SASI’s new Report, State of HIV in the US Deep South,[Full text] [Abstract] is co-authored by Susan Reif, Donna Safley, Carolyn McAllaster, Elena Wilson and Kathryn Whetten and published in the Journal of Community Health on February 28, 2017.

Recent SASI research has documented that the US Deep South region (AL, FL, GA, LA, MS, NC, SC, TN, TX) is a significant driver of the US HIV epidemic with especially high HIV and AIDS diagnosis rates and HIV-related death rates from 2008-2013.

This new paper examines recent data on HIV epidemiology, HIV care and prevention financing, and research literature on factors that predispose the Deep South region to experience a greater HIV burden. In 2014, the Deep South region continued to have the highest HIV diagnosis rate and numbers and the highest HIV-related death rate of any US region. African Americans have been hard hit by HIV and represent a majority of new diagnoses as well as a majority of people living with HIV in the Deep South. New diagnoses among African American gay and bisexual men who have sex with men continue to increase.

Despite the heavy HIV burden in the US South and Deep South, SASI’s research demonstrates that federal funding for HIV care and prevention continues to lag behind in the region, primarily due to lower levels of CDC funding. According to a study by Funders Concerned about AIDS, private foundation grants also lag behind with only 12% of private foundation funding for HIV going to the Deep South in 2014.

The Report also highlights recent research identifying contributing factors to the disproportionate HIV burden in the US South and Deep South, including pervasive and multi-layered HIV-related stigma, poverty, high levels of sexually-transmitted infections, racial inequality and bias, and laws that further HIV-related stigma and fear. The Report recommends closing the gap in federal and private funding for HIV prevention and care, along with additional strategies to address the factors fueling the epidemic. These strategies should include the enhancement of current HIV care and prevention models and innovative interventions to reduce the impact of stigma.

Key Findings from the Report:

Demographic Findings:

Deep South continues to lead in new HIV/AIDS Diagnoses. In 2014:

• The region had the highest number of persons newly diagnosed with HIV (18,087) of any region.
• The region had the highest HIV diagnosis rate of any region.
• The region had the highest number of persons newly diagnosed with AIDS (8,849) of any US region.
• The region had a higher AIDS diagnosis rate than the US overall.

Deep South continues to lead in HIV-related death rates. In 2014:

• The region had the highest HIV-related death rates of any US region.
• 2,952 persons died from HIV-related causes.

Deep South continues to face racial disparities in HIV epidemic. In 2014:

• 53.5% of persons diagnosed with HIV were African American, compared to 44% in the US overall.
• 37% of Hispanic/Latino persons diagnosed with HIV in 2013 lived in the Deep South.
• 50% of African American MSM diagnosed with HIV were in the Deep South (5,734 persons).
• Only African American and Latino MSM faced an increase in the proportion of total new HIV diagnoses.
• HIV diagnosis rates among African American women, although declining, remained over 10 times that of white women.
• African Americans had an HIV-related death rate more than 5 times that of whites.
• The death rates of African American men and women were higher than in any other region with 1,199 AA men and 657 AA women dying from HIV-related causes.

Federal and private funding disparities.

• Examination of CDC, Ryan White, HOPWA, and SAMHSA 2015 funding found that the Deep South received less funding per person living with HIV ($3313.80) compared to the US overall ($3410.80) driven largely by CDC funding disparities.
• A study by Funders Concerned About AIDS found that the Deep South, with 40% of persons living with HIV, received only 12% of private foundation funding for HIV in 2014. [$35 per PLWH in the Deep South vs. $116 per PLWH US average.]

Factors identified in the research literature contributing to the heavy HIV burden in the US South and Deep South:

• Pervasive and multi-layered HIV-related stigma, poverty, high levels of sexually-transmitted infections, racial inequality and bias, and laws that further HIV-related stigma and fear.

Report Recommendations:

• Close the gap in federal and private funding for HIV prevention and care.
• Adopt strategies to address the factors fueling the epidemic including:
  • Enhancement of current HIV care and prevention models;
  • Innovative interventions to reduce the impact of stigma.