Mississippi, one of the poorest states in the United States, has the worst healthcare evaluation, the 10th highest rate of AIDS and 16th highest rate of HIV diagnoses in the nation, according to a recent Human Rights Watch report. The AIDS epidemic has reached such staggering proportions in the state that about half of the population living with HIV/AIDS is not receiving care – akin to statistics in Botswana, Ethiopia, and Rwanda. These numbers are unacceptable for a rich nation with a multitude of resources, such as the United States.
How has the problem gotten out of control? HRW reports that state policies are counterproductive to preventing the spread of HIV and providing treatment for those living with HIV/AIDS. These policies also fail to provide a sex education curriculum that teaches methods of prevention other than abstinence, promoting stigmatization based on infection and sexual orientation.
The AIDS epidemic in the United States is at its worst in the South, which has the highest rates of new infections, the most AIDS deaths and the largest population living with HIV/AIDS. In Mississippi, the State Department of Health reported in 2009 that 9,212 people were living with HIV/AIDS, a 5% increase from 2007. This figure, unfortunately, grossly underestimates the actual number, because 10-25% of people are believed to be living with the disease, but are unaware. Additionally, the disease disproportionately affects those who need help from the government the most – minorities and the impoverished. African-American men who have sex with men are the highest proportion of HIV cases; although African-Americans are 37.5% of the population in Mississippi, they comprise 72% of people living with HIV/AIDS.
In 2006, 70% of all HIV/AIDS diagnoses were among African-American youth from 13-19 years old through sexual transmission. A proper sex education curriculum could help to prevent this if the state would change its laws. The current Mississippi code sets abstinence as the standard of sex education and does not require the provision of information on HIV/AIDS and other STD prevention. If the discussion does include the topic of contraceptives, then the discussion must include the failure rates of contraceptives like condoms, but not the diseases it protects against. Demonstrations involving condoms or any other contraceptives are prohibited.
Mississippi’s laws promote stigmatization of HIV/AIDS and homophobia. The sex education statute, for example, requires the teaching of an antiquated anti-sodomy law that criminalizes homosexual activity with a punishment of up to ten years, even though anti-sodomy laws across the nation have not been enforceable since the Supreme Court declared them unconstitutional in Lawrence v. Texas. The Mississippi Code also states that individuals testing positive for HIV shall be reported to the Department of Health and may be subject to quarantine. Such laws create an environment where people are afraid to get tested for HIV and are not given the information necessary to prevent infection, especially among gay men who are at the highest risk of becoming infected.
Many people with HIV/AIDS live under the Federal Poverty Line (FPL) and do not have insurance. This leaves them with very few choices. One option is Medicaid, although, Mississippi’s Medicaid eligibility requirements are among the strictest in the nation. In order to be eligible for Medicaid in Mississippi one’s income cannot be higher than 46% of the FPL – $845 per month for a family of four (the national average is 66% of the FPL). Thus, those who do not meet the strict income eligibility requirement must wait until their HIV advances to full-blown AIDS, when they may apply for Medicaid based on disability status. The Federal government allows states to apply for a waiver in order to provide HIV patients with Medicaid, however, this is something Mississippi has not done.
In March 2010, the Federal Government passed sweeping healthcare reform legislation that would, among other things, expand Medicare eligibility to everyone living at or below 133% of the FPL. This part of the legislation does not take effect until 2014, but states may apply for an early expansion. Again, Mississippi has failed to take Federal dollars to help provide adequate healthcare to its citizens. In fact, Mississippi Governor, Haley Barbour, has taken action against this healthcare legislation by joining a lawsuit with 26 other states challenging the constitutionality of the health care reform legislation.
Barbour, who may run for president on the Republican ticket in 2012, seems adamant about distancing himself from anything that may be seen as big government. He rejected $56 million in Federal stimulus funds for unemployment benefits in 2009, praised Mississippi’s Medicaid eligibility requirement that applicants must have a face-to-face meeting (the only one in the nation), which he cites as a key-factor in removing 100,000 people from Medicaid, and lambasted the Massachusetts state health care plan that was passed during the Governorship of another potential Republican presidential contender, Mitt Romney. Barbour’s leadership is detrimental to the citizens of Mississippi, especially regarding HIV and AIDS. He has a duty to protect his citizens, but seems more interested in shoring up his conservative base than aiding in the prevention of the spread of HIV and the treatment of those infected in his home state.
From a human rights standpoint, the United States, signatory to both the Universal Declaration of Human Rights (UDHR) and the International Covenant on Economic, Social, and Cultural Rights (ICESCR), but party to only the former, has a duty to provide adequate healthcare to its citizens. The UDHR states in Article 25,
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
Similarly, Article 12 of the ICESCR,
“recognize[s] the right of everyone to the enjoyment of the highest attainable standard of physical and mental health…[t]he prevention, treatment and control of epidemic, endemic, occupational and other diseases [and] creation of conditions which would assure to all medical service and medical attention in the event of sickness.”
The access to adequate healthcare in Mississippi is a problem that must be faced immediately. The racist, classist, and homophobic state policies that make it difficult for people living with HIV/AIDS to receive healthcare and to be open about their status must be repealed. The state must apply for waivers to allow people living with HIV to be eligible for Medicaid and to allow people living at or below 133% of the FPL to be eligible prior to its implementation in 2014 by the new Federal healthcare act. Additionally, sex education for Mississippi youth must be changed to include discussion of preventing the spread of sexually transmitted diseases, including HIV/AIDS. Finally, Governor Barbour must stop the political posturing and focus his energy, instead, on combating the AIDS epidemic in Mississippi.