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William Yarber

Tracy James
IU Media Relations

Last modified: Friday, February 13, 2004

Stigma, racism complicate HIV/STD prevention

Lecturer to discuss challenges faced in the South

Small-town life has its benefits and it has its drawbacks, one of which is gossip. In the country's rural, Deep South, gossip can hurt physically when it discourages people with sexually transmitted diseases, such as HIV and syphilis, from seeking diagnosis and treatment.

Bronwen Lichtenstein, a research scientist at the Institute of Rural Health Research at the University of Alabama, said residents in the poor rural areas she studies dread going to public health clinics, often their only medical option, to get checked out for STDs. Not only are there "patient spotters," neighbors who watch clinics to see who comes and goes, but clinic patients and even health workers can have loose lips.

"The smaller the place, the more likely it is for gossip to get around," Lichtenstein said.

Lichtenstein will discuss her findings during a lecture at Indiana University Bloomington on March 1 as part of the 10th anniversary recognition of IU's Rural Center for AIDS/STD Prevention. The center is part of the Department of Applied Health Science in the School of Health, Physical Education and Recreation (HPER).

Among African-Americans involved in her studies, STDs often mistakenly are associated with promiscuity when women have them, she said, and homosexuality when men have them.

Gossip and stigma are only part of the negative equation affecting the transmission of HIV and other STDs among the poor, typically African American residents in the rural Alabama areas studied by Lichtenstein. Poor rural residents often have trouble finding transportation to the public health clinics, which frequently appear run-down because of the low levels of public funding available for the services. Conspiracy theories and "folklore" about AIDS and STDs abound, fueled by a racist history that includes the disturbing revelations of the Tuskegee syphilis experiments, where for decades the federal government conducted experiments on 399 African-American men in the late stages of syphilis, never actually attempting to cure the men.

"Stigma of every imaginable type gets lumped on STDs," Lichtenstein said. "It often prevents people from getting the treatment or getting it sooner."

Lichtenstein was invited to speak at IU because of her focus on rural, African American communities in the South, where the spread of STDs, HIV and AIDS has become a serious problem. The South accounts for 36 percent of the country's population but 39 percent of the people estimated to be living with AIDS, a disproportionate number of whom are African American, according to the national Centers for Disease Control and Prevention. The region accounts for 46 percent of the estimated number of new AIDS cases.

William Yarber, professor of applied health science at IU and senior director of RCAP, said rural communities have 8 percent of total AIDS cases.

"But rural areas have unique problems, the fact of the stigma, isolation from health care, isolation from support services," he said, describing a state of denial often seen in rural areas. "Many rural communities believe they are isolated from the epidemic."

Lichtenstein said more money and evolved attitudes about sexuality would help remove the stigmas and other issues that prevent people in her region from getting the health care they need for their STDs. The United States has a higher rate of STDs than any other Western country, she said, describing it as a major health issue. Yet, information about STDs is generally lacking.

RCAP is the only center in the country that focuses solely on HIV/STD prevention in rural communities. The center distributes prevention and epidemiological information broadly through fact sheets, newsletters, monographs and its national conference, held every two years.

Lichtenstein will deliver her lecture at 3 p.m. in Room 125 of the HPER building, 1025 E. 7th St. An open house will be held at the center, 801 E. 7th St., from 1 p.m. to 2 p.m. Both events are open to the public.

EDITORS: Lichtenstein can be reached at 205-348-2839 or 205-348-3427. For more information about RCAP, visit