HIV misinformation is still highly prevalent in the Southern United States. That’s why AIDS Alabama South—a full-service sexual health clinic and a sister agency to AIDS Alabama—prioritizes meaningful relationships with its clients.

Doing so allows the clinic to provide education and outreach through courses designed to build community awareness about HIV, eliminate stigma and promote the health and well-being of people living with HIV and those who are HIV negative.

Such efforts have helped the clinic increase the uptake of pre-exposure prophylaxis (PrEP) to prevent HIV among Black women, who make up nearly 35% of the clientele the clinic serves.

Both images: Istock

Shey Thorn, co–executive director of AIDS Alabama South, oversees all of the nonprofit’s prevention, education and outreach initiatives. As a high school teacher, Thorn had been struck by the lack of comprehensive sexual health education available in the South. So he quit teaching and ended up accepting a position at AIDS Alabama. “Passion makes purpose,” says Thorn. “I fell in love with the work and [AIDS Alabama’s] mission, and I found my passion.”

Soon thereafter, Thorn founded Sexual Health Education Learning and Living (SHELL) Health. “We cover all of those aspects of sexual health that, in the Deep South, don’t typically get covered,” says Thorn. SHELL Health, now located at AIDS Alabama South, started as a PrEP clinic that was open only once a week for four hours, but thanks to a grant, the clinic was able to hire full-time staff, open its doors five days a week and expand services to reach every corner of the community.

“We specifically focus all of our work on those who are most disproportionately affected by HIV, and, even more so, we focus our work within our minority community,” says Thorn. “So not only the LGBTQ community but also our African-American, Hispanic and Indigenous communities.”

Today, SHELL Health has made community access to PrEP and post-exposure prophylaxis (PEP), which prevents infection after a potential exposure to HIV, “extremely easy,” according to Thorn.

“Creating that culture and that environment with equitable access and a focus on diversity and inclusion and being a radically inclusive space for all citizens of Mobile County and our surrounding areas,” says Thorn, “really brought a lot of people in through our doors and allowed them to see how important sexual health is.”

SHELL Health is just one part of AIDS Alabama South’s Prevention, Outreach, Testing, Education & Clinical Treatment (PrOTECT) Mobile, which addresses all aspects of sexual health. Project 1824, which offers prevention and education programs specifically for teenagers and young adults in southwest Alabama, is another part.

Project 1824, which Thorn also spearheaded, specifically prioritizes comprehensive sexual health education centered on HIV testing and PrEP education and access for young Black women between ages 18 and 24 in Mobile County.

“The point of [Project 1824] is to get larger groups of African-American women within our community together to just have simple, basic conversations so that we can eliminate their fears, eliminate HIV-related stigma in all of its forms and answer questions, and if we are unable to answer those questions, we link them to someone who can,” says Thorn.

Although Alabama is made up of 67 counties, the majority of African Americans newly diagnosed with HIV reside in Mobile, Montgomery, Madison and Jefferson counties, according to the Alabama Department of Public Health (ADPH).

Thorn encourages employees to make the most of the agency’s resources and partnerships and to get to know the people they serve through meaningful conversations “because that’s how we’re going to dispel these barriers: in between health care and community impact.”

Nationwide, African Americans bear a disproportionate burden of HIV cases. In 2020, African Americans made up 42% of new HIV cases but only 13% of the U.S. population, according to the Centers for Disease Control and Prevention. HIV is especially prevalent in the Deep South. According to a study published in the Journal of Public Health, these states—Alabama, Georgia, Mississippi, North Carolina, South Carolina and Louisiana—have a 30% Black population, yet African Americans in the Deep South account for 70% of HIV cases.

In Alabama, Black women are about nine times more likely to contract HIV than non-Black residents, according to ADPH. When it comes to equitable health care in Alabama, people of color historically have been disadvantaged.

As the coordinator of the Ending the HIV Epidemic initiative at AIDS Alabama South, Chance Shaw understands that transparency is key to chipping away at the Black community’s historic distrust of medical programs, which stems from years of systemic socioeconomic and cultural barriers in the United States.

That’s how we’re going to dispel these barriers: in between health care and community impact.

Shaw and the agency aim to consistently provide culturally sensitive services because “a lot of the communities that we serve, especially our priority populations, are not only marginalized by the health care system, but they’re also typically distrustful, so we try to—and do—provide our services in a very transparent way so that we can dispel that distrust.”

Shaw points to historical events, such as the Tuskegee syphilis study, that have impacted how the Black community regards the health care system and health care providers. Conducted over the course of 40 years, the study lied to hundreds of Black men with syphilis, telling them that they were receiving treatment for the disease when in fact researchers were observing the natural progression of untreated syphilis.

