North Carolina and the Problem of AIDS: Advocacy, Politics, and Race in the South

INTRODUCTION. In a Place So Ordinary: The Problem of AIDS in North Carolina and the American South

INTRODUCTION IN A PLACE SO ORDINARY The Problem of AIDS in North Carolina and the American South In February 2003, North Carolina’s Screening and Tracing of Active Transmission (STAT) team learned of two black college men who tested positive for “acute” HIV infections. After an initial HIV infection, it can take several weeks for the body to make antibodies. During this “acute” phase of infection, individuals are at their most contagious owing to a high viral load, but since standard HIV tests only detect antibodies to the virus, they often fail to detect infections in the acute phase. In the mid-1990s, researchers developed tests called nucleic acid amplification tests (NAAT) that could target nucleic acid sequences specific to HIV, allowing them to identify HIV infection at much earlier stages. By November 2002, North Carolina had established a team that performed NAAT tests on all new HIV-infected blood samples from publicly funded venues.1 It was this team that uncovered the acute infections in the two college men. These results caught the STAT team off guard: while they knew college students acquired HIV, they had not considered “colleges as hot spots for transmissions.” Indeed, the team realized they knew very little about how frequently seroconversions occurred among college students in North Carolina , and they set out to explain what was going on. Were these just incidental findings, common occurrences, or signs of a new trend? What the team uncovered was a mini-outbreak of HIV among college students in and around Raleigh and Durham. The particulars of the outbreak were unique: of the twenty-eight college men who had acquired HIV in the Raleigh-Durham area in the previous three years, most were black, most had sex with men, and most attended historically black colleges. In August 2004, the Centers for Disease Control and Prevention (CDC) published the results of the STAT team’s investigation in its Morbidity and Mortality Weekly Report (MMWR).2 At the time this report was published, I was a graduate student in the history of medicine at Duke University with a particular interest in the history 2INTRODUCTION of AIDS. I has also just taken paternity leave from my job as director of a mentoring project for at-risk children and adolescents in Durham, North Carolina. Part of my work with the project involved pairing disadvantaged but academically gifted high school students with doctors and medical students at Duke University School of Medicine. I also spent time with the students teaching them various life skills and healthy behaviors. Several of my students were African Americans, many planned on attending historically black colleges in the state, and at least two of them were gay. So when, in the course of my graduate research, this article caught my eye, I immediately thought of “my kids.” The truth was my students had seen a lot of life. Many of my students were sexually active, some had contact with gangs, and at least one was pregnant. We talked very openly about their private lives. I wondered what they would make of this study when I spent time with them later. Since I was writing letters for their college applications, I knew my gay students would ask me directly whether they should reconsider going to historically black colleges. The rest would ask more general questions, like why black men in North Carolina’s black colleges were at greater risk for HIV than others. These questions were only compounded in the ensuing months, after the CDC released a second report on high rates of HIV among local women, “HIV Transmission among Black Women—North Carolina, 2004.”3 These studies prompted the expected questions and several others when I broached them with my students and with others. How large a problem was HIV/AIDS among African Americans in North Carolina, everyone wanted to know. Moreover, if the problem was as dire as these CDC reports suggested, how had HIV/AIDS become such a problem? When I had discussed AIDS with my students, I largely referenced San Francisco, New York City, crack houses, or Africa; we never considered that a rampant AIDS epidemic might exist among African Americans in North Carolina. And yet here we were, with some of my students worried about what they might find when they started college the following year. How had things gotten this way, they wanted to know, and what was being done about it? At the time, I did not have any good answers...