December, 2014: SASI research team collaborates with the Centers for Disease Control to publish new article in the Journal of Community Health: HIV Diagnoses, Prevalence and Outcomes in Nine Southern States , Reif, Pence, Hall, Hu, Whetten & Wilson, Journal of Community Health, 19 December 2014, DOI: 10.1007/s10900-014-9979-7.

SASI researchers have previously documented the high burden of HIV in SASI’s targeted deep south states: Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas.  In 2011, 38% of those diagnosed with HIV in the United States were in the targeted states region; the targeted state region also had the highest number of persons living with HIV of any region in the US.

In this article, researchers analyze the characteristics of people diagnosed with HIV in the targeted states.  They also examine 5-year HIV and AIDS survival and deaths among persons living with HIV.

Key Demographic Findings:

• More people diagnosed with HIV and living with HIV in the targeted states are black/African American, female and aged 13-24 than in any US region.
• More than a quarter of persons diagnosed with and living with HIV in the targeted states region live outside of urban areas (population 500,000 or greater)—highest of any US region.
• As a region, the targeted states had a higher percentage of HIV transmissions attributed to heterosexual contact and a lower percentage due to injection drug use of any US region.
• The targeted states region has a higher percentage of both males and females living with HIV with heterosexual contact as the reported transmission category than any US region.

Five-year Survival among persons diagnosed with HIV and AIDS:

• Overall, 5-year survival among persons diagnosed with HIV or AIDS was lower in the targeted state region than in any other US region.
• 15% of persons diagnosed with HIV in the region had died within 5 years of diagnosis.
• 27% of persons diagnosed with AIDS in the region had died within 5 years of diagnosis.
• In the region, Louisiana had the lowest survival rates after a diagnosis of HIV or AIDS, followed by Mississippi.
• In Louisiana, 19% of persons diagnosed with HIV had died within 5 years and one-third of persons diagnosed with AIDS had died within 5 years.
• 5-year survival after a diagnosis with HIV or AIDS was lower in the rural and suburban areas of the region than in the urban areas.
• 29% of females diagnosed with AIDS and 26% of males in the targeted states had died within 5 years of diagnosis.
• Blacks had the lowest 5-year HIV and AIDS survival of any race/ethnicity in the region.

Deaths Among Persons Living with HIV (rate of deaths among 1,000 PLWH in 2010):

• The death rate among persons living with HIV was higher in the targeted states than in any other US region (even after adjusting for age, sex, transmission category and area population size).
• Blacks had a higher death rate among persons living with HIV in the region than whites.
• Women had a higher death rate among persons living with HIV in the region than males.
• Suburban and rural residence at diagnosis significantly predicted greater death rates among persons living with HIV in the region compared to urban residence at diagnosis.
• Louisiana had the highest death rate among persons living with HIV followed by Alabama, South Carolina and Florida.

Connections and Recommendations:

• Characteristics of persons diagnosed with HIV in the targeted states differ from the US overall.
• “These differences are crucial to consider, as are other factors prominent in the targeted states including poverty and stigma, when creating strategies to address HIV in this region.”

• Higher death rates among persons living with HIV in the targeted states

• “…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.”
• “An additional contributing factor may be the social class system unique to the US South that has traditionally allowed for little social mobility, along with marginalization of, and discrimination against certain groups and often resulting in distrust of systems of care among those in a lower social strata.”
• “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.”
• “The targeted states with the most concerning mortality statistics, particularly Louisiana, may especially be in need of focused attention on addressing the factors contributing to these concerning statistics.” 

• Higher death rates in the suburban and rural 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.”
• “suggests a disconnect between diagnosis and maintenance of HIV care in this region—particularly in non-urban areas.”

• Higher diagnosis rates among youth

• Could be attributed, in part, to: lack of education about HIV transmission; less gravity placed on HIV infection due to improvements in available drug regimens.
• “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.”

If we are to achieve the goals of the National HIV/AIDS Strategy, federal and state public health officials and policy makers must direct a laser focus on the deep south region of the US where HIV diagnosis rates are highest and more people are living and dying with HIV.  This article gives us a deeper understanding of the characteristics of those most affected by HIV in our region and documents the dire consequences that having an HIV diagnosis in the deep south has for too many in our region.