Twenty-six years into the fight against HIV/AIDS, statistics show that prevention programs aren't reaching a population that is among the most vulnerable to the disease: low-income, Southern black women.

Indeed, HIV rates are rising rapidly among these women, said University of California, Los Angeles, professor and minority health expert Vickie M. Mays, PhD, in her Board of Scientific Affairs-sponsored Master Lecture at APA's 2007 Annual Convention.

Black women and adolescents are 23 times more likely than white women to be diagnosed with AIDS, and the South has the highest percentage of HIV/AIDS cases of any region in the country, she explained.

"If we don't take some bold and innovative actions in the South...we will in 25 years have lost so many African-American women that here in the United States we will have a set of conditions that begin to mimic those in parts of Africa," explained Mays.

According to Mays, the risk for these women is fueled by:

  • A gender-ratio imbalance. In some Southern cities the ratio of unmarried African-American women to men is 19 women to one man, said Mays. The greater the gap, she explained, the less likely women are to use condoms since conceiving children can serve as a means for relationship attachment. According to Mays, women want intimate relationships, and that desire tends to override worries about HIV infection.

  • Southern prisons. States build prisons to boost the economy, and the South over-relies on this strategy, said Mays. "Very quietly, it's emerging that there's an epidemic of HIV infections in prisons, particularly in the South," she noted. Upon their release into these communities, inmates with HIV get little education or follow up care aimed at preventing its spread, she said.

  • Migration patterns. Increased numbers of young African-American men are moving to the South to reconnect with family or leave gang life in urban areas-and their migration increases the vulnerability to HIV/AIDS, said Mays. "There's a clear trail of drug trade, STD infections and HIV with the migration of African-American men from the Northeast to the Southeast."

  • Below-standard education and health care. The South has the highest school dropout rates and some of the lowest education expenditures per student in the country, Mays said. As a result, women with less education tend to have fewer career opportunities and greater vulnerability to needing to be in relationships-two factors that put them in danger for ignoring HIV risk when choosing mates, said Mays. Likewise, the region's health care lags behind most parts of the country in providing HIV prevention and education programs.

Given these obstacles, the two public health messages associated with HIV prevention-wear a condom and get tested-simply aren't enough, said Mays. The key for these women is helping them find, maintain and nurture healthy relationships, she said.

"Psychologists have not focused on this enough," she stressed. "We have not made this a priority, particularly among women who must make choices in the midst of so many challenges and priorities, of which HIV prevention sometimes pales."

Psychologists need to better understand sexuality and intimacy in the South and tailor HIV-prevention and education programs accordingly, Mays said. She also encouraged her peers to find ways to work with prisons on stopping the spread of HIV within their walls and out into the communities, and to push for better funding for schools throughout the country.