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HIV “Cure” Found in Mississippi: Nothing to be proud of

Dubious reports have surfaced that an allegedly HIV positive infant born prematurely in rural Mississippi to an HIV infected mother has been cleared of the virus due to a non-standard administration of HIV drugs. Naturally, I am extremely skeptical.

I wonder if the child ever truly had HIV in the first place. Given that the child was born prematurely, I also wonder how generalizable the strategy would be, assuming that the child did, in fact, have HIV.

The world, however, seems to believe that this is a “cure” for HIV. Optimistically, I would call this a case of prophylaxis.

Most frustrating for me, is the surge of pride from Mississippians. Having grown up there, I don’t think that this is anything to be proud of. The profile of HIV in Mississippi (see my paper draft) is overwhelmingly rural, poor and, most salient, black (See my lit review on HIV in Mississippi).

The simple reason that this so-called “cure” was “found” in Mississippi, as opposed to say, Vermont, is Mississippi’s crushing level of endemic poverty, entrenched racism, and institutionalized marginalization and exclusion. Mississippi’s backward politics and racist history are what caused this epidemic in the first place. Nothing to be proud of.

Equally frustrating are the absurd comments to the effect that “God has come and given us this cure” likely stemming from the heart wrenching involvement of an infant. Assuming that such a deity exists, we should probably fault God with creating the disease in the first place, and allowing babies to be infected through no fault of their own. It seems silly to me to praise a despot for delivering services after he’s made a mess of the place.

Mississippi is sixth in the nation for new cases of HIV. The social dynamics which determine transmission are different in rural and urban areas. Dividing states into clases of rural HIV and urban HIV, Mississippi would come in number 3 just behind Georgia and Louisiana. In fact, though, I would argue that Mississippi’s rate of new HIV cases (25 per 100,000) is actually an underestimate. Health delivery in Mississippi’s HIV hotspots is so inadequate and health care utilization so low, that many new cases are undetected.

I will wait and see if the optimistic reports are true. My feeling is that this is a case of hopeful overstatement. Until then, I will remain skeptical.

Where Guns and I Part Ways

Firearm deaths, US population and gun policy events.

Firearm deaths, US population and gun policy events.

I will admit, I don’t get guns at all.

As readers of this blog know, I grew up in Jackson, Mississippi, where owning a gun is seemingly mandatory (for white people, at least). It would seem that guns are as important to life as Jesus, fried food and philandering.

Some white metro-Jacksonians are so afraid of black people, that they won’t enter the city limits without carrying one. I always thought this was rather odd way to stave off muggers, particularly if one were attacked from behind. Better to provide some poor kid looking for drug money with $10 than a loaded gun. (To be fair, Jackson is one of the most crime ridden cities in the US.)

I’ve seen three people shot in my life-time. Once, I was behind a line of cars in Brooklyn, NY coming back from a show. A man on the street fired 12 shots into the car in front of me, possibly killing both of the people inside. I can’t verify whether the victims survived, but it didn’t look good as I passed.

Another time, I saw a man shot in the head on the street in New Orleans. I learned that all of the arguments over concealed carry are bunk. Shootings happen really, really fast. So fast, that if you blink, you’ll miss it. More disturbing is that manner in which people fall when they’re shot. It’s nothing like the movies and something one doesn’t ever forget.

I am convinced that the many gun rightists have never seen someone shot.

Much of what I know of guns, comes from my drug-addled, socio-pathic step-father. Most Mississippi households have at least one firearm, and mine was no exception. In the darkest days of my childhood, they would be placed haphazardly around the house, in plain reach of anyone who wanted to grab one. Every once in a while, he would pick one up and wave it around for dramatic effect, to punctuate whatever insanity he was spewing at the time. My step father loved guns, presumably because they made up for his own figurative, and possibly literal, impotence.

My father would tell tales of having killed a cocaine dealer in downtown Jackson by shooting him in the chest. The man was so full of lies, that it was difficult to know whether to believe him or not, but for me it was unsettling to know that I might be sharing a home with a murderer.

Which is where guns and I part. That my step-father was able to easily obtain guns is a travesty of public policy. That gun retailers and manufacturers seemingly actively target mentally unstable, paranoid and psychologically weak people like my step-father is unforgivable. That profits are made off the sale of guns to people like him is patently disgusting.

