Friday, Jul 25, 2008
Could Southern politeness be hindering efforts to stop the spread of AIDS?
Feb 26, 2003 | When the Centers for Disease Control announced last November that the American South has more people living with HIV and AIDS than New York or San Francisco, it came as a shock to people who've always associated AIDS with urban centers.
According to the CDC, the 17-state Southern region, from Texas to Washington, D.C., not only has more residents with HIV and AIDS, it also has the ugly distinction of being the only area in the country with a significant increase in infections (9 percent). And worse, the CDC says the South accounts for 40 percent of people estimated to be living with AIDS and 46 percent of the estimated number of new cases.
Why did the South get this most unwanted distinction? There are a lot of demographic reasons. We have the highest concentration of the group most likely to be infected: African-Americans. We have the highest concentration of another group most likely to be infected: poor people. We also have the highest concentration of the group most likely to stop effective AIDS prevention efforts: Bible Belters. But there's something more. A context that amplifies these demographic factors: the southern culture of politeness and indirectness.
Why would the South's emphasis on civility and genteelness contribute to the rise of infection? Because one of the most effective ways to stop the spread of HIV is to know if your potential sex partner has it. Sexual behavior changes dramatically with that knowledge. It'll either prevent you from having sex with him or her in the first place, or severely limit what risks you're willing to take.
But unless your potential sex partner volunteers the information, the only way to know if he has HIV is to ask. Imagine what Southerners, some of whom still refer to the Civil War as "the recent unpleasantness," think of the propriety of asking whether you have a virus coursing through your body.
To test my hunch I conducted an unscientific poll of readers to my sex advice column (which runs in all regions of the country). I asked one simple question: "Who is the least likely to ask if you have HIV?" "Southerners," was the unanimous answer.
Dr. Brad Thomason is a psychologist and one of the main advisors to my column. He is a clinical supervisor for the Center for HIV Educational Studies and Training in the Chelsea area of New York City. Born in Kentucky, schooled in Louisiana and a resident of Georgia, Thomason agrees that the Southern tradition of avoiding "difficult" conversations has contributed to the rise of HIV and AIDS here.
When Thomason moved from Atlanta to New York he noticed a vivid difference: Southerners almost never ask or volunteer their HIV status while New Yorkers won't shut up about it. "I always ask my partners," Thomason says. "I know too much not to. But what I notice is that in New York I don't often get a chance to ask because my partners beat me to it."
Unlike Dr. Thomason, I do not have the privilege of saying I'm from the South, only the honor of saying I live in it. I've had plenty of chances to move but I've stayed for 17 years. I'm too enamored of the Southern trait of minding your manners.
I remember my first experience with Southern "indirectness." I was in a hot stuffy class waiting for the teacher. I was about to blurt out, "I'm hot, somebody open up a window," when I heard a guy say, "Is anyone else warm? A breeze would certainly be a welcome addition."
The charm of the euphemism is everywhere in the South. Where a Northerner might ask you why you're so freakin' angry, a Southerner would say, "Who licked the red out of your candy?"
Last month a girlfriend of mine came over with her dog, Millie. I blurted out, "God, Millie's gotten fat!" Now, that's not what a true Southerner would say. When my girlfriend's Georgia-born neighbor saw Millie he said, "Gosh, she hasn't missed any meals, has she?"
Sometimes the habit of indirectness goes beyond charm into the absurd. Take my friend Durrett. He and his two brothers are gay. Every year they take their boyfriends to Mississippi and have Christmas dinner with their mom. They've never come out to her and she's never asked why they keep bringing guys home instead of girls. Six men, a mom, a meal, and no mention of the obvious. It perfectly captures the paradox of the South: love, warmth and silence.
Unfortunately, silence is the shortest distance between social grease and spreading disease. Southern propriety doesn't just prevent Southerners from asking a question that might save their lives ("What's your HIV status?"), it -- along with school policies -- also prevents AIDS workers from communicating in ways to save those lives. According to Chris Parsons, director of community relations for the South's largest AIDS prevention organization, AID Atlanta, the South's reticence to speak about uncomfortable subjects effectively shuts down any meaningful dialogue about ways to keep people safe.
For instance, AID Atlanta does a lot of education in middle schools and high schools. They bring their message to classrooms, but according to Parsons, "We can't talk about HIV in the way we want because all sex education in the South is abstinence-based."
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