A group of 9 states in the southern U.S. had a higher rate of HIV diagnosis compared to the country as a whole; had more women, African-Americans, and young people living with HIV; and had a higher death rate among people with HIV or AIDS, according to a study recently published in the Journal of Community Health. The researchers suggested that socioeconomic disadvantages, stigma, and discrimination contribute to these disparities.

The south has the highest HIV and AIDS diagnosis rates and the highest number of people living with HIV in the U.S. While the region makes up 37% of the U.S. population, it accounted for nearly half of people diagnosed with HIV in 2010.

Susan Reif from the Center for Health Policy and Inequalities Research at Duke University and colleagues used HIV surveillance data from the Centers for Disease Control and Prevention (CDC) to examine characteristics of people diagnosed with HIV in 9 targeted states: Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas.

The researchers used multivariate analysis to look at the effect of living in the targeted states after adjusting for potentially confounding factors including demographics and transmission risk. As a limitation, they noted that their data captured new HIV diagnoses rather than actual incidence or new infections.

Results

In 2011, the southern states had a higher HIV diagnosis rate than the U.S. overall (24.5 vs 10.0 per 100,000 people), as well as the highest of any region.

Compared with the U.S. as a whole, people diagnosed with HIV in the targeted states were more likely to be black, female, adolescents or young adults, and living in suburban or rural areas.

The southern states had the highest death rate among people living with HIV of any region in the country.

The targeted states had lower 5-year survival rates than the U.S. overall for people with HIV (85% vs 86%, respectively) and for people diagnosed with AIDS (73% vs 77%, respectively).

However, HIV survival and death rates were not uniform across the region -- for example, 5-year survival with AIDS was only slightly lower in Texas than in the U.S. overall, but substantially lower in Louisiana.

"HIV surveillance data indicate a disproportionate impact of HIV in the targeted Southern states in terms of higher HIV diagnosis and prevalence rates and greater HIV mortality," the study authors concluded.

"Regional differences in demographics and transmission risk did not explain the higher death rate among persons living with HIV in the targeted states, indicating that other factors contribute to this disparity," they wrote. "These contributing factors likely include characteristics of the targeted states such as lower levels of income, education, and insurance coverage and higher levels of HIV stigma and racism."

"Higher HIV diagnosis rates among the younger age categories, particularly in the targeted states region and the rest of the South, could be attributed, in part, to lack of education about HIV transmission and less gravity placed on HIV infection due to improvements in available drug regimens," they continued. "Development and implementation of effective prevention and treatment strategies for the younger population will be critical to stemming HIV transmission in the targeted Southern states."

"Challenges to HIV prevention and care in rural and suburban areas of the targeted states, such as lack of transportation, lack of qualified providers, and HIV-related stigma, may provide some explanation for the study findings regarding lower 5-year HIV and AIDS survival proportions in the targeted states in comparison to other US regions," the authors wrote. "The higher death rate among persons living with HIV in the targeted states suggests a disconnect between diagnosis and maintenance of HIV care in this region, particularly in non-urban areas. Identifying effective ways to structure prevention and care services so that they address common barriers to care such as accessibility and pervasive stigma will be critical to improving HIV outcomes in rural and suburban areas of the targeted states."

"These societal factors have likely collectively contributed to creating an environment in the targeted states in which HIV infection is more likely and health outcomes for HIV-positive individuals are poorer than in other U.S. regions," they suggested. Additional research is needed to better determine and understand the factors that influence the higher death rate among persons living with HIV in the targeted states and to identify effective mechanisms to address known barriers including HIV stigma."

1/21/15

Reference

S Reif, B Wells Pence, I Hall, et al. HIV Diagnoses, Prevalence and Outcomes in Nine Southern States. Journal of Community Health. December 19, 2014 (Epub).

Other Source

Duke University. Lower Survival Rates for HIV/AIDS Patients in South. Press release. January 14, 2015.