trust to talk
by Mary Alice Scott

You're the First One I've Told: New Faces of HIV in the South. By Kathryn Whetten-Goldstein and Trang Quyen Nguyen. Rutgers University Press, 288 pages, $22.00.

my's mother thought Amy was too black, so her aunt and uncle raised her. Amy regularly witnessed her uncle beat her aunt, and more than once she called the police about it. At school, classmates teased her because of her old clothes and her smell. She dropped out in the tenth grade, embarrassed by always being late because her aunt frequently asked for her help in the mornings. When she was a teenager, she was gang raped. But Amy says that her most difficult experience was finding out that she was HIV-positive and four months pregnant by a man who physically abused her. The health department staff persuaded her to have an abortion, telling her that her baby would also be HIV-positive.

Amy's story is one of the life histories of eastern North Carolinians with HIV and AIDS collected in You're the First One I've Told: New Faces of HIV in the South, coauthored by Trang Quyen Nguyen, a Carolina doctoral student in epidemiology, and Kathryn Whetten-Goldstein of Duke University. For this increasingly poor, rural, female, African American group of HIV-infected people, managing illness is more difficult than organizing life around medications.

ealth care providers are trained to deal with patients' medical needs, but many of these patients also experience physical and sexual abuse, discrimination, peer rejection, poverty, and other factors that limit their trust of authority and their ability to adhere to medical treatment and advice. "I was surprised by the number and intensity of traumatic experiences throughout the participants' lives," Nguyen says. "People had to set aside their feelings about their diagnosis in order to move forward." Often moving forward meant neglecting their mental and physical health care.

The book alternates between describing life histories of the interviewees and analyzing how policy makers and healthcare providers can meet the needs of this new population of HIV patients. Nguyen and Whetten-Goldstein suggest that changes need to be made in policy and practice involving people with HIV and AIDS in the rural South. Nguyen says, "By learning about the degree to which people have been traumatized and have difficulty trusting others, we can better meet HIV patients' needs and capabilities."

Mary Alice Scott is editorial assistant for Endeavors magazine.
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