Painting a Picture of HIV Prevalence in Rural Kentucky
The article is from our special issue on Mpox. You can access the full issue here.
In a previous article, we saw that only an estimated 28.8% of Kentuckians have been tested for HIV at least once in their lives. This means that around a quarter of Kentuckians know their status … or have known it. STI testing, like any other form of responsible self-improvement, is best performed routinely and with intention. One doesn’t go to therapy once and declare himself trauma-free or take a look at the weather one day and declare that it’s always sunny from now on—so why are we so quick to take one test and be done with the whole affair? The answer is a complex web of cultural stigma and access to healthcare in the Bluegrass state.
Stigma around HIV rages strong due to its connection with the LGBTQ+ community (let’s not forget that HIV/AIDS was originally called “gay cancer“) and intravenous drug users. In the United States, anti-LGBTQ+ sentiment rages strong due to flame-fanning from right-wing evangelicals, politicians, and social media personalities. Similarly, the public’s association with intravenous drug users and those living with addiction is very negative—particularly in areas where drug use is pervasive and heavily associated with violent crime. The negative associations people have with these two communities translates to stigma—literally “a mark of shame.” If one’s only understanding of HIV is that it’s a disease for “queers and addicts,” but your math teacher or your congressman comes out as HIV+, one is likely to transfer those associations onto them: to stigmatize them, or apply that mark of shame. The prospect of suddenly losing reputation or standing within one’s community is terrifying, and that deters people from getting necessary care. While there are some protections in place for people taking and receiving results of an HIV test, they may not be enough to ensure people feel safe enough to test in the first place.
Add to this fear of stigma to the legal ramifications of knowingly spreading HIV—which is still a Class-D felony offense in the state—and there are very real ramifications to being diagnosed with HIV. You can’t unknow something like that, so diagnosis opens up a whole can of worms beyond one’s individual health.
All of these compounding issues mean that getting tested isn’t as simple as it may seem for Kentuckians. Up until June 2023, even selling or distributing home HIV tests was considered a felony. This was overturned thanks to the work of the HIV Is Not A Crime Coalition, powered by the Fairness Campaign. At-home testing provides the privacy, ease, and accuracy necessary for more Kentuckians to be regularly informed about their status, and to act accordingly.
Beyond the issues of stigmatization, legal persecution, and access to testing, Kentucky faces an additional barrier to effective HIV treatment and prevention: an epidemic of intravenous drug use. A 2019 by Kentucky Public Health and the CDC found that of 220 U.S. counties at risk for an HIV/HepC outbreak among intravenous drug users, 54 of those (24.5%) were in Kentucky.
A number of concrete steps have been taken to reduce harm within the region, namely increasing the accessibility of syringe services programs (SSPs). Syringes are single-use tools—they should not be used more than once or, even worse, shared. Generally speaking, people using intravenous drugs are focused on other things and don’t have tens of spare needles lying around in sterile conditions. SSPs allow them to reduce the potential harm associated with these activities by safely disposing of used needles, getting access to clean ones, and ultimately offering screening, treatment, and support. These, too, were illegal until 2015.
As we’ve seen, the statistics paint a negative picture of HIV in Kentucky—low STI literacy rates, stigmatization, legal barriers, and other factors have often blocked meaningful progress. But in the last decade, Kentucky residents on both the local and state levels have organized to make meaningful strides in preventing, treating, and destigmatizing HIV across the state. But there is still work to do! If you’re inspired by all this progress and want to ensure we keep moving forward, join local activist groups like the Fairness Campaign or AVOL and carry on the work that has been done in the name of health and wellbeing.
The article is from our special issue on Mpox. You can access the full issue here.
