Showdown in Choctaw County

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When deShazo gets back to the trailer, Sara has put the place together: The tricycle has been righted, and the clothes that were on the floor have been put away. Rebecca is sitting up, talking on the phone. She flashes a smile and for an instant looks like any other teenager. DeShazo sits down in front of her. She puts down the phone and is holding William tightly in her arms on the couch.

"Do you ever feel like there’s no reason to live, Rebecca?" deShazo asks.

William’s head is buried in her breast, and she is rocking him back and forth. "Sometimes," she says and stares at the ground.

"Is there anybody you can go to when you feel like that?" he asks.

"There ain’t nobody but myself," she says and clenches her jaw. Her eyes fill with tears, but she stops herself just short of crying.

It is late afternoon, and deShazo prepares to leave. He has scheduled an appointment with the sisters for next week and has asked them to arrange for their mother to be there. On the drive back to Mobile he has Jimi Hendrix playing on the tape deck, and he’s muttering about the chaos of the situation. Why hasn’t Rebecca been given her medication for her depression? And how is he going to deal with a girl who is on the verge of death, a couple of boyfriends who might be infected, an illness that is a secret, and another infected girl who is pregnant and about to lose her Medicaid?

If Sara is denied benefits, deShazo says, he will apply for free medications from one of the pharmaceutical companies. He also wants to get the sisters on a program that will help pay for electricity and heat without exposing that they have HIV. He carries a generic business card that says he works for the United Way. Maybe he can use it to cut a deal with the local utility company. He would like to find a nurse in the area with some HIV experience who will check up on Rebecca, but that will involve getting Rebecca approved for Alabama’s home health program, which requires a medical history from her doctor and the cooperation of the Choctaw County health department. She might be dead by then.

There is a horror to this situation that makes it seem out of place in the United States. "The thing that’s most frightening to me," says Sandra Thurman, who ran the White House Office of National AIDS Policy during the Clinton administration, "is that we are putting the epidemic on the back of a health care and social welfare system that is already failing to serve those most in need."

The job of getting AIDS patients like Rebecca and Sara Jackson the drug cocktails that have been popularly heralded as a panacea will ultimately fall on the shoulders of community-based organizations like MASS. In 2000, MASS, which operates on an annual budget of $600,000, had to "professionally beg" pharmaceutical companies for $1.8 million in medications for uninsured clients. The Alabama legislature has been unwilling to fully match federal funds to help the poor pay for expensive drugs, which can cost anywhere from $10,000 to $18,000 a year. And during any given month, about 400 infected Alabamians—mostly black, all living below the poverty line—can be on a waiting list to get on the federal government’s drug assistance program.

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