I advocate that America needs to reign in the gun industry, who have distorted the conversation from a discussion of public safety, to one that borders on the religious, uses fantasy, anecdotal evidence and misinterpreted realities to further justify the addition of more weapons to our already massive personal armory. Moreover, in the name of a poorly reasoned political ideology, large amounts of industrial money from non-transparent entities is sloshed at Congress to support a thankfully dwindling minority.

I won’t pretend to be an expert on gun policy. While I would love to live in a gun-free world, it would be wholly impractical to round up all existing weapons in the United States. Moreover, the presence of law-abiding and harmless gun owners make this radical step unnecessary.

If we are going to continue to allow personal stockpiles of weapons, we should follow the model of Switzerland, where, lacking a formal army, citizen gun ownership is almost universal. Intensive training, yearly re-certifications and household inspections, such as that of Switzerland, should be the norm. For well meaning and honest gun owners (which I maintain to be the majority), this will not be a problem.

The American government, as a representative of its people, needs to pull the conversation of guns away from the paranoid nonsense so often peddled by gun profiteers. We need to, as Switzerland does, hold all gun owners to this standard to promote responsible use and attitudes toward gun ownership. Gun ownership should be promoted as a hobby and as a means of reasonable self-defense.

There were 31,347 firearm related deaths in 2011. That’s almost the same as all deaths due to automobile accidents (34,485). Yet, owning a gun is easier than owning a car and requires less training in most states. We would also note that cars are used more frequently than guns. Any regulation that drops that number by even a quarter would be welcome. There would be at least 7,500 more people alive today than otherwise.

John Stuart Mill spoke of the tyranny of the majority, but here, a vocal and well funded minority has dangerously forced the conversation on guns into the world of delusion.

Russell Allen 1962-2012: Mississippi’s First Punk Rocker

Russell (photo by Ed Inman)

I just heard the awful news that Russell Allen, a friend of mine from Jackson, Mississippi, has passed. I hadn’t kept up with Russell much since I left Mississippi, but never forgot him.

Russell was one of Jackson, Mississippi’s first punk rockers. He would enthusiastically show up to just about any show and tell you about it. It was absolutely true. Being a punk in Mississippi can be a lonely affair but Russell pulled it off, mostly because he never considered that it might be a bad idea. Russell was never afraid of anything. He had a suit of armor forged of smiles and laughter.

Sometimes Russell would show up to our band practice space. We would be trying to write lyrics and Russell would come up with lines that would have us rolling on the ground in laughter. I think that he was completely serious, but it was hard to tell. He would deliver his lines in typical Mississippi fashion, totally serious with complete conviction, dressed up in his ultra thick and authentic outer-Jackson drawl:

“Electric energy, unseen force, thrash into oblivion on a pale white horse”

In retrospect, we should have fired our singer and hired Russell. I’m not sure why it didn’t occur to us at the time.

Once Russell led us into the practice space of the WindBreakers, a local band which had achieved some success at the time. I never could figure out if he had the key or he broke in, but we got in, fired up their gear and started jamming out. Russell would again spit off these lyrics that would have you laughing to hard to worry about playing. Eventually, Tim Lee and the WindBreakers showed up with their mouths agape.

You couldn’t really be angry at Russell. He was just too much of a nice guy. Whatever infraction he might have committed was done only in the interest of fun and good times. I never, ever saw Russell say a bad word about anyone at all.

Russell eventually put on a suit and got a job as a jeweler at a mall store. He never ever stopped being Russell, however. Later, after we were somewhat in touch, he sent out a couple emails to me to say “I HOPE YOU’RE HAVING A ROCKIN DAY!!!!!” and really not much more. That was Russell.

Now, I’m kicking myself for not having gone to see him when I was in Jackson last year. Too busy, can always meet him later…. but later will never happen now.

Russell, take it easy, man. You were loved.

A Short Literature Review on HIV in Mississippi

In lieau of an actual post….

Despite making up only 37% of the state population, African Americans account for 78% of HIV cases[1]. HIV infections nationwide are increasing rapidly among African American women(find ref). In 2000, Rural Mississippi had the second  highest incidence of HIV of any region in the country, and heterosexual transmission of HIV was highest in Mississippi, compared with other states[2].  State policies such as abstinence only education, low access to health services and policies which prevent individuals from entering the system until they have full AIDS are exacerbating transmission[3]. HIV in Mississippi has long been shown to be disproportionately high in rural African-American compared with urban and rural whites[4]. Among HIV infected pregnant women, African-American women far outnumber women of other ethnicities, are less likely to present to clinics and more likely to have co-infections with other STIs[5].  Incarceration has been shown to be associated with HIV/Hep C co-infections[6].

