Background:
The rural Black Belt is among the poorest areas of the nation. Poverty, lack of health infrastructure, and health disparities involving HIV/AIDS, non-HIV STIs, and other diseases reflect the lower life expectancy of the region. The Black Belt states as a whole have the highest STI/HIV rates in rural America.

Objective:
Using Alabama as a case example, this presentation will describe the role of illicit drug use and socio-contextual factors in HIV transmission in the Black Belt.

Method:
Published research and national and state data on HIV/AIDS and drug use were triangulated for information on interactions between illicit drug use, social context and HIV/AIDS. Relevant data from national databases on drug use and drug arrests were matched with HIV/AIDS surveillance data from the CDC and the Alabama Department of Public Health.

Result:
Illicit drug use is implicated in HIV risk in the Black Belt, but less so than in other parts of the nation. Published research suggests that the impetus for drug use involves economic disparities and status-seeking in the context of heterosexual relationships. HIV transmission in Alabama's Black Belt speaks to the tyranny of small places; that is, the risk of HIV/AIDS occurs in geographically bounded areas with a history of racial homogeneity, historically high rates of sexually transmitted infections, and the focality of sexual networks in this rural region.

Conclusion:
Social context is an important predictor of HIV risk in the Black Belt. The role of drug use in HIV risk is secondary to social-contextual factors involving rural isolation, racial homogeneity, and the racial disparities of the region.

Implications:
This presentation will help policy makers understand that illicit drug use may have been overstated as a risk factor for HIV/AIDS in the rural Black Belt. Further research is needed on non-drug related factors that contribute to the high STI/HIV rates of the region.