Research

July 18, 2014: The Potential for Elimination of Racial-Ethnic Disparities in HIV Treatment Initiation in the Medicaid Population Among 14 Southern States; Shun Zhang, Shanell L. McGoy, Daniel Dawes, Mesfin Fransua, George Rust, David Satcher; PLOS One, April 2014.

Medicaid Matters! Important new research from the Morehouse School of Medicine with Tennessee’s State AIDS Director Shanell L. McGoy, Ph.D MPH as co-author finds that access to Medicaid has the potential to eliminate racial-ethnic disparities in the initiation of antiretroviral (ARV) treatment of HIV. Researchers found no significant diference between black (35.8%) and non-Hispanic whites (35.7%) in 14 Southern States who received ARVs when on Medicaid.  Hispanics/Latinos (26.2%) were significantly less likely to receive ARVs, a finding that was linked to structural barriers, including US immigration policies,  experienced by Hispanic and Latino patients in enrolling in Medicaid.

Multiple SASI research reports have demonstrated that the Southern region of the United States is disproportionately impacted by HIV. In their study, researchers at Morehouse School of Medicine explored the racial and ethnic disparities in the initiation of ARV/ART among HIV positive Medicaid enrollees 18-64 years of age in 14 southern states.

Dr. Shanell L. McGoy, Director of HIV/STD, Tennessee Department of Health states, “we are hopeful with persistent and collective efforts, particularly in policy and advocacy, we can eliminate not only geographic but also racial-ethnic disparities in HIV.”

From the article: “The fact that black-white racial disparities in treatment initiation have been eliminated in the Medicaid populations of fourteen southern states is a profound affirmation of the possibility of achieving equality in treatment and outcomes.  In this case, Medicaid matters!”

April 23, 2014: Updated SASI Research Report released: HIV/AIDS in the Southern US: Trends from 2008-2011 Show a Consistent Disproportionate Epidemic

  • The percentage of new HIV and AIDS diagnoses that were black or African-American MSM increased fastest in the targeted deep south states.
  • In 2011, the highest percentage (47%) of new diagnoses among black or African American MSM were in the targeted deep south states.
  • The large disparity in HIV diagnosis rates between black or African American and white women remains high in the targeted states.
  • Overall, in 2011, the targeted states had the highest number of people living with HIV of any region and the highest number diagnosed.

February 21, 2014: New SASI Research Report released:  HIV/AIDS in the Southern US: Trends from 2008-2011 Show a Consistent Dispropotionate Epidemic. The SASI research team analyzes 4 years of HIV/AIDS epidemiological data for the Southern Region to explore trends in the Southern HIV/AIDS epidemic.

  • From 2008-2011, the deep south states consistently had the highest HIV and AIDS diagnosis rates in the U.S.
  • During this 4-year period, the deep south states also had 9 of the 10 metropolitan areas with the highest AIDS diagnosis rates in the country.
  • Most telling, the deep south region had the highest HIV case fatality rates in the country (deaths among people living with HIV).
  • African Americans were hardest hit in the deep south comprising the majority of AIDS diagnoses (range 58-60%) in 2008-2011.

January 17, 2014:  SASI publishes article in AIDS Care: HIV/AIDS in the Southern United States: A Disproportionate Epidemic. Abstract available here.

Using 2011 CDC data, SASI researchers have documented the continuing disproportionate epidemic in the Southern United States and particularly in 9 targeted deep south states, Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and East Texas.

New HIV Diagnosis Rate Map

2011 data re: HIV/AIDS in the Southern Region

  • 49% of new HIV diagnoses and 49% of new AIDS diagnoses in 2011 were located in the South, a region that accounts for only 37% of the US population.
  • The South had the highest HIV diagnosis rate in the US.
  • The South had the highest HIV diagnosis rate and the highest AIDS diagnosis rate in the US in 2011.
  • All 10 metropolitan areas with the highest AIDS diagnosis rates in 2011 were in the South.

2011 data re: HIV/AIDS in the targeted Deep South

 (AL, FL, GA, LA, MS, NC, SC, TN and East Texas)

  • 32% of new HIV diagnoses in 2011 were located in 9 targeted deep south states that account for 22% of the US population.
  • The targeted deep south states, when considered as a geographic region, had the highest HIV diagnosis rate and the highest AIDS diagnosis rate in the US in 2011.
  • Nine of the 10 metropolitan areas with the highest AIDS diagnosis rates in 2011 were in the targeted deep south states. 

