In Sherryl Broverman's AIDS/Emerging Diseases class students often begin the course expecting to learn about the worldwide pandemic.
What many may not know, however, is that HIV infections and AIDS is a growing problem in the South, especially North Carolina.
"We tend to think of [HIV] as an urban issue and... we culturally associate drug use and sexual activity with urban anonymity, but that is not the case," said Broverman, associate professor of the practice of biology and director of the global health certificate. "HIV is becoming a rural disease."
In 2005, North Carolina and four other states combined to account for 52 percent of new HIV infections in America, according to statistics compiled by the Henry J. Kaiser Family Foundation, a nonprofit organization focusing on national health care issues.
As of June 2007, there were 11,271 individuals who were HIV-infected and 8,192 who were living with AIDS in North Carolina, the statistics indicate.
As a result of the epidemic's spread in the state, several measures have been taken to curb the rate of new infections.
Last Wednesday, the North Carolina Commission for Public Health voted to make HIV screening a requirement for pregnant women who come to a medical facility ready to deliver and have not already taken the test.
"We are trying to routinize HIV testing... and we rather it be an opt out than an opt in," said Jeff Engel, chief of epidemiology at the North Carolina Division of Public Health.
This will make it possible for health providers to reduce the risk of HIV transmission from mother to child from 25 to 2 percent if the test is positive.
Currently, two to four babies are born HIV positive every year in North Carolina, said Dell Williams, head of epidemiology and special studies in the HIV/STD branch of the North Carolina Division of Public Health and one of the authors of the regulation.
"Not every provider will suggest testing or will motivate patients to be tested, especially women with no prenatal care," he said. "At this moment, we have one last opportunity to try to provide an intervention if it seems to be necessary."
Mandatory testing, however, is not likely to be extended to any other sector of the population, health care officials said.
"Because of the individual rights issues... adults living in the United States should be able to make a decision on their own health care," Engel said. "Where it differs in the mother-child infection is because you're dealing with someone else's life. That's when the state should step in to protect life."
A significant number of states with the highest proportion of new AIDS cases are in the South, including Texas, Louisiana, Florida, Georgia and North Carolina. Broverman said poor-health indicators in the South are generally higher than the rest of the country.
"It's a reflection of a greater failure of health care in the southern part of the United States," she said. "But why? Nobody knows."
North Carolina has a strong grassroots movement to promote testing and prevention in community health centers, Williams said.
Yet the Durham County Health Department and the Partnership for a Healthy Durham still list AIDS as one of the leading causes of death in the area.
"I think we've made great strides in the past few years. However, primary prevention can always be improved," Engel said. "It is a very difficult public-health intervention because of people's lifestyle choices."
At Duke, the Know Your Status campaign sponsored by the Student Health Center encourages students to make HIV testing a routine and provides rapid HIV testing weekly on West Campus on a walk-in basis.
Get The Chronicle straight to your inbox
Signup for our weekly newsletter. Cancel at any time.