Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, January 21, 1994 TAG: 9401260023
SECTION: EDITORIAL PAGE: A11 EDITION: METRO
SOURCE: ABIGAIL TRAFFORD
DATELINE: LENGTH: Medium
But he and country singer Mary-Chapin Carpenter last week launched a public-service campaign called ``Break the Silence'' to heighten awareness of AIDS in rural areas.
It's the official entry of the country-music industry into the AIDS epidemic, a chip in the wall of denial that down-home folks with ``achy-breaky hearts'' and good ol' ``outlaws like us'' - as the song goes - are not immune to the risk of this lethal virus.
While the numbers of cases in small-town America are still relatively low - so far about 14,000, or 5.5 percent of the epidemic's total of 253,448 cases through 1992 - the infection is increasing outside the cities. In 1992, according to the most recent government statistics, some 17 percent of new cases were reported from areas with fewer than 500,000 people.
``We're seeing young women in rural areas, especially where there is a high rate of sexually transmitted disease. The disease is heterosexually transmitted,'' says Kristine Gebbie, National AIDS Policy Coordinator in the White House, who with Rep. Bob Clement, D-Tenn., helped kick off the country-music campaign.
This is not the first time the problem of rural AIDS has surfaced in Washington. In 1992, the Bush administration launched an $1.5 million AIDS-education campaign aimed at rural Americans, and several studies have documented the lack of medical and social services for those with AIDS outside major cities.
``The numbers are beginning to increase dramatically, and the infrastructure of the public-health system is not there. It is hard for people with AIDS to access services. A lot of people are being diagnosed late and dying quicker,'' says Jeremy Landau, executive director of the National Rural AIDS Network in Santa Fe, which has the same per-capita incidence of AIDS as Los Angeles.
Now, country stars such as Tammy Wynette, Emmylou Harris and Garth Brooks are putting the celebrity spotlight on AIDS in hopes of changing the culture of the heartland. As Landau says, ``If anyone can reach the Bible Belt, country music can.''
Beyond statistics, the AIDS epidemic is about images and stereotypes of who is at risk of the disease. First was the face of white gay men, symbolized by Rock Hudson. Then came the face of the African-American male, symbolized by Magic Johnson and Arthur Ashe, as the disease spread to minority populations. There were also faces of children, like Ryan White. And more recently, there were women, like Belinda Mason, the Kentucky journalist who served on the National Commission on AIDS.
With each new face, the public has had to revise its definition of the AIDS patient. ``The more we understand the many faces of the epidemic, the better,'' says Jim Graham, executive director of the Whitman-Walker Clinic in Washington. ``There's not just one face.'' The addition of new faces doesn't take away from the statistics that just over half the AIDS cases are among homosexual men and nearly 30 percent of cases are due to intravenous drug use. The rates, however, among these groups appear to be slowing, while the growth among the newer faces of AIDS is more rapid. In 1992, for the first time, more women got AIDS through heterosexual contact than from intravenous drugs.
At first glance, the young woman in the rural South with the human immunodeficiency virus that causes AIDS doesn't seem to have much in common with the middle-aged gay man in San Francisco or the intravenous drug user in New York City.
But there is a commonality among the faces of AIDS. Increasingly, the epidemic is spreading among the poorest and most disadvantaged populations.
The virus also affects minorities disproportionately. In the rural Southwest, the cases are found in Native Americans and Hispanics; in the Southeast, among blacks. The faces of AIDS, as Gebbie puts it, are ``the demographics of disenfranchisement.''
Which is why country music may have a strong message for those at risk. There's often a populist streak in the lyrics speaking up for the little guy. As one song cries out: ``Lord Have Mercy on the Working Man.'' The song ends with a question: ``Why's the rich man busy dancing while the poor man pays the band?''
It's a reminder that regardless of the color or sex or address behind the faces of AIDS, the poor are at high risk of paying the human price of the epidemic.
\ Abigail Trafford is editor of The Washington Post's Health section.
\ The Washington Post
by CNB