to close the gap between this amount and what’s actually needed to care for all these people, said Jocelyn Cooper, operations manager.

Jocelyn Cooper is operations manager at the Albany HIV clinic.
Jocelyn Cooper is operations manager at the Albany HIV clinic.

The Rural Model Clinic has more than 1,100 HIV-positive clients right now.

But the total number of infected people in the area is likely much higher, given the CDC estimate that one in six people living with HIV is not aware of being infected.

Hitting some populations harder

People in the area who are newly infected with HIV tend to be young African-American men who have sex with other men, Miranda said.

Medical assistant Shaquetta Hilson at the HIV clinic.

The district is trying to work with Albany State University, a historically black campus with more than 4,000 students and the largest university in the area, for targeted prevention efforts, Miranda said.

More than 70 percent of Albany residents are black, according to the most recent census, and more than 35 percent of local people live in poverty, double the national rate. The city’s plight is reflected in the shuttered storefronts of the downtown area. A few functioning businesses — pawnshops and a sandwich shop — are the exceptions among an array of abandoned buildings.

Many low-income families live in small clusters of run-down houses or trailers surrounded by fields of peanuts, cotton or row crops. Some of these people are HIV-positive. Since many don’t own cars, it’s a challenge for them to make it to medical appointments, Miranda said.

The rural clinic has a van that picks patients up and takes them to the Albany location. And twice a month, members of the clinic staff travel 60 miles south to work at the other clinic branch, in the city of Thomasville.

Thomasville, like Albany, has a poverty rate that hovers just above 30 percent. But Thomasville’s poverty is much less obvious. In fact, the city is renowned for its elegant, affluent side.

Downtown Thomasville is a beautifully preserved showplace and a tourist attraction. Victorian-style shops sell high-quality cosmetics and designer shoes. Ritzy restaurants serve yellow fin tuna and quail. It’s a popular getaway destination for people in Tallahassee, the capital of Florida, less than hour to the south.

But behind the public face of Thomasville are many poor people. And when it comes to HIV, the city “was a third-world country right under our noses,” said Carol Biggs, who used to run a local nonprofit there called Safe Haven, Inc.

Are attitudes part of the problem?

The charity provided food and other necessities for HIV-affected people and their families for 17 years, but it ran out of funding and steam two years ago this May.

The Rural Model Clinic treats HIV-positive people in Albany.

On the first and third Friday of every month – the days when the rural clinic staff came to see patients – Safe Haven distributed two weeks’ worth of groceries to HIV/AIDS patients in need. The nonprofit also distributed sheets, light bulbs and other basics. Sometimes it even gave away used furniture.

One thing that ultimately led to the charity’s demise was that many donors did not want to be publicly associated with it. These people feared that others in the community would assume they had the virus and were gay, Biggs said.

“Being in Southwest Georgia . . . there’s still stigma about being HIV-positive,” Miranda said. “There’s still stigma about being homosexual.”

Activists say the fear of being stigmatized is killing some people, causing them not to confront the reality of HIV infection.

Since 2010, 145 people have died from HIV/AIDS in District 8-2. Almost 90 percent of them were African-American, according to official data collected by the Georgia Department of Public Health.

People who choose not to be tested for HIV can pretend they’re fine, said Terri Clark, a nurse who coordinates patient care for the rural clinic. But if they get tested and the result is positive, their lives change forever.

Dougherty County
Dougherty County

In a small town, other people are almost bound to find out, and the fallout can be ugly. “You have to be thick-skinned” to handle the gossip, Major said.

Fear that clients will be outed as HIV-positive is one reason why New Beginnings, the program he leads, doesn’t advertise its services.

The rural clinic also relies on word of mouth, and it doesn’t call attention to itself. It’s in a nondescript building that most people would pass by without a thought if they were not looking for it.

The clinic used to have a highly visible sign, but it was vandalized twice, so the staff decided not to replace it. Now, beside the door, there’s a tiny plaque with the clinic’s name and hours on it, but no mention of HIV.

Major and others are impatient with the secrecy surrounding HIV in small Southern towns. HIV infections that could have been prevented are spreading in southwest Georgia, and keeping quiet isn’t helping anyone, they say.

“I feel like it’s time,” Major said. “We need to get this out. It needs to be known that there are people out there who are not ashamed to talk about it.”

Leigh Beeson is a graduate student at UGA in the health and medical journalism program. She had a bachelor’s degree in communications and was editor-in-chief of her undergraduate university’s newspaper.

Read the other stories in the Place Matters series:
At Easter Seals, ‘every single life has potential’
Child obesity in farm country: Colquitt fights nutrition battle
Ramp builders to the rescue: A life-changing service for Georgians with disabilities
Loss of the local hospital leaves a big hole in a rural region

A clubhouse for learning gives hope to kids with mental illness
Fighting ticks with fire: A health benefit from forest management
Food insecurity in farm country, and how a ‘manna drop’ helps fight it
Clay County: A lot of impoverished patients . . . and one dedicated doctor