In the summer of 1981, doctors in the United States first reported outbreaks of rare opportunistic infections among young, otherwise healthy gay men in New York City, San Francisco, and Los Angeles. These cases represented the advent of a new, terrifying, and deadly disease: Acquired Immune Deficiency Syndrome, or AIDS.
The disease would remain closely associated in the public imagination with the communities of gay men in which the disease was first identified and with the coastal cities where they lived. However, as the burden of AIDS and HIV—the virus that causes AIDS—has shifted to the U.S. South, states such as Georgia have come to seem more typical of the epidemic.
Key Organizations
AID Atlanta, founded in 1982, was perhaps the first organization created in Georgia to respond to AIDS. The group emerged from Atlanta’s gay community, which had become more socially and politically visible during the 1970s. Under the leadership of Reverend Ken South, AID Atlanta offered support to those who were sick and accurate information about the new disease to the public. Like other similar organizations nationwide, the group matched people with AIDS to volunteer “buddies” who offered emotional support and help with daily tasks. AID Atlanta also designed a safe sex “party” workshop titled “P.S.—I Love You” to teach gay men how to reduce the risk of HIV transmission through sex.
However, AIDS was not only affecting gay men, as a growing number of women of color in Georgia were also becoming sick. Dázon Dixon (later Dázon Dixon Diallo), a reproductive justice activist who worked as a counselor at the Infectious Disease Clinic at Grady Hospital, saw this firsthand. In 1987 she helped to adapt AID Atlanta’s safe sex “party” for women, and in 1989 started SisterLove, Inc., to offer AIDS education and services to Black women. Dixon was based in Atlanta but was also concerned about AIDS among Black women in rural Georgia. Accordingly, she worked with the chapter of the Delta Sigma Theta sorority at Fort Valley State College (now Fort Valley State University), a historically Black college in rural Peach County, to train women in the area to educate their peers about safe sex and AIDS.
Atlanta was also home to a local chapter of the AIDS Coalition to Unleash Power (ACT UP), which used direct action tactics in the fight against AIDS. In Atlanta, members staged “die-ins” at Grady Hospital to protest the months-long waiting list for care for people with AIDS and picketed a grocery store that had fired a worker with HIV. They also worked with activists from across the country, as well as Dixon and SisterLove, to demand that the Centers for Disease Control and Prevention (CDC) change the clinical definition of AIDS. The CDC had defined AIDS based on how the disease presented in gay men, leaving out women-specific opportunistic infections such as pelvic inflammatory disease. As a result, many women with advanced HIV were unable to be diagnosed with AIDS, and thus ineligible to receive disability payments and other social benefits. In December 1990 this coalition of activists staged a massive march on CDC headquarters in northeast Atlanta. This demonstration, along with similar actions at other federal agencies and a lawsuit brought by the HIV Law Project, pushed the CDC to officially expand its definition of AIDS in January 1993.
ACT UP Atlanta also helped to secure supportive housing for people with AIDS. In 1988, a coalition of public officials, faith leaders, and medical professionals formed Jerusalem House, Inc., to open a housing facility for people with AIDS at risk of homelessness. They selected a site in the Druid Hills neighborhood but met opposition from local homeowners. In response, ACT UP Atlanta canvassed the community to build support for the facility, which opened in November 1989. In the years that followed, Jerusalem House continued to expand its operations, and in 2023 changed its name to Status: Home. As of 2026 it provides housing and rental subsidies to individuals and families living with HIV across Atlanta.
The fight against AIDS also mobilized veterans of the civil rights movement. In May 1986 the women’s auxiliary of the Southern Christian Leadership Conference (SCLC), SCLC/W.O.M.E.N., hosted a national conference on AIDS and the Black community, the first such meeting organized by a prominent civil rights organization. The group followed the national meeting with a series of regional conferences in 1987, held in Albany, Macon, and Savannah. In 1988 SCLC/W.O.M.E.N. received a major federal grant to conduct AIDS education programs in Black churches in six cities in the Midwest and South. Known as the National AIDS Program, the initiative operated out of SCLC’s headquarters in Atlanta, which was also the most active of the six local project sites. Maurice Franklin, a Black gay man, was hired in 1990 to oversee the program.
However, divisions of race, class, and sexuality made it difficult to forge solidarity across the groups most affected by HIV in Atlanta. In the early years of the epidemic, AIDS was seen as a “white gay disease,” in part because organizations like AID Atlanta were founded and staffed by white gay men, and because the gay communities in cities such as Atlanta were segregated by race and class. Some activists also recall that there was also a group of prominent—but closeted—middle-class Black gay men in Atlanta who refused to be visible out of concern for their respectability. In the same vein, Maurice Franklin found his work complicated by resistance from Black church leaders and congregants, and a conflict with Evelyn Lowery, the head of SCLC/W.O.M.E.N., over a grant to a Black gay advocacy group in Atlanta led him to resign from leadership of the National AIDS Program.
As the number of AIDS cases in Georgia grew, other organizations cropped up as well. Len and Peggy Terrell, a married couple in Gwinnett County, began hosting a support group for the families of people with AIDS in 1989 after their son, Ric Crawford, was diagnosed with the disease. After Crawford died the following year, the support group grew into AID Gwinnett, a fully-fledged nonprofit organization, with buddy, meal, and case management services, overseen by multiple staff and dozens of volunteers. By 1995 their work had grown to encompass nearby Rockdale and Newton counties, and in 2015 the organization merged with Positive Impact to form Positive Impact Health Centers, a comprehensive care agency.
