HIV Prevention Fractures Into Local Struggles

Nine of South Carolina's 46 counties still are not part of the regional collaborations formed to administer almost $ 1 million in federal funds and thus have received none of the money. Located in western South Carolina, they include some areas whose AIDS rates are among the highest in the state, said Dorothy Waln, the state planning group's other co-chairman.

"The [local] health department could have taken the lead and pulled some folks together . . . but they didn't," said Waln. "Who knows why?"

One reason is that in conservative regions like the rural South, many local organizations are reluctant to get involved in AIDS prevention. Although churches are among the most powerful local institutions in the South's rural African American communities, they have not taken an active role in preventing HIV and serving people with AIDS, said David James, a minister at Brooklyn Baptist Church in Columbia.

Thanks to James's efforts, his own church is an exception. In 1994, he announced to his congregation that he was HIV-positive. They responded by forming care teams to help people with AIDS and sponsoring educational conferences. James's attempts to get other congregations to follow his church's example have failed. Brooklyn Baptist remains the only African American church in the capital with an HIV ministry, and few exist elsewhere in the state. He said churches refuse to get involved because of the disease's association with homosexuality. "It's not the HIV," he said. "It's homophobia."

Harrison Ervin, a minister at Lake City's Wesley Chapel Methodist Church, which has formed an AIDS care team, said fear of HIV and of the stigma attached to the disease are additional reasons. "People shun away from it," he said. "Even individuals who have the illness shun the public." He said one woman in his congregation has known for two years that she is HIV-positive but has been afraid to tell her brothers and sisters.

But AIDS activists say the community planning process seems slowly to be changing public attitudes in South Carolina and other conservative states. After Gov. David M. Beasley (R) last January requested that the state health department stop distributing condoms to public clinics and private family planning and AIDS organizations -- saying the distribution implied "that the government condones behavior that many of our citizens view as unhealthy, inappropriate and in some cases illegal" -- AIDS organizations and other health agencies acted immediately.

"That morning the article [about Beasley's position] came out, we were all on the phone calling each other," recalled Carmen Julious of Palmetto AIDS Life Support Services, Columbia's oldest AIDS service organization. "We emphasized that it is responsible behavior to use condoms, whether you're male, female, heterosexual or homosexual."

Although condom distribution was halted for two weeks, health officials -- with broad public support -- ultimately were able to convince the governor that giving away condoms would prevent disease and save money in treatment costs. Distribution was permitted to resume provided that abstinence was emphasized as the preferred means of preventing infection.

CDC officials say the future of the epidemic depends on the outcome of countless local battles, such as the efforts in South Carolina to teach teenagers such as Sauls about AIDS and to keep condom distribution programs intact. If the state gains ground against the epidemic, the heroes of the South Carolina campaign will be DiAna, James and other local activists and health educators who have spent much of the last decade trying to change people's minds.

"Just the number of years they have put into it, doors slamming in their faces," said K. Allen Campbell, a member of the community planning group that sets HIV prevention priorities for the state. "They tell [people] what they don't want to hear, but after a while they have to listen."