The Rising AIDS Epidemic Among Dallas's Young Poor People
The number of young people in Dallas contracting HIV and AIDS is increasing, KTVT-Channel 11 reported Monday, and those young people, ages 13 to 24, now make up 25 percent of all new diagnoses. And those stats were compiled before the state decided to gut family-planning funding and run Planned Parenthood out of business.
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The numbers come courtesy of the Dallas County Health Department, which reports that in 2010, there were 908 new HIV/AIDS diagnoses in Dallas County. Among those, 25 percent were between 13 to 24 (only two were under age 19). That's a slight increase from 2009, when around 20 percent were people aged 13 to 24. Dallas County has the highest total rate of new HIV/AIDS diagnoses in the state, which has been the case for several years, although Harris County is close behind and has more total people currently living with AIDS.
Texas isn't faring much better overall. In 2009, it had the fourth-highest rates of new HIV/AIDS diagnoses in the country, and it's among the 10 states that account for around 70 percent of diagnosed HIV/AIDS cases since the start of the epidemic in the '80s.
"We are seeing more younger clients come through our door over the past two or three years," says Raeline Nobles, director of AIDS Arms, the largest private non-profit provider of HIV services in North Texas. "And over the past 12 months that has definitely increased as well. They do not make up 25 percent of the new infections that we're seeing, but they are definitely rising."
She cautions, though, that some of the statistical increase might be because AIDS Arms, along with the Department of Health, the Resource Center, Urban League, and Planned Parenthood are engaged in aggressive outreach and testing efforts.
"When you offer that kind outreach explosion, it's only natural that statistically your numbers are going to go up, because you're out there on the streets trying to find them," she says. "Some may have had the disease for years, but they're just now being identified because of testing efforts across the city."
But Zach Thompson, director of Health and Human Services for Dallas County, says he believes the numbers are increasing overall, and says public officials are struggling to pinpoint exactly why. In a series of forums that HHS has been holding with children and parents, he says, "What we're finding from the community level is we see a lot of young people between those ages who think they're invincible, think it's not going to happen to them. They're involved in sexual activity, risky behavior, and unprotected sex. ... If you look at teen pregnancy, there's a significant number in Dallas/North Texas area. That's telling you there are a lot of kids out here who are having unprotected sex. When you look at the number of HIV cases on the rise, those numbers are very alarming."
Nobles believes that although the reasons for the increase are complicated, there's one overriding factor: poverty.
"We do have a poverty issue here in Dallas," she says. "Really the HIV epidemic has found its home in communities of poverty. When I say communities of poverty, it's not just income, but a lack of access to information, a lack of access to medical care, and lack of access to a lot of resources out in the community that keeps them healthier in general: not just HIV-free, but diabetes-free, among other things."
Social stigma around discussing HIV and AIDS is another key factor, she says.
"Dallas is trying to get over stigma of HIV and AIDS," she says. "There's still a lot of push-back from the conservative circles. Dallas is very much a part of the Bible Belt, and conversations about sex, drugs, HIV, syphilis and other STDs are harder to take place than in other places." According to the Kaiser Family Foundation, the South accounted for 45 percent of new AIDS diagnoses in 2009, and has the greatest numbers of people who are thought to be living with AIDS, followed by the Northeast.
Nobles in part faults faith communities that aren't willing to talk to their congregations about safer sex. For many people, she says, "the church is really the center of their social interaction, and definitely their support system. If the minister or preacher or priest is not willing to talk about HIV and keeping people healthy, getting tested, those communities usually don't do it."
"There needs to be more involvement in community churches," Thompson adds, "as well as more condom distribution, and, of course, more talk about safe sex at home."
School, though, remains a sticky issue. "Based on teen pregnancies, abstinence education is not working," Thompson says. "The issue is we basically have to go into the 21st century and find a way to have a healthy conversation about sex. How do we involve the schools and the parents in a way that it's win-win? I think that what it's always been is no one wants to feel like you're pushing this subject down their throats."
Nobles says that sex education in Dallas schools, and even somewhat in its churches, looks a little better lately. "Over the past couple of years, the pulpit in faith based organizations is talking more now than they ever have before about HIV. What we're noticing in DISD and other school districts is they're trying to expand their health education, particularly around sex and sexual relationships to become more progressive and responsive to needs of students. It's not where we want it to be by any means, but it is better than it has been in the past."
The majority of new HIV cases she sees among young people, Nobles says, are African-American gay men. "In the young gay community, part of the issue is they know HIV is out there, but there is a percentage of folks who are very fatalistic about it."
The attitude, she says, is almost, "'I'm gay, I'm young, and I know I'm going to get HIV-positive at some time in my life. Why not now? Let's get it over with.'"
Pharmaceutical ads filled with rosy-cheeked, active men, which make HIV management look as easy as popping a pill, are also to blame, she says. "Believe me, none of my clients here look like that young man in the picture."
But the problems go deeper than just HIV, Nobles says.
"Dallas is the No. 1 city in the United States for syphilis cases," she says. "We have a horrible teen pregnancy rate here. We have a horrible STD rate and we have the highest HIV rate in Texas. And a lot of those folks are young folks. What that should tell all of us is that sex is happening. 'Just say no' is not working. We really need to arm our young people with the tools they need to survive and remain healthy as they grow into effective, healthy adults. But that's a very difficult message to get across in Dallas."