The South is the epicenter of new HIV infections in the United States

selma, ala. — Afew blocks from the historic downtown, between a boarded-up office building and a vacant lot, sits a compact, one-story brick building with metal bars across the windows, a former doctor’s office that — like so much in this city of 20,000 — has seen better days. There are no signs or logos in front and to the casual passerby the building might look closed or even abandoned.

This is the city’s only HIV/AIDS organization, and it is purposely unmarked. Patients come here to Selma AIR (AIDS Information and Referral) from all across rural south Alabama, one of the states with the highest rate of HIV infections. “We don’t have a sign on purpose,” said Mel Prince, the group’s director. “We have patients who are scared to death that people will find out about their condition. People in the South are still in the dark ages about HIV.”

The stigma surrounding AIDS is a key reason that the South is the epicenter of new HIV infections in the United States. Half of all new infections in the United States are in the South, although the region has only a little more than a third of the country’s population, according to the U.S. Centers for Disease Control and Prevention. The South also has the highest death rate due to HIV.

The disproportionate number of cases in the South has many causes: widespread poverty, a shortage of health care, a lack of HIV testing and education, a shortage of accessible medical specialists for the many who live in small rural areas and a persistent prejudice by many in the Bible Belt against homosexuals, the group most affected by HIV/AIDS.

“For many people in the South, HIV is not on the radar,” said Jonathan Mermin, director of the CDC’s HIV/AIDS prevention division. “But the South is heavily affected.” The Deep South — Mississippi, Alabama, Louisiana, Georgia, North Carolina, South Carolina and east Texas — has been hit hardest. “HIV is exploding in these states,” said Carolyn McAllaster, director of the Southern HIV/AIDS Strategy Initiative. A key reason, she said, is because people don’t get tested.

Lynette Oliver, 46, an unemployed nursing assistant in Houma, a town of 34,000 in southeast Louisiana, had her HIV infection diagnosed this year. “People are scared to talk about it. I’ve had friends with HIV; their family disowns them, doesn’t let them eat off the same plates or drink out of the same cups.”

Oliver decided to get tested when she kept losing weight. She is unsure, she said, of how she got infected but she is not all that surprised: “In my younger days, I did a lot. I been there, done that.”

She has no health insurance; her medicine is paid for through state and federal programs for the indigent. “People just keep back from you” when they know you have HIV, she said. “I’ve felt it, that feeling that you’re not wanted.”

Those who earn less than $10,000 a year are three times more likely to be infected with HIV than those who make more than $50,000, according to the CDC.

“HIV is clearly a disease of poverty,” said Michael Saag, director of the Center for AIDS Research at the University of Alabama at Birmingham. “And there is a lot of poverty in the South.”