Alina Oswald Talks with Dr. Bambi Gaddist About Linking Individuals to Affordable Care & Reaching Out to African-American Women with a Message of AIDS Awareness
In the wake of any tragedy, people need heroes, and heroes emerge. It happened after the September 11 attacks, after Hurricane Sandy, and in the wake of the Boston Marathon bombings.
Many heroes emerged from the tragedy of AIDS, as some have called it. Bambi Gaddist, PhD, executive director of the South Carolina HIV/AIDS Council, is one of them.
The label fits, and not just because she was named a 2008 CNN Hero. I quickly learned why. For example, her agency has the only mobile outreach van in the state. “Still have the van,” she tells me over the phone. “As a matter of fact, we’re out today, in a rural community, in three rural counties that have little or no access to testing.”
A native of Vineland, New Jersey, Dr. Gaddist attended Tuskegee University, and, after that, Indiana State University, where she studied reproductive health. Then, in the seventies, she spent a lot of time at the Kinsey Institute. She majored in physical education and health, but she has always pursued adolescent pregnancies, the topic of her dissertation.
“Then I got sucked into HIV,” she adds. “I met this hairdresser, Diana, who was doing this [kind of] work in her beauty shop. I was a doctoral student. We worked together for fifteen years.” Gaddist bases the HIV/AIDS work she does today on the work she engaged in back in the eighties, at the beginning of the epidemic.
She is known as “the AIDS Lady.” When I mention it to her, she laughs and mentions that little children call her “Miss Bambi.” Her story is one of AIDS advocacy as an intrinsic part of the bigger story of AIDS seen through a Southern lens.
Dr. Gaddist sits on the board of the Southern AIDS Coalition. A manifestation of SAC’s body of work is the Southern AIDS Living Quilt. The idea of the Quilt was to address and eliminate AIDS stigma, and bring attention to the Southern epidemic through video testimonials of men and women living with the virus, and also of activists (like Gaddist) and health professionals fighting the epidemic. The Southern AIDS Living Quilt celebrates living with the virus. Its message is: know your status; get tested; and make HIV testing an integral part of the annual medical exam.
Gaddist still believes in the Quilt’s message. She also believes that education is imperative. She stays informed and, in turn, informs her staff, about the latest legislative rules and the Affordable Care Act, and how they will impact her work as an activist, and how they are going to impact AIDS in the South.
There are a variety of issues that define AIDS in the South. A lack of interest and/or knowledge to treat HIV/AIDS, related stigma, (lack of) AIDS education and prevention, anonymity, poverty, and the reaction of Southern states to the new healthcare law are only a few of them.
The majority of Southern states are defined as “default,” meaning they will not accept any medical expenditure money. “Like my state, they have no intention of taking that money,” Dr. Gaddist reiterates. “That’s what will happen here, unless something will happen between now and the end of the legislative period. Right now, today, it’s not looking good.” (Months after the interview, it still is not looking good.)
The ACA will be fully implemented in 2014. Meanwhile, there’s a lot of homework to be done, by everybody, and it requires a change in attitude. “We have spent more than thirty years of AIDS telling people who have become newly infected and have lived for a period of time that they don’t qualify for health insurance,” she explains. “We have told them that ‘you have a pre-existing condition and as a result we can’t cover you.’ Or, ‘we’ll cover you but it’s gonna cost you an arm and a leg.’ And so, when you don’t have to deal with something, when you have the ability and the power to tell someone, ‘you don’t qualify,’ you don’t establish that infrastructure to deal with the issue, because you don’t have to.
“So now we’re moving into this federal mandate that’s going to totally change the way we provide healthcare in this country. And it’s going to cause [those working in the healthcare system] to look at their biases and prejudices and all the -isms that have never been confronted. Some folks are not ready, and quite frankly some folks will never be ready. The way they’ll deal with it is that they are gonna set up structures within their practices, within the private sector, where they won’t have to deal with it.”
To understand the Southern AIDS epidemic, we have to understand the mindset that comes with it. Uninsured individuals present themselves in an emergency room setting, in late stages of the disease—they don’t only have HIV; they have AIDS. On the other hand, insured individuals are unsure of what they would do, if they test positive.
“My statement to them is ‘you should call me,’” Gaddist says. The reality is that there are few places individuals diagnosed with HIV can go to in the South. They are forced to travel to a large city where they can find physicians specialized in treating HIV/AIDS and where they cannot be recognized.
