Mississippi HIV crisis exacerbated by government, says human rights report

Rampant poverty, stigma and a state budget process that ignores the problem are all contributing to an HIV crisis in Mississippi where access to life-saving medical care and basic prevention services are delayed or non-existent.

Those factors combined to force Human Rights Watch to issue a scathing report earlier this month highlighting the crisis as one of fundamental human rights violations.

AIDS activists protesting at the state Capitol in Jackson, MS earlier this month were ordered to hide a bowl of condoms because they were considered “offensive.” To ensure the condoms remained out of sight, Mississippi state police stayed at the protest for the remainder of the day, reports Luke Versher of AIDS Action Mississippi.

This simple bowl of condoms whipped up an astounding controversy. Unsatisfied observers quickly placed calls, and an unidentified representative approached a member of our group. He said, (and I paraphrase):

“Do you realize where you are? You are in the great state of Mississippi Capitol, and such a display [the condoms] is offensive.”

Minutes later the capitol police was dispatched, and the chief of police was standing in front us. The condoms could not be displayed, he said, and had to be removed. Immediately. To ensure that they were not shared again, additional police officers were stationed close by.

This attitude, the Human Rights Watch report found, was not an isolated belief in Mississippi. According to the report, Mississippi schools are prohibited from discussing condoms except in a negative light. Further, Mississippi school sex education programs are required to focus on abstinence-only education. The result, the report found, was an rising rate of HIV and other sexually transmitted infections.

In 2008, Mississippi ranked number one in both chlamydia and gonorrhea rates among the 50 states. Mississippi ranked in the top 10 in rates of syphilis, with a rate that has more than tripled since 2004. These diseases affect African-American women and girls in Mississippi disproportionately. For example, 62 percent of women with chlamydia in Mississippi are African-Americans. Almost half are in the age group 10-19, and of these, 61 percent are African-American girls. Sixty eight percent of girls 10-19 with gonorrhea in Mississippi are African-American. Mississippi also ranks first in the nation in rates of teen pregnancy, an indicator of high levels of unprotected sexual activity among youth.

Those indicators, as well as the staggering increase in new HIV infections prompted a joint health investigation by the Centers for Disease Control and Prevention and the Mississippi Department of Health in 2008. That investigation found the state was woefully unprepared for and unable to address the epidemic.

According to HRW, the state’s sole spending on HIV comes from $27 million in federal cash sent to the state for the Ryan White Care Act and the AIDS Drug Assistance Program. Because the state spends none of its own tax dollars on the problem, vital services such as access to medical care, housing, and transportation to medical appointments are lacking. Access to stable health care is also limited by the strict eligibility requirements for Medicaid/Medicare in the state. In order for a person with HIV to qualify for such insurance, they have to have developed AIDS.

The state also provides only 21 annual weeks of housing assistance to people living with HIV, which leads to more instability in housing because so many people with HIV are living in poverty. Some are surviving on such small amounts of money they consistently face a housing crisis, the HRW report concludes.

Perhaps most troubling, according to the report, are state laws and policies which create a hostile environment for people with HIV.

Like 33 other states, Mississippi has a law making failure to disclose an HIV-positive status to sexual partners a felony. Conviction under this law can result in a prison term of three to 10 years.

As in Michigan, the state has the ability to use public health authority to control people. In Michigan, “recalcitrant persons” are subjected to potential involuntary incarceration, forced medical care and more. In Mississippi, health authorities can issue a quarantine order under a law which empowers health authorities dealing with persons “afflicted with a life-threatening communicable disease.” Failure to follow the quarantine order can result in a felony conviction, sending an HIV-positive person to prison for five years.

The HRW report argues that such measures are ineffective and possibly even counter-productive to their goal:

Targeting people with HIV for penalties related to their sexual behavior is problematic for both health and human rights. Because other criminal laws prohibit acting against another person with intentional harm, laws that single out people with HIV are unnecessary and discriminatory. These laws may have been expected to increase communication between sexual partners thereby reducing transmission but there is no evidence to support this. Imposing harsher penalties on those who are aware of their HIV status may discourage HIV testing and diminish an individual’s willingness to seek care and services. In addition, studies conducted in the United Kingdom have found that some gay men are less likely to insist on condom use with a partner whom they perceive as being under a legal duty to disclose his HIV status, as they assume he will comply with the law.

Most troubling to the HRW researchers, however, was the impact on African-Americans in Mississippi in relation to the HIV epidemic.

The severe and disproportionate impact of these failed laws and policies on African-Americans in Mississippi is highly problematic from a human rights perspective. The US is obligated to address health disparities based on race, an obligation that includes the duty to end ostensibly neutral policies that nevertheless have a discriminatory impact on racial groups and to ensure compliance at the state and local levels. Mississippi’s current approach to HIV is inconsistent with both public health and human rights imperatives.

In addition to the issues cited above, the report documents widespread actions by health officials in the state which might inappropriately impact HIV prevention and treatment options in that state. Health officials have been documented as rude and abusive by officials from Mississippi as well as HIV positive clients and HIV groups in the state.

Like Michigan, the state health department also uses documents which advocates, including Human Rights Watch, raised red flags about. Until very recently, the state officials required HIV infected persons to sign a document which indicated they understood the “necessity of not causing pregnancy or becoming pregnant.” That document led many HIV positive women to believe it was a crime to become pregnant, even though studies show that women on successful anti-retroviral medications are likely to give birth to uninfected, healthy babies and have little to no health effect on the mothers.

In a video put out by HRW, Sandra Stringfellow, a Mississippi woman with HIV, explains what living with the infection in that state is like.