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While New York and California remain the states most damaged by H.I.V., the southern United States share a surprisingly high burden. Two reasons infection rates have increased in the South, despite what we know today about transmission and prevention, are that individuals delay testing and seek medical attention only in late stages of the disease. "One reason seems to be the strong stigma in the South attached to HIV infection and AIDS, an attitude that is reinforced by many cultural and religious attitudes against homosexuality."

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Another cause of H.I.V. transmission is higher poverty rates in the south as lack of funds delay testing and treatment. "Money cannot cure all the obstacles to improving the HIV picture in the South, but it could certainly help." And while Medicare is facing budget cuts at the federal level, some States are beginning to innovate: "South Carolina has an H.I.V. education program that aims to reduce stigma by reaching out to churches and ministers. Arkansas, for the first time, has allotted funds to test the feasibility of offering routine H.I.V. screening to the general population."