A study done by Janssen Pharmaceuticals found that African-American physicians report feeling uncomfortable talking about the HIV test with their patients. “What was so profound to me,” Gaddist comments, “was that, despite the whole pandemic of AIDS, particularly among young men eighteen to twenty-four, black physicians report feeling uncomfortable asking about the test. Many of them don’t even offer it….It’s mind-boggling to me.” She further explains that professional women, in particular, are the most difficult to approach, “because then we get into a conversation of classism,” she says, “and the medical provider fears that if he insults you, you won’t return.”
Gaddist recalls a conversation she had with a teacher who showed up in her office, asking for an HIV test, because she had discovered that her husband of thirty years was having an affair with another man. The HIV test came back negative, yet the experience prompted the teacher to reexamine her attitude and beliefs around her false sense of security.
This happens to many women, in particular Southern African-American women. One reason is the disparity between the number of available men and the number of women—a ratio of twelve or fifteen women to one man, where Gaddist lives. Another key issue is the number of incarcerations.
“Most black women will never get married,” Gaddist says, mentioning that she’s been married for most of her adult life. “Look in the Sunday newspaper,” she adds. “Look in the marriage section. You don’t see black brides in there. I look every Sunday. It’s a habit. I know many black women who are not married. Part of it is availability. The other part is cultural. We’re talking about the elements of the South. People don’t feel comfortable having this conversation about a time in our history that still impacts how we behave today. Even among husbands and wives.”
Gaddist explains that slaves were not permitted to maintain family structures. Then the diabolical (intended or not) incarcerations, poverty, and changes in the social justice system that made one drug more illegal than the other added to the destruction of the family structure. “There are so many African-American women out here with so few men that they share. There’s a lot of sharing that goes on, whether it’s knowingly or unknowingly.
“That’s not to say anything negative because there are plenty of good black men, [but] a lot of it has to do with how women see their men. It’s really profound in the South when you have so many people who are unemployed, [where] poverty is a real issue, [especially for those] living in the rural community, and how [all these dynamics feed] upon this pick-yourself-up-by-your-bootstraps mentality, if you will….”
The reality for black women in South Carolina is that eight out of ten women with HIV are black; that a black woman is twelve times more likely to have HIV than a white woman. Black women make over eighty percent of all cases of HIV/AIDS among women.
These disproportionate numbers reflect on the mother-to-child HIV transmission rates in the U.S., particularly in the South. “We had a major decline in the perinatal infections,” Gaddist comments. “The fact that we encourage and promote testing among women, certainly among African-American women [and] that they know their HIV status during their pregnancy is of high importance here. At least in South Carolina it is. However, you still have women who, for whatever reason, don’t get into prenatal care, and then present far into the pregnancy, but then they have never been in treatment.”
Although mother-to-child HIV transmission rates are almost non-existent in white women, black women are eight times more likely to transmit the virus to the child, compared to white women. It may not be significant, but among those who are pregnant and have been diagnosed as HIV-positive, the majority of them are comprised of black women.
Despite the seemingly insurmountable obstacles often placed in her way, Gaddist seems to never get tired. Despite working in the most stressful of times, her passion and determination never dwindle. How does she do it?
“I believe in God,” she simply answers. “I believe He places us where He wants us to be. There are times when you don’t have anybody else but God [to depend on.]” She also believes that “until it’s time for you to leave, you’ll always be brought back to that same place. It’s like Groundhog Day. That’s how it’s been for me. The good part is that I’m always grateful that I got put back.”
For people like Dr. Gaddist the biggest challenge is not to keep working, but what to do after giving up the reins to someone else. “Personally I look forward to turning this organization over to someone, and hope it survives,” she says. “That would be the true test of what I sought to achieve, that the work will continue. If it doesn’t continue there’s something I didn’t do or something I should have done better.”
Yet, she doesn’t want to leave the impression that there has been no progress in fighting AIDS, in particular, in the South, because, despite all the challenges, progress has been made.
“Not as quickly as we would like,” Gaddist says, “but I don’t know any social change that’s ever occurred without years of struggle. If I thought this was dismal, I would have departed. I think the test would be for those who come after me, how they take whatever the barriers are at the time when they step into these shoes and address the challenges in a way that break down the barriers.
“That’s what I’m hanging on to: If I just talk a little longer, if I advocate a little more, somewhere down the road you’ll get it. It may be nothing that I said. It may be a situation you find yourself in, but you remember it because we had the conversation.”
Alina Oswald is a writer, photographer, and the author of Journeys Through Darkness: A Biography of AIDS. Contact her at www.alinaoswald.com.