Back Talk from Appalachia: Confronting Stereotypes

Stories of AIDS in Appalachia

Stories of AIDS in Appalachia Mary K Anglin History is memory's skin, under which pulses the blood and guts ofour real lives. Our stories are our way offashioning a surface with which we can live, that we may present to our neighbors, our friends, our family, our children (especially these last). The truth lies not in the facts of the stories but in the longings that set them in motion. Fenton Johnson, Scissors, Paper, Rock There are many stories about human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). Some of these are the "official" accounts offered by journalists and experts on AIDS, and some, the literary imaginings of writers such as Fenton Johnson. Others are stories of ordinary people living, and dying, with HIV disease. This essay explores each of these kinds of stories for what they tell us about Appalachia, and the motivating forces behind these accounts. However, the purpose of this inquiry is more sharply fixed. It is to show that in the 1990s, stories of HIV and AIDS have been presented in a manner that portrays Appalachia as backward and inhumane. While these stories are told in lively and even compassionate ways, they have no more truth to them than accounts that show how families and communities have cared for men and women, often all too young, who are dying from AIDS. In part, what makes the negative tales so compelling is that they resonate with centuries-old imageryofAppalachia as"broken" and in need offixing bythose with greater knowledge and resources. My Own Country, byAbrahamVerghese, is a good example ofthese issues. Subtitled A Doctor's Story ofa Town and Its People in theAge ofAIDS, the book chronicled the difficult circumstances experienced by people living with AIDS in the southern mountains. Presenting himself as a "foreign physician" and "Western shaman:'Verghese described how he tried to make a difference in the lives ofhis patients during the mid- to late eighties, when he was an infectious disease doctor in East Tennessee.l 268 ~ Mary K. Anglin To explain what these experiences meant, Verghese offered a portrait of the mountains he called his own: "I know how the road rises, sheer rock on one side, how in places the kudzu takes over and seems to hold up a hillside, and how, in the early afternoon, the sun glares directly into the windshield ... [I can see] hay rolled into tidy bundles, lined up on the edges of fields. And tobacco plants and saggingsheds with their rusted, corrugated-tin roofs and shutterless side-openings:'2 In this rustic setting were an "earthy and appreciative" people who sought care in the regional hospitals where Verghese worked, first as a physician just out of medical school, and later as a specialist.3 The residents , as much as the beauty of the place, were what enticed Verghese back to southern Appalachia after he had completed his training elsewhere. There were, according to Verghese, two kinds of people in East Tennessee: "rednecks" and "good ole boys:' The former term applied to people whom he characterized as living in"little hollows:' in trailers"with no underpinning and dogs all around ... and children playing under[neath].... That world was food stamps and ignorance and rotted teeth and rheumatic fever and a suspicion of all strangers:' (Italics Verghese's.)4 "Rednecks:' from this perspective, lived in poverty and ill health, conditions they were apparently unable or unwilling to change. "Good ole boys:' however, "had evolved from fighting with the Indians and feuding with each other to become folk who, as they told you themselves, would give you the shirt offtheirback-ifyou were their friend:'5 Theylived in an increasingly gentrified world ofshopping malls and high-tech medical centers , and wore their flannel shirts tucked in their jeans. These were the people who drew Verghese back to the mountains of East Tennessee and to the mission of a rural doctor. What marks this account is its mixture of sympathy and stereotype. Yet even the sympathetic dimensions ofVerghese's characterizations reveal the distance that separated him from the east Tennesseans he came to know during his five-year stay. Negotiating that gap was certainly not easy for the young physician whose foreign accent and appearance distinguished him from many residents of the region and whose work with people living with AIDS often served to alienate him from other health care providers in the early years. While mindful ofthe complex position occupied byVerghese, we must be equally sensitive to...