SASI Releases the HIV/AIDS Care and Prevention Infrastructure in the U.S. Deep South Report

SASI’s HIV-AIDS Care and Prevention Infrastructure in the U.S. Deep South is co-authored by SASI research team, Susan S. Reif, Kristen Sullivan, Elena Wilson, and Miriam Berger of the Duke University Center for Health Policy & Inequalities Research.

Recent research from SASI documented that nine states in the US Deep South (AL, FL, GA, LA, MS, NC, SC, TN, TX) had especially high HIV diagnosis rates and death rates due to HIV from 2008-2013.[1]

This new Report examines HIV care and prevention infrastructures and factors that contribute to poorer outcomes in the Deep South. Researchers studied four metropolitan statistical areas MSAs) with pronounced HIV and AIDS diagnosis rates (Baton Rouge, LA; Columbia, SC; Jackson, MS; Jacksonville, FL) and compared them to two metropolitan areas with similar demographics but less severe HIV epidemics (Birmingham, AL and Cincinnati, OH).

All four study areas had HIV epidemics that are predominantly affecting Black/African American people with high HIV and AIDS diagnosis rates and HIV death rates.  There were differences among the MSAs, however. For example, Baton Rouge and Jacksonville had some of the highest proportion of new female diagnoses in the US, whereas Jackson and Columbia had high proportions of minority men who have sex with men (MSM) among those diagnosed with HIV.

Common Barriers to HIV care participation identified in the study areas:

  • Pervasive HIV-related stigma
  • Lack of sufficient transportation resources
  • Lack of an adequate supply of housing options
  • Lack of quality mental health and substance abuse treatment options
  • Lack of political support and advocacy for positive change

Common Barriers to HIV prevention participation identified in the study areas:

  • Pervasive HIV-related stigma
  • Lack of comprehensive sex education in schools
  • Inadequate HIV prevention interventions beyond testing
    • Lack of faith-based prevention initiatives
    • Inadequate availability of PrEP (pre-exposure prophylaxis) to prevent HIV transmission
    • Lack of community messaging about HIV
  • Lack of political support and advocacy for positive change

Common Strengths identified in the study areas:

  • Passionate and experienced HIV care and prevention providers, leaders & organizations
  • Some strong collaborations among HIV care and prevention organizations
  • Innovative programs on which to build and that could be implemented in other areas (See Table 6, p. 29 of the Report for Innovative Programs)

Differences between Control MSAs and Study MSAs:

  • Cincinnati and Birmingham have comprehensive tertiary medical care infectious disease clinics that were the hub of HIV care and research.
  • Both have long standing HIV testing programs in their medical center emergency rooms with HIV screening, testing, and linkage to HIV care.
  • Birmingham has well-organized and active advocacy efforts, particularly including those living with HIV.
  • Birmingham has structured and consistent collaborations between community organizations and medical practices.
  • Cincinnati has a syringe exchange program.
  • Cincinnati benefits from Ohio having expanded Medicaid resulting in a substantial decrease in the numbers of person living with HIV who are uninsured.

The case studies of Deep South metropolitan areas that have been hard hit by HIV identify critical resources deficiencies and barriers to HIV testing and treatment that likely contribute to the disproportionate HIV diagnosis and death rates in the region. Researchers in the Report discuss strategies identified to reduce barriers and stigma including enhancing mechanisms and incentives for collaboration, increasing resources for transportation, housing and behavioral health, enhancing prevention and stigma reduction through collaborations with communities of faith, saturated media HIV education, and increased opportunities for advocacy. Federal funders must also address resource allocation inequities across the region.

[1] Reif, Safley, Wilson, Whetten, HIV/AIDS in the Deep South: Trends from 2008-2013, January 2016.


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