The study, conducted by the Centers for Disease Control and Prevention, the Alabama State Health Department and the Macon County Board of Health, was exposed in 1972, yet no one has been prosecuted.

Shaw says “laying everything out so that they know what they’re getting into” is extremely important for Black men and women looking to start taking PrEP or to get tested for HIV.

To put clients at ease, nurse practitioners and other employees at the clinic prioritize being open and communicating about the whole process—for example, what they are testing for, what the test looks like and how long they must wait for test results.

“[People] know what we’re doing and know exactly how they can engage with us,” says Shaw. “They feel empowered when you do that because you’ve made them part of their treatment.

“Educating the people we come into contact with is almost secondary to the education they do in their own communities,” Shaw continues. “When they can get this proper education and take it back to their communities, they feel empowered to correct [misinformation] because they’ve had that education.”

Leaders at AIDS Alabama South recognize the importance of hiring culturally diverse employees who not only relate to clients and encourage education but also make difficult conversations about sexual health easier. They believe culturally sensitive services are key to dispelling misinformation and stigma surrounding HIV.

Shanmeshia “Shan” Thompson, the agency’s HIV testing and education outreach coordinator, says “a lot of people don’t really know or understand the importance of getting tested or know the definition of HIV.” She says a lot of people who come in for sexual health services simply need more information about HIV.

In her position, Thompson constantly builds trust with those in need of care. She reassures every person who enters the clinic that they are in a judgment-free zone and that PrEP is extremely safe and effective in preventing HIV. Thompson regards clients as her sisters and brothers.

“I’m not going to force you to get into details about anything,” says Thompson. “But as we sit there and talk, they start actually opening up to me. And I know that’s another reason why we do have a lot of people that do come in and get on either PrEP or get tested [for HIV].”

Thorn and Shaw both credit Thompson’s patience and calming energy for the increase in the number of Black women getting tested for HIV and going on PrEP.

“She is so vital to the agency. I just can’t express it enough,” says Thorn. “She creates truly impactful, compassionate, personal relationships with these clients that come through the door, and she gets to know them on a personal, first-name basis and checks in with them, and they share such a deep connection. I think that is really what initiated the acceptance within the [Black] community.”

Access to care is one of the utmost health concerns in Alabama, alongside mental health and substance use, according to ADPH. Rural Alabamians are especially unlikely to be able to access care in a timely fashion.

Shaw says many people who utilize the agency’s PrEP services “lack access to reliable transportation, especially in our more rural areas.” Distance paired with poor infrastructure prevents people in Alabama from accessing potentially lifesaving health care.

“They may have ways to get them around town, a few miles down the street, things like that, but maybe not necessarily two counties over,” says Shaw.

That’s exactly why AIDS Alabama South implemented a clinical van service that travels throughout the 12 counties it covers in southwest Alabama. It provides people with all the services offered in-house, including free testing for HIV and other sexually transmitted infections, as well as PrEP services.

Thorn and Shaw are proud the agency and its employees are so responsive to clients in need. On numerous occasions, Shaw, along with nurse practitioners, will drive directly to a person in need of an HIV test, PEP or other services. “I’ll just grab a backpack and throw in a set of gloves and a test, and we’ll go meet them at their house,” says Shaw.

Furthermore, AIDS Alabama South has also partnered with specialty pharmacy Avita, a national health care services organization, to easily enroll clients in its ship-to-home pharmacy, which fills and delivers prescriptions to a person’s residence.

“We’re always looking for better ways to serve our community,” says Shaw.

AT AIDS Alabama South, providers consider mental health to be as important as physical health. The agency offers individual, couples and group counseling to people living with HIV. Sessions aim to help people adjust to and cope with their HIV-positive status as well as other challenges they may be facing, including anxiety, depression, low self-esteem and relationship issues.

The agency also offers individuals who misuse drugs and alcohol a safe space to explore sobriety and provides referrals to help with different forms of addiction.

Clients may also be connected to case managers, who can provide them with a continuum of care, including medical and dental care, housing resources, financial assistance, nutrition support via food pantries and more.

For those who have newly tested positive for HIV, the linkage to care program at AIDS Alabama South allows individuals to attend up to five sessions that cover topics including what to expect when you talk to your doctor, medications and their side effects, adherence, life span and more. The program prioritizes privacy and works with clients to identify the locations and times that work best for their schedule.

Looking to the future, AIDS Alabama South is seeking to add services, such as providing the overdose-reversing medication naloxone, sold under the brand name Narcan, as well as clean needles through a needle/syringe program.

“I believe that having dedicated staff and creating programs specifically for [Black women] to show how much we love and care for them and are here to support them,” says Thorn, “is what has allowed us to be so successful for the women in our community.”