Southern States had some of the worst HIV Death rates 

  • The Southern US had significantly lower 3-year HIV survival rates than the US average.*
  • Nine of the 10 states with the highest HIV case fatality rates were in the South; 8 were in targeted deep south states.**

The article highlights social determinants of health that may contribute to the Southern HIV epidemic, including high rates of sexually transmitted diseases, high poverty rates, stigma, the disproportionate impact of HIV on racial minorities in the South, state geography and culture, and the lack of adequate health care financing.

* Hanna, D., Selik, R., Tang, T., & Gange, S. (2011). Disparities among states in hiv-related mortality in persons with hiv infection, 37 U.S. STATES, 2001-2007. AIDS, Early Release.

** Prejean, J., Tang, T., & Hall, I. (2012). HIV diagnoses and prevalence in the southern region of the United States, 2007-2010. Journal of Community Health, Epub.

July 15, 2013HIV AIDS in Metropolitan Statistical Areas – 9 Southern States

SASI releases new research report analyzing CDC data in Metropolitan Statistical Areas (MSAs: with populations greater than 500,000).  “Fifteen of the 20 MSAs … with the highest HIV diagnosis rates were located in a 9 state region of the South (AL, FL, GA, LA, MS, NC, SC, TN, and East TX).” Nine of the 10 MSAs with the highest HIV diagnoses rates in 2008-2010 were in these targeted states.

“Nearly one-half of new HIV diagnoses in 2010 in Jackson MS (45%), Atlanta GA (47%) and Charleston, SC (47%) were among African-American MSM.”

“Baton Rouge LA had the highest percentage of new HIV diagnoses occurring among African American females, at nearly one-third of new diagnoses (31%).”

The HIV epidemic is not concentrated solely in MSAs in the South, “the South has a higher proportion of new HIV diagnoses in rural and suburban areas than all other regions and also has higher HIV diagnoses rates per 100,000 population in suburban and rural areas than the other US regions.”

More research is needed to better understand the limitations of the HIV care and prevention infrastructures in the South and to determine how these infrastructures are influenced by state poverty and culture and how they in turn impact HIV incidence.”

February 23, 2013: Housing Opportunities for Persons with AIDS (HOPWA): Distribution of Funding to the Southern States

SASI releases new research report: Housing Opportunities for Persons with AIDS (HOPWA): Distribution of Funding to the Southern States. This report analyzes the HOPWA entitlement grant funding formulas.  Specifically, HUD uses a formula based on cumulative AIDS cases to distribute approximately $225 million of the $300 million entitlement grants to cities and states for short-term and long-term housing.

SASI’s analysis of this HOPWA funding stream concludes that the South is receiving 4.1% less of this funding than it would receive if the formula was based on living HIV/AIDS cases.

Nov. 22, 2012HIV Diagnoses & Prevalence in the Southern Region of the US

HIV Diagnoses and Prevalence in the Southern Region of the United States, 2007-2010, a new paper published in the Journal of Community Health by CDC authors documents the high HIV burden borne by the Southeastern United States.  According to the paper, “the southern region is home to the largest percentage of new diagnoses and the largest percentage of people living with a diagnosis of HIV infection of any region in the United States..”:

  • “In 2010 46.0% of all new diagnoses of HIV infection occurred in the South.”
  • “Compared to other regions, a higher percentage of diagnoses in the South were among women (23.8%), blacks/African Americans (57.2%)…”
  • “…a greater percentage of the estimated diagnoses of HIV infection in the South were among suburban…and rural residents…”
  • “…the estimated rate of diagnoses of HIV infection in the two youngest age groups of men (13-19 and 20-29) increased significantly…”
  • “…after diagnosis individuals in the South have worse outcomes….the percentage of persons surviving 36 months after a diagnosis of HIV infection is worse in the South than in all other areas…”

November 28, 2012SASI Update–The Continuing HIV Crisis in the US South 

SASI releases updated report, SASI Update: The Continuing HIV Crisis in the US South.  Report highlights include:

  • 8 of the 10 states with the highest HIV diagnosis rates were in the South*; 7 were in targeted southern states (AL, FL, GA, LA, MS, NC, SC, TN, (East) TX).
  • 48% of new HIV diagnoses were in the South, while the South contained only 37% of the population.
  • 32% of new HIV infections in 2010 were in the 9 targeted southern states, which contain only 22% of the US population.
  • The targeted southern states had the highest new diagnosis rates in the US.
  • 7 of the states/district with the highest AIDS diagnosis rates were in the South; 4 were in targeted states (FL, LA, MS, SC).
  • 9 of the 10 metropolitan areas with the highest HIV diagnosis rates were in these targeted southern states, including Miami, FL and Jackson, MS.
  • 9 of the 10 metropolitan areas with the highest AIDS diagnosis rates were in the South; 7 were in targeted states.
  • 6 of the 10 states with the highest HIV prevalence rates in the US were in the South (FL, GA, LA, DE, SC, MS).
  • Southern states/DC represented 6 of the 10 areas with the highest AIDS prevalence rates (DC, MD, FL, GA, DE, LA).
  • 9 of the 10 US states with the highest rates of death due to HIV are in the South, and all 9 targeted southern states are among the 15 states with the highest HIV death rates.