Adherence to treatment regimens is affected by lifestyle factors such as drinking and drug use, individual symptoms of depression and social attitudes which stigmatize HIV infected individuals in rural Southern populations [7]. HIV transmission in rural areas of Mississippi has been shown to occur through heterosexual contact and partnerships largely occur between older men and very young women[8]. In urban areas, HIV transmission among MSM has been well documented. Increases in incidence rates of MSM in the urban South is higher than that of MSM in all other regions combined[9]. Like heterosexual partnerships among African-Americans in rural Mississippi that results in HIV transmission, age disparities among MSM pairings are highly associated with HIV transmission[10]. Rural African American male HIV cases were more likely to report being IDUs, were more likely to report concurrent sexual pairings and to report having exchanged sex for money than urban cases. Urban cases, however, were less likely to use condoms than rural HIV positive individuals. These results suggest vast differences in the nature of sexual pairings and thus opportunities for HIV transmission between urban and rural African American populations[11].

Mississippi has one of the highest incarceration rates in the country, and prison populations tend to be overwhelmingly African American and male[12]. Prisons and crime are known to be associated with HIV transmission[13].  Among formerly incarcerated HIV positive males residing in rural areas, those with larger number of past arrests are associated with more sexual pairings, are less likely to use condoms and more likely to buy or sell sex[14]. Risky sexual behavior among parolees has been shown other contexts to be common[15].

Migration which might affect spatial data quality appears to not coincident with HIV diagnosis. One study concluded that although IDUs were more likely than others to change location of residence following diagnosis of HIV, in general HIV transmission in new HIV cases in rural Mississippi and Alabama appears to be occurring locally[16].

 

1.            Mississippi State Department of Health SHO: Reported cases of HIV disease in Mississippi, 2010. Jackson, MS: Mississippi State Department of Health, STD/HIV Office; 2010.

2.            Hall HI, Li J, McKenna MT: HIV in Predominantly Rural Areas of the United States. The Journal of Rural Health 2005, 21:245-253.

3.            Talha Khan B: State policies worsen HIV/AIDS crisis in Mississippi. The Lancet, 377:1994.

4.            Young RA, Feldman S, Brackin B: HIV SEROPREVALENCE AMONG ADOLESCENT MISSISSIPPI SEXUALLY TRANSMITTED DISEASE (STD) CLINIC ATTENDEES-IS THIS A RURAL EPIDEMIC? Southern Medical Journal 1990, 83:2-103.

5.            Rana AI, Gillani FS, Flanigan TP, Nash BT, Beckwith CG: Follow-up care among HIV-infected pregnant women in Mississippi. Journal of women’s health (2002) 2010, 19:1863-1867.

6.            Burton MJ, Reilly KH, Penman A: Incarceration as a risk factor for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection in Mississippi. Journal of health care for the poor and underserved 2010, 21:1194.

7.            Amico KR, Konkle-Parker DJ, Cornman DH, Barta WD, Ferrer R, Norton WE, Trayling C, Shuper P, Fisher JD, Fisher WA: Reasons for ART non-adherence in the Deep South: adherence needs of a sample of HIV-positive patients in Mississippi. AIDS care 2007, 19:1210-1218.

8.            Cluster of HIV-Infected Adolescents and Young Adults–Mississippi, 1999. JAMA: The Journal of the American Medical Association 2000, 284:1916-1917.

9.            Mena L, Johnson K, Thompson C, Thomas P, Toledo C, Heffelfinger J, Sutton M, Ellington R, Larkins T, Rynn L, et al: HIV Infection Among Young Black Men Who Have Sex With Men-Jackson, Mississippi, 2006-2008 (Reprinted from MMWR, vol 58, pg 77-81, 2009). JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 2009, 301:1428-1429.

10.          Oster AM, Dorell CG, Mena LA, Thomas PE, Toledo CA, Heffelfinger JD: HIV risk among young African American men who have sex with men: a case-control study in Mississippi. American journal of public health 2011, 101:137-143.

11.          Williams PB, Sallar AM: HIV/AIDS and African American men: urban-rural differentials in sexual behavior, HIV knowledge, and attitude towards condoms use. Journal of the National Medical Association 2010, 102:1139-1149.

