Showdown in Choctaw County

A weary social worker fights an AIDS epidemic in rural Alabama

| May/June 2002

Discuss the AIDS epidemic and Rudolph Virchow in the Globe forum in Café Utne's:
David deShazo is chain-smoking Marlboros as he drives north out of Mobile on a bright November morning. A garbage bag stuffed with blankets, baby clothes, and toys takes up most of the backseat of the Pontiac. The car is chilly because deShazo’s heater is busted, and he doesn’t have the two hundred bucks it will cost to get it fixed. He’s headed up to Choctaw County to find two sisters, Sara and Rebecca Jackson, who are infected with HIV. They live with their mother and their two baby sons down a dirt road somewhere outside of Gilbertown, near the Mississippi border. The girls haven’t been heard from in seven months. He takes another draw off his cigarette, squints through his bug-smeared windshield at the two-lane highway, and tries to resist a flickering current of anxiety.

DeShazo hadn’t really known what to expect when he was hired to work in the poor counties of southern Alabama to search out people infected with HIV, to convince the at-risk to get tested, and to warn community leaders about the threat of AIDS. In the 18 months since he took the job, he’s driven more than 60,000 miles talking about the virus to just about anyone who will listen. He’s caught hateful stares at general stores and gas stations. A county commissioner over in Wilcox attacked him verbally at a church meeting for talking about AIDS without permission. And he’s heard comments that the "niggers" and "faggots" are just getting what they deserve. None of these things has really surprised deShazo. What’s unsettling is the silence that surrounds him in these towns. When he talks to people it often seems as though he is shouting across an unbridgeable chasm.

THE ALABAMA THAT DESHAZO has been traveling for a year and a half ceased to exist in the minds of most Americans after the Civil Rights movement. Somehow it was never remade into the New South of Ted Turner, Emeril Live, and urban sprawl. There remains an expansive, aching beauty to these counties. The countryside, with its forests of hickory, oak, and pine, its cotton fields and tangles of green creeks and rivers, feels timeless. A procession of churches lines every road: NEW PROVIDENCE BAPTIST, JESUS IS LORD OLD ZION MISSIONARY, LITTLE ZION BAPTIST.

All of this lends the region a sense that it is somehow insulated from the perils of modern life. But now the greatest epidemic of recent times is spreading slowly and quietly through the black communities of rural Alabama. In the years since AIDS hit the headlines, the disease gradually has become a black epidemic. In 2000, according to the Centers for Disease Control, 54 percent of all new AIDS cases were African Americans. The disease is now the number-one killer of both black men and black women between the ages of 22 and 45. What’s perhaps even more surprising is that the South is the new epicenter of AIDS in the United States. More people are living with AIDS in this region than in any other part of the country. And while the disease is still concentrated in Southern cities, there are warning signs that it is creeping into the countryside. The number of rural cases in the South more than doubled in seven years.

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.

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