Showdown in Choctaw County

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DESHAZO AND HIS co-workers represent a thin line of defense against this brewing public health crisis. Impoverished patients already have overburdened Alabama’s small network of AIDS agencies. Mobile AIDS Support Services (MASS), for which deShazo works, has five caseworkers for roughly 800 clients in Mobile and the surrounding six rural counties. Most of their patients don’t have private insurance, Medicaid, or direct access to the new drug cocktails. The caseworkers spend the bulk of their time just trying to get medicine for their clients. MASS needs to hire more staff, but as it is can only afford to pay people like deShazo a salary of $23,000.

As deShazo crosses Choctaw County, a couple of logging trucks stacked with clear-cut pine trees rush by in the opposite direction. The last cotton plantations disappeared in the 1960s, and paper mills are pretty much the only industry now. The county is home to 16,000 people, roughly half of whom are black, with 22 percent of the population living in poverty. And there are no hospitals or infectious-disease doctors in Choctaw County.

DeShazo drives through Gilbertown, which isn’t much more than a stoplight, a cemetery, a grocery, a pharmacy, and a dollar store, and makes a right turn down a narrow, unmarked dirt road. He saw the Jackson sisters once before, as a favor to the social worker in Selma who is supposed to be in charge of their case. A part of him is pissed off that they’ve dropped off the agency’s radar since then. At the same time, he’s not surprised, given the patchwork nature of AIDS care in Alabama. As worried as he is about these girls, he seems charged up about the case, confident that he has the skills to work through the welfare system so that the sisters can get the medications, doctors, and care that might save their lives. It’s a sense of purpose that he has rarely felt in other social work jobs, which mostly left him feeling weak and hopeless.

DeShazo pulls over in front of a trailer home, steps out, climbs three rickety steps, and knocks. A female voice yells to come on in.

DeShazo opens the door and feels a wave of heat. The first person he sees is Sara, who is sitting on a couch changing a 2-year-old boy on her lap. She’s wearing a Michael Jordan T-shirt and her hair is in long cornrows. He is relieved to see that she has full cheeks and looks healthy. Another child in blue pajamas is giggling and waddling back and forth on the floor. Piles of clothes, empty soda cans, and an overturned tricycle litter the living room. A raspy cough comes from the kitchen, where Sara’s sister, Rebecca, is slumped over a chair facing an open oven, trying to keep warm. She must have fever chills because the trailer is stifling, almost too hot to breathe in. DeShazo sets his bag of clothes and toys down on the floor. "Hi, I’m David deShazo from Mobile AIDS Support Services," he says. "How y’all doing?"

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