12.          Stemen D, Sorensen J: The Effect of State Sentencing Policies on Incarceration Rates. Crime & Delinquency 2002, 48:456-475.

13.          Okie S: Sex, Drugs, Prisons, and HIV. The New England Journal of Medicine 2007, 356:105-108.

14.          Oser CB, Leukefeld CG, Cosentino-Boehm A, Havens JR: Rural HIV: Brief interventions for felony probationers. American Journal of Criminal Justice 2006, 31:125-143.

15.          Morrow KM: HIV, STD, and hepatitis risk behaviors of young men before and after incarceration. AIDS care 2009, 21:235-243.

16.          Agee BS, Funkhouser E, Roseman JM, Fawall H, Holmberg SD, Vermund SH: Migration patterns following HIV diagnosis among adults residing in the nonurban Deep South. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV 2006, 18:S51-S58.

 

Welcome Back to Jackson, MS.

I’ve long slacked on writing anything new on this blog. In addition to life’s daily set of challenges and chores, I had to suddenly travel to Jackson, MS on some family matters. Truthfully, since I’ve returned, I’ve been far too depressed to write much of anything.

Most people who know me are aware that I lived in Jackson, Mississippi from 1974-1988, which pretty much encapsulates my entire elementary, middle and high school years. Jackson is a vastly complicated city, and the capital city of an even more complicated State. Jackson rarely makes the national news unless one of its young, white residents is caught running over random black people in the night.

To deflect the inevitable rash of hate mail that I’m certain to receive, I will first point out that there are many, many positive and wonderful parts of Jackson. The people of Jackson have worked hard to make something out of an otherwise desolate place, including the Fondren Arts area, numerous cultural areas and hang outs, a music history walk that explores the deep African-American musical roots that run deep there, the renovation of the King Edward Hotel and the welcome but quite slow revitalization of downtown. Plus, the food is amazing. I’d end up with some kind of chronic condition if I lived there.

It’s the other parts that bother me. What bothers me most is the mass silence of Mississippians on the most salient of all their problems. Growing up, we weren’t allowed to talk about them, but rather had to act like the problems didn’t exist and go about life oblivious to that which made Mississippi inherently different than other states. So, for those that may be offended at my list of grievances and complaints, I apologize. You’re still my friends but I can’t be silent.

Violence informs just about every aspect of Mississippi life. Historically, this is true throughout the United States through the bloody displacement of the Native Americans. In Mississippi, however, the slave trade compounds this history. Society in Mississippi does not operate through discussion, compromise and the rule of laws for the people, but rather through the enforced protection of resources for the wealthy, the violent subjugation and suppression of the poor, and the systematic denial of political and societal rights to the vast majority of the state.

A tell-tale sign of the extent of this violence is the presence of security guards from Group 4 Securicor, the world’s second largest private sector employer (after Wal-Mart). G4S, as a large private security firm, operates in areas where state police and security forces are non-existent, castrated or impotent. The presence of G4S usually indicates a failure of the state to provide security for its people. G4S guards are ubiquitous all over Africa. While I was in Jackson, I saw not one city police car, but no less than 20 G4S guards, all of whom were obviously poor African-Americans. Ironically, the job of a Mississippi G4S guard, who is nearly always African-American, is to protect middle class and wealthy white people from other African Americans.

While I was down there, gubernatorial candidate (he’s now won) and Lt. Gov. under the present Haley Barbour, Phil Bryant, stated on the radio that he is upset that Affordable Health Care Act will require that MS add 400,000 people to the Medicaid roles in addition to the 600,000 people that already receive it. In a state of only 2.9 million people, that would mean that more than a third of the state’s population will be on Medicaid. I don’t think this is a bad thing, health care can only be a good thing, but the problem is that for most adults to qualify for Medicaid, one has to make $8,000 a year or less, or 40% of the poverty line. Mr. Bryant is worried (and stated as such) that wealthy MS will have to foot the bill for health care for poor people, and doesn’t even bother to ask what kind of a world (or state) would allow nearly half the state to get by on less than $8000 a year. He doesn’t seem to think that’s a problem at all. Worse yet, the emergency ward at Baptist Hospital is packed to the gills with poor people who aren’t poor enough to receive Medicaid and likely have no health insurance at all, but this isn’t a problem, either.

In fact, white Mississippi blames black people for their poverty, though vague on where the capital is to come from for economic development and jobs in impoverished areas that would inevitably cure most social problems. This is a mantra repeated by the “haves” all over the world and not restricted to Mississippi. To be fair, the African American middle class in Jackson has vastly expanded, which is a good thing. It’s the poor that I’m worried about.

