A grassroots fight against HIV in the Tar Heel State

Raymond Velazquez stood in the Asheville post office in a daze.

Holding a letter from the blood bank in his hands, he read the lines of print over and over: HIV antibodies had been detected in his blood.

He started to shake. Driving home, he fought to keep his grip steady on the steering wheel. There, his worried sister asked if he was OK. “And I sat there at the table, and I told her. And I cried.”

Velazquez is one of 1.2 million people who are estimated to be living with HIV in America. It’s been more than four decades since the first cases of AIDS were reported in New York City and Los Angeles. But the nation’s HIV epidemic is far from over — especially in the South. In 2021, the Centers for Disease Control and Prevention estimated 32,100 new HIV infections across the country. More than half of those infections (52%) occurred in the South.

This disproportionate impact is clear in North Carolina. In 2022, the N.C. Department of Health and Human Services reported that 36,581 people in the state were living with HIV. That year, 1,366 people were newly diagnosed.

Many of those people live in rural areas where HIV support and healthcare aren’t around the corner. For them, a diagnosis can be isolating and frightening, and fear of repercussions can leave them feeling frozen.

Facing an overwhelming combination of distance and emotion, taking the steps to care can feel nearly impossible. And the stakes are high: the longer care is delayed, the more sick they will become.
That’s where regional agencies step in. They bridge the gap between individuals and their healthcare — and give people living with HIV the chance for a long, healthy life long after their diagnosis.    

When Velazquez received his diagnosis four years ago, he knew about HIV from friends and partners living with the virus. Still, after receiving the blood bank’s letter, he was unsure where to turn.

A Google search for “HIV testing” directed him to an organization called the Western North Carolina Aids Project (WNCAP). There, when a test confirmed what the letter reported, the staff helped him start medication.

Less than two months later, Velazquez was “undetectable” — the level of HIV in his body was so low that the virus could not be transmitted.

Along with life-saving medication, Velazquez received something equally valuable that day: acceptance. Velazquez is still tearful when he remembers the kindness of the staff member who gave him his results.

“He says something very simple to me, but very profound,” Velazquez recalled. “Would you like a hug?’”

According to the CDC, a number of factors are driving the HIV epidemic in the South. These include poverty and unemployment — which are associated with poorer health outcomes — lack of access to health insurance, lack of public transportation and stigma. And the impact of the epidemic is uneven; people of color are most affected. In North Carolina, Black adults and adolescents made up 56.7% of those newly diagnosed with HIV in 2022 — even though just 22.2% of the state’s population is Black.

There’s no singular reason for the disproportionate geographical impact of HIV in the South. So, for organizations like WNCAP working to end the epidemic on the ground, there’s no singular solution. The effort spans across sectors: advancements in medicine, public education, funding, policy and tackling HIV stigma are interconnected, and equally critical to connecting life-saving care to the people that need it most.

This work is not simple. It takes staff members driving thousands of miles down remote mountain roads to bring clients to their doctors. It takes distributing thousands of tests, and thousands more clean syringes to keep the community safe. It takes grueling emotional work — challenging the deep-rooted fear and shame of HIV still entrenched in some communities.

And it takes facing heart-wrenching loss. Not everyone survives.

“It’s not because HIV is deadly anymore,” said John Chaffin, WNCAP’s community navigation coordinator. “It is if it’s not treated. It’s not treated because we face a population of individuals who are underserved.”

Serving the state

The Western North Carolina AIDS Project is housed in a small beige building, tucked in a street corner of Asheville. From there, the headquarters offers a robust array of services to 18 largely rural counties across western North Carolina.

The nonprofit was founded by a group of volunteers in 1986, during a decade that saw more than 100,000

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