HIV has burrowed into the Deep South, feeding off some of the most impoverished people in the nation and creating a health catastrophe, according to a report being released Monday in Birmingham.

    The report from the Southern AIDS Coalition says federal funding to fight the disease has not followed the epidemic's path, with an unfair share of money for treatment, education and support services remaining in other, wealthier parts of the nation that have fewer new HIV cases and declining death rates.

    "Rising infection rates coupled with inadequate funding, resources and infrastructure have resulted in a catastrophic situation in our public health care systems in the South," the report says. "Unless we act to correct funding and treatment disparities, we endanger not just isolated communities, but our states and our nation."

    Kathy Hiers, chief executive officer of AIDS Alabama and co-author of the report, said HIV/AIDS has settled into remote areas of the South inhabited by black people who are at great risk for infection. "The ruralness of the epidemic is what's becoming painfully clear," Hiers said.

    The report notes that the number of deaths from AIDS decreased in the rest of the nation 2001-05, but continued to rise in the South. During that period, more than 190,000 Southerners died from AIDS.

    Not the Big Cities

    For years health authorities knew HIV was shifting south, with a the 16-state region leading the nation in the number of new infections. But they believed the increase was coming from big cities in Florida, making the problem appear worse in the South, Hiers said.

    Now, experts have zeroed in on the Deep South - Alabama, Georgia, Louisiana, Mississippi, North Carolina and South Carolina - and found HIV infections spreading in rural areas inhabited by blacks with overwhelming financial, health and social problems.

    "You don't think of the rural areas as driving the epidemic in the South, but that's clearly what's happening," Hiers said.

    Gary A. Puckrein, president and CEO of National Minority Quality Forum in Washington, said Southerners need to understand what has happened with HIV.

    "Certainly one of the big misconceptions is it is big cities on the West Coast and East Coast that are really driving the disease, and it's not so," Puckrein said. "It's moved both in terms of geography and demography. It's really important for people in Southern states to know that because they're not getting their fair share of support."

    Driving the Epidemic

    Much of the problem revolves around funding formulas devised early in the HIV/AIDS epidemic. They relied primarily on cumulative cases of full-blown AIDS, as opposed to HIV infections. That gives an advantage to large metropolitan areas where the epidemic started.

    For instance, Hiers said, in Alabama 40 percent of all HIV cases have matured into AIDS. In New York, where the epidemic is older, 62 percent of HIV cases have matured into AIDS. So New York ends up with more money per person with HIV/AIDS when funding formulas are weighted toward AIDS cases.

    People can live many years with HIV infections before they convert to full-blown AIDS, but these patients still need costly medications and help with things such as housing, food, transportation and health care.

    Last year, the Southern AIDS Coalition persuaded authorities to adjust the funding formula for the Ryan White HIV/AIDS Treatment Act, which contains much of the federal money to fight the disease. The changes have helped, but the South, which ranks No. 1 in new HIV cases, still ranks last out of four regions in overall federal funding.

    "We're driving the epidemic, but we're still getting the least money," Hiers said. The federal government spends an average of $6,565 a year in the South for each person living with AIDS. In the North, that amount is $6,963, according to the report.

    Where are donations?

    The South has also come up short in attracting private money to fight HIV, according to another recent report from Funders Concerned About AIDS, an organization with headquarters in New York.

    "The U.S. South is home to 40 percent of all people living with AIDS in the United States," the group reported in May. "And yet, in 2006, only 19 percent of U.S. philanthropic commitments for HIV/AIDS went to the South."

    The report focused on Alabama, noting that the state was facing the challenges and funding shortfalls typical in the South.

    "Like much of the Deep South, Alabama faces a growing HIV/AIDS epidemic in the context of broader health care challenges," the report said. "Alabama is among the three poorest states in the nation and ranks 45th among all states in overall population health."

    High rates of other sexually transmitted diseases, a rural population, poverty, mental health problems, lack of insurance and a host of other factors make fighting HIV/AIDS in Alabama difficult and complex, the report said.

    Poverty and the Stigma

    Mel Prince will attest to that. She is executive director of Selma AIDS Information and Referral, a service agency responsible for assisting HIV/AIDS patients in much of the state's Black Belt. Her agency covers eight counties with some of Alabama's highest rates of HIV infection and poverty.

    "We're poor, poor, poor," she said.

    Selma AIDS Information and Referral relies on grants and donations, and operates on a budget of about $180,000 a year. The agency has 125 clients, representing just a fraction of the infections in the area, she said.

    There is no money for educating ignorant, impoverished people about how to avoid HIV, and most of the agency's clients have substance-abuse problems, Prince said.

    A further complication is that people in rural counties know each other well, and there's a stigma attached to HIV. Prince said some ministers still tell congregations that the disease is God's punishment for homosexuals. (The state Department of Public Health reports that about as many people in Alabama are infected with HIV during heterosexual activity as are infected during homosexual activity.)

    Given the stigma, people don't want to get tested and don't want to get treated, Prince said. "They'd rather die."