This presentation seeks to move the field in the discussion of rural disenfranchised individuals living with HIV. The first objective is to provide statistics concerning the status of HIV in the United States and the South Eastern United States. Additional statistics will be presented concerning Alabama as a travel state for the spread of this disease. Moving from infection rates to the demographic makeup of these rural populations provides the foundation to develop a working theory for the continued spread. The ecological issues surrounding the spread of HIV in rural disenfranchised populations are framed against the insidious operations of the South East United States Human Trafficking industry. It is through the use of this paradigm shift that the difficulty of treating and decreasing the spread of HIV is exposed. In closing, this presentation discusses the Proactive Case Management Model of working with these populations and the related research tied to the efficacy of this model. This research is supported by a grant from the Alabama Council on Developmental Disabilities and Medical Aids Outreach of Alabama.