Social/sexual norms and AIDS in the South. Ethics and the politics of aids: lessons for small cities and rural areas throughout the U.S.

No one denies that the face of AIDS (the "AIDS profile") is changing, and it is clear that we are entering a new phase in our understanding of this disease. As the AIDS profile changes, however, we are seeing a change in attitudes about prevention. In this stage of the epidemic there seems to be a move toward adopting more coercive strategies for breaking the chain of transmission. One concern, obviously, is that newly HIV-infected persons will find that they have little capacity to demand recognition of their rights to consent, to be treated, to confidentiality, to move about freely in society, to work, and so on. Unfortunately, this bodes ill for newly infected persons in previously low-incidence areas. Two very recent studies suggest that rates of high-risk sexual behavior among homosexual/bisexual men in smaller cities and rural areas in the South are much higher than rates now reported for gay men in large city epicenters. This paper attempts to examine the implications of differences in social and sexual behavior norms in the South for the spread of AIDS/HIV and to suggest morally appropriate primary prevention strategies for working within them.