Several times, I went driving around through poor areas of Jackson. The elementary school on Lynch St. had cardboard over broken windows. They obviously have no money to fix them. In some places, the living conditions are as bad if not worse than some shanty towns in SSA. A house burns every night in the winter because people burn wood in their homes to stay warm. The worst of it is only a stone’s throw from the Capitol of the State of Mississippi. While State legislators and lobbyists are having dinner in upscale Jackson eating establishments, poor black kids are living in Somalia like conditions and no one seems to think this is a problem.

This phenomenon existed when I lived there and exists in many, many parts of the US, but the inequality in Mississippi is immense even by Sub-Saharan African standards. In fact, Hinds County’s Gini coefficient (.49) is higher than that of Mozambique, Madagascar and Uganda. Granted, the GDP and average income of Mississippi is higher than all of those countries. Money, however, is linked to the ability of citizens to participate effectively in the political process and, thus, in the distribution of resources. Mr. Bryant’s comments clearly indicate that there is little political will to distribute anything at all.

The problem with the city is that the entire white tax base has moved north of County Line Rd. White people come in to work, but spend their entire paychecks outside the county. It’s the same situation as Detroit over the divide of 8 Mile, which separates Detroit from the suburbs. To make matters worse, since the city doesn’t have any money, the schools are bad, so no one will move back, perpetuating the entire cycle. Meanwhile, black Jackson is angry because they have to live in shit, violence against white people becomes common in either real or imagined terms, which only isolates the white community further, again perpetuating the cycle of separation and marginalization.

Alright, enough. Here are some pictures I took between hospital visits and good food.

Jesus Can’t Even Help Us: HIV in Mississippi

Most people who know me know that I grew up in Mississippi. Everyone who knows that I grew up in Mississippi knows the extent of my disdain for the place. However, I’m thankful for having had the experience, as it has informed much of the kind of person I’ve become, for better or worse. It’s a place filled with incredible challenges and problems, economic inequality is incredible and those on top aren’t interested in the problems of those on bottom. Compound this with a bloody and inexcusable history of slavery, human trafficking, lynchings and hate motivated violence that extended even to my lifetime and you might conclude that Mississippi is an extension of Africa. All of this lined along a background Muzak of Jesus, hellfire and unattainable moral standards that few people actually adhere to. My assessments might seem unfair, but it’s worth mentioning that they are largely fueled through my childhood and high school eyes, rather than adult reason.

Mississippi is already a hotspot for STI’s, with infection rates dwarfing many other states in the union, often on par with those of developing countries. People still die of syphilis in Mississippi in 2010. Low insurance coverage among the largely African American poor, distrust in medical professionals through the fault of exploitative and unforgivable events such as the famed Tuskegee syphilis study, lack of education, lack of political will and political representation create conditions that fuel the spread of a host of infectious diseases, not the least of which is HIV.

HIV is hitting the American South at levels not seen in any other part of the country, outside of Washington, D.C. Most people living with HIV are heterosexual African American men, and African American women aren’t far behind. Mississippi jails more people per capita than any other state besides Louisiana, Georgia and Texas. Incarcerations among African American men are common in the South, often under reprehensible conditions that facilitate HIV transmission. Couple that with social conditions that are unfathomable in other parts of the country (outside of Native American reservations), and it’s easy to see why it’s so bad.

I pulled a table of county level HIV data for Mississippi of of the Mississippi State Department of Health website and fed it into ArcGIS to produce the map above. Logically, population centers produce the largest number of overall cases. However, adjusted rates indicate that the large urban centers (of which there aren’t that many), are not the places facing the highest overall spread of the disease, but rather areas along the Mississippi Delta and traditionally African American counties proximal to Hinds (where Jackson is) are.

A Getis-Ord hot spot analysis finds areas that deviate greatly from the overall mean, both above and below. Basically, it points out areas where the outcome is extreme, relative to everyone else. An analysis of HIV rates for Mississippi counties confirms the existence of areas of extreme concern, when accounting for neighbor effects and overall mean rates. From this, we conclude that rural Holmes and Leflore counties in the middle of the state are by far the worst. While counties in the north and northeast are disproportionately low, these counties west and north of Hinds are of incredible concern. I’ve been to these places. I don’t find this results surprising. I also don’t find it surprising that very few people care.

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