North Carolina and the Problem of AIDS: Advocacy, Politics, and Race in the South by Stephen J. Inrig (review)

In North Carolina and the Problem of AIDS, Stephen J. Inrig revises narratives of the AIDS epidemic in the United States that have foregrounded primarily gay men living in major urban centers such as New York and San Francisco. This history of AIDS in North Carolina not only introduces geographical diversity but also demonstrates the extent to which histories of the epidemic among white and black communities, in both urban and rural areas, have differed from one another. Inrig tackles two overarching questions. First, why did the AIDS epidemic follow two overlapping but different paths in North Carolina, one among the gay white male community and another among African Americans? And second, how did the earliest programs developed to fight the epidemic, particularly among gay white men, translate to African American and other minority communities?

To answer these questions, Inrig mines a rich array of sources, including institutional archives of AIDS service organizations (ASOs), oral histories, and public health studies, centering his account on the institutional history and policy-based approaches developed to fight the epidemic. Six chapters narrate the history of AIDS in North Carolina, from the first cases in the early 1980s to continuing difficulties in addressing infection, particularly among minority communities, since new medical treatments have emerged. The development of protease inhibitors and highly active anti-retroviral therapy (HAART) in the mid-1990s effectively transformed AIDS into a chronic and manageable disease for people with access to health care. Yet, Inrig shows, this medical advance has had little effect in curtailing the epidemic among minority and rural communities.

Following national trends, leaders within North Carolina’s white gay community responded most quickly to the outbreak. In 1982 Carl Wittman and David Jolly joined their lesbian friends Timmer McBride and Aida Wakil to form the Lesbian and Gay Health Project (LGHP), the state’s first ASO. Growing out of the women’s health movement and experiences with antigay discrimination, the LGHP developed health policies grounded in concerns for individual privacy and nondiscrimination, an approach that worked well for many within the white gay community. As Inrig points out, however, African Americans in North Carolina also confronted a high number of cases in these first years, though they often remained underreported. Moreover, the epidemic proved more diverse in the black community: it affected both men and women, and methods of contracting HIV included both same-sex and opposite-sex sexual encounters as well as intravenous drug use (40).

Attention to this early history of infection among African Americans revises what Inrig terms “the changing face of AIDS” model for understanding the epidemic (4). This historiographical narrative emphasizes the shifting racial and gender demographics of the epidemic, from white gay men in urban centers in the 1980s to African American and Latino communities and women since the 1990s. In contrast, Inrig details two simultaneous epidemics, often split along the lines of historically segregated communities. Inrig examines the historical and structural factors that shaped the epidemic among African Americans and subsequently made outreach to members of this community far more difficult, especially for ASOs staffed mostly by white leaders accustomed to working with predominantly white gay communities. Issues of poverty, violence, drug addiction, and community dispersion and higher rates of incarceration collided to elevate the risk of HIV infection among African Americans.

By the mid-1980s, the LGHP had realized the necessity of addressing the epidemic in the African American community. It responded by hiring racial minorities such as Garry Lipscomb, who AIDS workers hoped could more effectively break into underground circuits of black gay culture and men who have sex with men (MSMs). Even members of the African American community who attempted to wage an effective campaign faced an uphill battle. Activist Howard Fitts and his AIDS Clearinghouse approached a broader range of minority populations by reaching out to schools, historically black churches...