By Rachel Baldauf
Border Belt Independent
When Brenda Hunt helped start the Borderbelt AIDS Resources Team in 1996, the small nonprofit was the only place in Robeson County for people living with HIV or AIDS to get support and connect to resources.
Hunt, who now serves as the BART director, would drive clients to Laurinburg or Chapel Hill to receive a cocktail of medications. She would deliver two or three eulogies a month for those who died.
“We started it all with just nothing,” she said.
Much has changed over the past few decades. HIV treatment centers have opened throughout Robeson County, and health outcomes for those diagnosed with the virus have drastically improved.
But now cases of sexually transmitted diseases, including HIV and syphilis, are on the rise in Robeson County.
In 2022, 524 people were living with HIV in Robeson County, a 24 percent increase from 2012, according to the N.C. Department of Health and Human Services. That’s higher than the statewide increase, which rose nearly 18 percent during the same period.
Robeson County had a rate of more than 25 new HIV diagnoses per 100,000 people in 2022, one of the highest rates in North Carolina.
Across the country, HIV cases dropped 12 percent between 2018 and 2022, according to the Centers for Disease Control and Prevention. But southern states accounted for nearly half of the nation’s new HIV infections in 2022.
Syphilis cases are also on the rise. Nationwide, syphilis numbers are the highest they’ve been since 1950. Since 2018, early syphilis cases in North Carolina have more than doubled.
Last year, Robeson County saw 70 newly diagnosed cases of early syphilis, a dangerous bacterial infection typically transmitted through sexual activity. If left untreated, syphilis can damage the body’s organs and cause tumors. If treated during the early stages of disease, syphilis is easily curable with medication.
The county’s number of newly diagnosed syphilis cases has risen 180 percent since 2017, an increase that’s over 1.5 times higher than the statewide figure.
In nearby Bladen and Scotland counties, the number of new syphilis cases has more than doubled since 2017.
Chlamydia and gonorrhea are also on the rise in southeastern North Carolina. Cases of both diseases in Bladen and Scotland counties have risen more than 14 percent since 2017.
Hunt said she was not surprised to hear that HIV and syphilis are on the rise. “People have been so relaxed with it.”
Many young people don’t understand the dangers, she said, and educating the public is difficult in Robeson County, where poverty and social stigma are widespread. In 2022, over 32 percent of the county’s 117,000 residents lived in poverty.
Brooke Blackmon, a UNC Pembroke student and summer intern at BART, moves a watermelon from a storage area. A food pantry is one of the services provided by BART. Photo by Les High
Drug misuse plays a role in the spread of both diseases. It can lead to behaviors that increase the risk of HIV and syphilis transmission, including inconsistent condom use and having multiple sex partners. Injection drug use accounted for 3.4 percent of HIV transmissions in North Carolina in 2022.
For decades, HIV has disproportionately affected vulnerable groups, including drug users, gay and bisexual men and minorities. In 2022, over half of all adults newly diagnosed with HIV in North Carolina were Black, and nearly 58 percent of reported transmissions were through men who had sex with men, according to DHHS. Men who have sex with men also experience higher rates of syphilis than other groups in North Carolina and nationwide.
“STDs and substance misuse, they go hand in hand,” said April Oxendine, a health educator at the Robeson County Health Department.
Drop in funding
Rates of STDs, including HIV and syphilis, soared in the 1990s and early 2000s in Robeson County. In 2001, Robeson had the highest rate of syphilis in the country, according to a CDC report.
Funding for nonprofits like BART was easier to come by back then, Hunt said. As newer public health issues like opioid misuse have taken center stage, funding for HIV prevention has become less of a priority.
“Opioids is the new kid on the block,” Hunt said.
Over the past few years, Hunt said BART’s total funding has decreased more than 25%.
Tracy Jones, the communicable disease supervisor at the Robeson County Health Department, said an HIV diagnosis used to spell death for many patients in the 1980s and ’90s. But now it’s managed like a chronic health condition, often treated by a single pill per day.
“The state of HIV care has changed a lot over the last 20 years as far as regimens and how well they’re tolerated and how simple they are compared to when I started working here,” said Jones, who has been with the health department since 2002.
A bulk of the funds that HIV treatment organizations receive is distributed through the Ryan White HIV/AIDS Program, a federal program that began in the 1990s. In North Carolina, counties are grouped together into networks of care, and funding is meted out to those networks on a yearly basis. Since 2021, funding for the network of care that includes Robeson, Bladen, Scotland and six other neighboring counties has dropped by more than $10,000, according to DHHS.