Similarly, Pandora Singleton began hosting a support group for HIV-positive women in her home while working as a counselor at the Chatham County Health Department. In 1993 she formed Project AZUKA to offer HIV testing, education, and services to Black women in the Savannah region. Through Project AZUKA, Singleton also reached incarcerated women, rural women, and sex workers, all of whom were ordinarily overlooked. Singleton passed away in September 2004, and Project AZUKA ceased operations in 2005.
Changes in Treatment and Care
The system of treatment and care for people with HIV in Atlanta grew along with the epidemic. Grady Hospital had opened its Infectious Disease Clinic in 1986, one of the few in the state to treat uninsured people with AIDS. The clinic struggled to keep pace with the epidemic until 1993, when it was renamed the Infectious Disease Program (IDP) and moved to a new facility in Atlanta’s Midtown neighborhood. Over the next few years, the IDP developed an integrated approach to care for people with AIDS, offering emergency services, dentistry, substance abuse treatment, and social assistance. By the end of the 1990s, the program was providing care to most Georgians receiving public assistance for HIV, and by 2020 was treating one in seven Georgians living with AIDS.
The advent of antiretrovirals—highly effective drugs used to treat HIV—in the mid-1990s marked a turning point in the fight against AIDS. All of a sudden, people who were very sick and prepared to die faced the prospect of living much longer. At the same time, AIDS advocates worried that the new treatments would lead to complacency in HIV prevention. If having the virus was no longer viewed as a death sentence, would people still take steps to protect themselves?
In this context, AID Atlanta designed “Reconstruction,” a series of educational forums intended to help people with AIDS deal with the emotional and logistical issues associated with their suddenly increased life expectancy. Individual sessions covered topics such as navigating social security benefits and the return to work, as well as how to deal with the psychological reality of living longer. At around the same time, AID Atlanta also launched a public awareness campaign stressing that the advent of antiretrovirals did not mean the AIDS crisis was over.
Antiretrovirals gave some people with AIDS a new lease on life, but not everyone benefited equally. The new treatments were expensive, required strict adherence in order to be effective, and sometimes came with serious side effects. Many who lacked insurance could not afford antiretrovirals, and doctors would not prescribe them to people with AIDS who were less likely to take them consistently due to struggles with unstable housing and drug use. As rates of new HIV infections, AIDS diagnoses, and deaths declined sharply among gay white men, who had the greatest access to resources, the burden of the epidemic shifted toward Black communities. In 1988, for example, 56 percent of reported AIDS cases in Georgia were among whites, and 43 percent among African Americans; by 1998, those figures had nearly flipped, with whites making up 20 percent of cases, and African Americans just under 78 percent. Women were especially affected. By 1997 the proportion of women among people with AIDS had risen from 4 percent at the beginning of the epidemic to 23 percent. At the same time, the burden of the epidemic was shifting away from cities and toward rural areas where people were harder to reach with information about HIV treatment and prevention.
Some observed that as HIV was becoming a chronic, manageable disease for some, and the “face of AIDS” was seen to shift from white men to Black women, fewer people cared about the disease. Jerusalem House had fewer volunteers coming to visit with residents, organizations such as SisterLove had to cut staff because they had less grant money coming in, and others reported that individual and corporate donations had dropped as well. “It’s about racism,” Paul Kawata, executive director of the National Minority AIDS Council, told the Atlanta Journal-Constitution in 2001. “America doesn’t care about people of color.”
Advances in HIV Prevention
In 2004 the Food and Drug Administration (FDA) approved Truvada, an antiretroviral drug, to treat HIV, and in 2012, the agency approved the drug’s use to prevent transmission of the virus. When taken daily by an HIV-negative person as pre-exposure prophylaxis (PrEP), the drug has been shown to be extremely effective at preventing HIV transmission. The FDA has since approved similar medications, and the availability of PrEP has been associated with a significant decline in new HIV infections, especially among young people.
However, PrEP use has been largely concentrated among white gay men, who have also seen the most dramatic reductions in new HIV infections. Meanwhile, the rate of new HIV infections in Georgia, where the epidemic has especially impacted Black gay men and Black women, has remained high. As of 2022 the state had one of the highest levels of unmet need for PrEP in the United States, surpassed only by Puerto Rico, Mississippi, Alabama, and South Carolina.
Also as of 2022, 6.6 percent of people newly diagnosed with HIV in the United States were living in Georgia, and the state had one of the highest rates of new HIV infections in the country, surpassed only by Washington, D.C. Within the state, the five core counties of the Atlanta region contributed over 58 percent of new HIV infections to the statewide total. However, the highest rate of new infections among Georgia counties could be found to the south, in mostly rural Butts County. Across the state, poverty and lack of access to quality health care continue drive both the spread of HIV and deaths from AIDS, as people struggle to access HIV prevention, testing, and treatment. Notably, Georgia is one of ten states that have not expanded Medicaid under the Affordable Care Act, which is associated with improved HIV prevention, early identification of new HIV infections, and health at the time of HIV diagnosis.