January 2012HIV/AIDS Epidemic in the South Reaches Crisis Proportions in the Last Decade

In January 2012, SASI released the report, HIV/AIDS Epidemic in the South Reaches Crisis Proportions in the Last Decade, prepared by the Duke Center for Health and Inequalities Research.  The Executive Summary of this report was released in November 2011.  Some of the report’s highlights are included below.

HIV in the Southern United States

  1. New HIV diagnoses:
  • In 2009, 50% of individuals newly diagnosed with HIV infection resided in the Southern USi and the rate of diagnosis of HIV infectionii in the South was the highest of all the US regions.1,2  Seven Southern states (FL, GA, LA, MS, NC, SC, TX, VA) were among the 10 statesiii with the highest rates of diagnosis of HIV infection in 2009.1
  • 9 of the 10 metropolitan areas with the highest rates of diagnosis of HIV infection in 2009 were in the Southern US.1  Two of these Southern cities (Miami and Atlanta) are part of the 12 Cities Project.3
  1. Individuals living with HIV (HIV prevalence): Forty-three percent of people who are HIV-positive live in the Southern US while the South comprises only 37% of the population.1,2 Southern states account for 7 of the 10 statesiii with the highest HIV prevalence rates in the US in 2009 (FL, GA, LA, MS, SC, TX, VA).1
  1. Death Rates: Data on deaths among individuals with HIV that occurred from 2001-2007 indicated that nine of the ten states with the highest age adjusted HIV case-fatality rates were located in the Southern US (AL, MS, FL, GA, LA, OK, NC, TN, SC).4
  1. Rural HIV/AIDS: 64% of individuals living with an AIDS diagnosis in rural areas reside in the Southern US.5 In the South, 22% of individuals living with HIV resided in rural areas or metropolitan areas with populations under 500,000 in comparison to 11% nationally. Providing HIV care in rural areas may be particularly challenging due to barriers such as lack of transportation, shortages of medical providers, and fear of discrimination and confidentiality breaches.6,7
  1. Race/ethnicity: African Americans are disproportionally represented among new HIV diagnoses (2005-2008) in the South, as 50% of men and 71% of women diagnosed with HIV in the South were African American.8 African Americans with HIV have been identified as having higher levels of morbidity and mortality.4,9

The Census Bureau defines the Southern US as including Alabama, Arkansas, Delaware, DC, Florida, Georgia,  Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia

ii Rates are calculated as new HIV cases per 100,000 population

iii Among the 40 states with mature HIV reporting systems (CDC technical notes1).

REFERENCES:

1. Centers for Disease Control.  Diagnoses of HIV Infection and AIDS in the United States and Dependent Areas, 2009. HIV Surveillance Report, Volume 21. Available at http://www.cdc.gov/hiv/surveillance/resources/reports/2009report/index.htm. Accessed October 2011.

2. U.S. Census Bureau, Population Division. Table 1, Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2000 to July 1 2009. Released December 2009.

3. Gomez M. The 12  Cities Project. 2011. Available at http://blog.aids.gov/2011/02/the-12-cities-project.html.

4. David B. Hannaa, Richard M. Selikb, Tian Tangb and Stephen J. Gange. Disparities among States in HIV-related mortality in Persons with Hiv Infection, 37 U.S. States, 2001–2007. AIDS, 2011, published ahead of print.

5. Centers for Disease Control. HIV Surveillance in Urban and Nonurban Areas. 2011. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/slides/urban-nonurban/. Accessed October 2011.

6. Sutton M, Anthony MH, Vila C, McLellan-Lemal E, Weidle PJ. HIV Testing and HIV/AIDS Treatment Services in Rural Counties in 10 Southern States: Service Provider Perspectives, The Journal of Rural Health. 2010;26: 240-247.

7. Reif S, Whetten K, Raper J. Characteristics of HIV-Infected Adults in the Deep South and their Utilization of Mental Health Services: A Rural Vs. Urban Comparison. AIDS Care, 2006;18(Supp 1):10-17

8. Centers for Disease Control. Disparities in Diagnoses of HIV Infection Between Blacks/African Americans and Other Racial/Ethnic Populations – 37 States, 2005—2008. Mortality and Morbidity Weekly Report, 2011.60(4):93-98.

9. Meditz A, Mawhinney S, Allshouse A, et. al, Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection, Journal of Infectious Diseases, 2011: 203(15); 442-451.