Today BART cares for about 20 clients living with HIV. Hunt would like to add more but can’t afford to hire additional employees. Getting reimbursed for care provided to Medicaid patients enrolled through managed care can be a slow process, she said.
“I wish there was money to hire more people,” she said. “It’s just not easy. You’ve got to jump through so many hoops, it’s unreal.”
Funding for programs aimed at reducing syphilis has decreased as well. In 1999, Robeson was one of six North Carolina counties to receive a grant from the CDC. That year, Robeson reported 152 cases of early syphilis. The initiative brought more than $100,000 to the county’s health department and was used to fund a team dedicated to syphilis treatment and education.
“We were pretty much boots on the ground,” said Oxendine, who worked on the health department’s syphilis elimination team. “We were knocking on people’s doors at night or in the evening, saying, ‘Hey, we’re in this area, would you like to get tested for syphilis?’”
A poster and prayer in the BART office in Lumberton. Photo by Les High
Oxendine and her team built relationships with the community. Local drug dealers would ask if the team could test people who bought drugs from them. Some days the team tested more than a hundred people using a mobile unit provided by the CDC. For those who tested positive, the team would connect them with medical care and provide resources to help them leave high-risk lifestyles.
“It met people where they were at,” Oxendine said. “We had formed those relationships of trust.”
The effort was a massive success. In 2006, Robeson County didn’t report a single new case of primary or secondary syphilis.
“We eliminated it. Cases were down completely,” Oxendine said. Decades later, Oxendine is still in contact with people who say the program changed their lives.
But in the late 2000s, the grant ended, and the health department no longer had the money to fund many of its syphilis outreach programs. As the money went away, cases began to rise again.
“We knew whenever the monies would leave, cases would start going back up,” Oxendine said.
Education and stigma
Educating residents on safe sex methods and the dangers of used needles is vital to prevent the spread of HIV, Hunt said. But stigma often stands in the way of education and prevents some people from seeking treatment.
Hunt decided to become an HIV case manager after a friend was diagnosed with the disease in the ’90s. Her friend told people she had cancer to avoid the stigma surrounding HIV, which killed nearly 60,000 Americans in 1996 and was seen by many as a curse.
“Her family wouldn’t want to eat in the same house as her,” Hunt said, adding that they wanted “absolutely nothing to do with her.”
Hunt faced discrimination as well. Some friends no longer wanted to associate with her because of her job. “I’d stand up in church and ask for prayer, and they’d tell me to sit down.”
Perceptions have changed over the years, Hunt said. BART does outreach work at schools and began educating churchgoers after a local choir leader and assistant pastor died from AIDS.
BART Director Brenda Hunt says the opioid epidemic has surpassed HIV as a public health crisis. Photo by Les High
Still, it’s tough for many to seek treatment.
“The stigma in this area and discrimination that is associated with it is still extremely horrible,” said Al Bishop, who has supervised the HIV treatment program at Robeson Health Care Corporation for nearly 20 years.
Carisa Collins-Caddle, an outreach worker who helps connect those who misuse drugs with vital resources, sees the struggle every day.
“Especially here in Robeson County,” she said, “we are very conservative and very Christian. I just don’t see much support in the community.”
Many fear that testing and treatment won’t be confidential. Collins-Caddle, who has been in recovery from drug misuse for eight years, said she used to regularly get tested for HIV. The first time she got tested, the nurse who gave her the results was her childhood babysitter.
“I was absolutely mortified,” she said. “We’re very rural. Everybody knows somebody, married somebody, is kin to somebody.”
Collins-Caddle said one of her clients, an individual who participates in sex work, has avoided HIV treatment for three years.
“I tried to talk to him: ‘Listen, it is what it is, let’s just go get some medicine. I want you to live. I don’t want you to die,’” she said. “And I think he’s just scared of the diagnosis itself.”
Oxendine has hope that Robeson’s STD numbers will decrease. The key, she said, is “boots on the ground” outreach.
“We have the tools out there to prevent anyone from contracting any of these STDs,” Oxendine said. “Those tools are out there. Those medications are out there.”
But more funding is needed. “We could still bring back that program,” she said. “We’d need money to bring it back, but it worked.”
For Hunt, who has worked at BART for nearly 30 years, the lack of funding has her finally considering retirement.
“The day and hour that it starts feeling like a job, I’m gonna go home. And right now, it’s beginning to feel like a job,” she said. “And you know why? Because the funding’s been cut.”
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