SASI Publishes New Paper: State of HIV in the US Deep South

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.

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Join the Southern HIV/AIDS Strategy Initiative and the Southern AIDS Coalition at the US Conference on AIDS

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Join the SASI and the Southern AIDS Coalition

at the United States Conference on AIDS:

 Southern Pathway Workshops: September 15-17, 2016

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SASI Releases New Report/Recommendations re: PrEP

SASI releases new report: WE HAVE THE TOOLS TO END HIV- Benefits, Barriers, and Solutions to Expanded Utilization of Pre-exposure Prophylaxis (PrEP) in the US Deep South

The benefits of PrEP to prevent HIV transmission are well established. It is critical that we overcome the multi-faceted barriers to achieving widespread PrEP utilization among vulnerable populations. The barriers are especially prohibitive in the US South where rates of poverty are higher than the national average, conservative attitudes about sex and HIV may heighten stigma concerns, where few states have expanded their Medicaid programs under the Affordable Care Act, and health outcomes are generally poor.

RECOMMENDATIONS FROM THE REPORT TO INCREASE PrEP UTILIZATION IN THE SOUTH AND IN THE U.S.:

Federal Policy Recommendations

  • The Centers for Disease Control and Prevention (CDC) should work with the US Department of Health and Human Services, state health departments and community-based organizations to:

    • Develop best practices to reach at-risk persons who could benefit from PrEP;

    • Develop best practices to reach and train primary care medical providers on PrEP;

    • Develop a PrEP surveillance system to measure PrEP utilization.

  • The CDC should ensure that CDC funding focused on PrEP:

    • Allows for flexibility to pay for labs and provider time.

    • Is broadened to include smaller cities and rural areas in the South with heavy HIV burden.

  • Demonstration Projects are needed that are focused on:

    • PrEP uptake, adherence, and acceptability.

    • The efficacy and utilization of PrEP by and for women, including trans women, sex workers and women of color.

Pharmaceutical Company Policy Recommendations

  • Gilead Sciences should:

    • Continue its investment in community-based projects supporting PrEP education for high-risk populations;

    • Invest in a larger PrEP mass media campaign to raise awareness and contribute to the normalization of PrEP use for those at risk.

    • Invest in comprehensive education for primary care providers related to PrEP.

    • Improve its Medication Assistance Program (MAP) for PrEP specifically to allow persons under the age of 26 who are on their parent’s health insurance plan to access the PAP.

    • Expand the cap on its Co-payment Assistance Program (CAP) contribution from $3600 to match the out-of-pocket maximum cost for Affordable Care Act plans ($6,850 in 2016.)

    • Provide data on PrEP utilization broken down demographically by gender, race, age, geography and insurance status to identify patterns of and gaps in PrEP uptake.

State Policy Recommendations 

  • State governments, particularly those in the US South, should expand their Medicaid programs under the Affordable Care Act.

  • Fund PrEP clinics for vulnerable populations. 

State and Local Health Department Policy Recommendations

  • State and local health departments should:

    • Fund PrEP clinics for vulnerable populations;

    • Raise awareness about PrEP in communities at risk;

    • Work with community-based organizations to educate and engage communities at risk about PrEP.

    • Provide comprehensive PrEP education for primary care providers.

 

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New SASI Report: Medicaid Expansion in the South

SASI’s new report, Medicaid Expansion in the South, examines efforts in nine Deep South states to expand Medicaid under the Affordable Care Act. Thirty-two states have expanded Medicaid. Many of the remaining states are located in the Deep South: Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, Tennessee, and Texas. Louisiana plans to expand Medicaid in July 2016.

In states that have not expanded Medicaid, people remain uninsured because they do not qualify for traditional Medicaid under the states’ rules and cannot afford to purchase insurance on the ACA Insurance Marketplace.  These people fall into what is known as the “coverage gap.” According to the Kaiser Family Foundation, 90% of people who fall in the coverage gap live in the South. *

SASI’s report looks at the impact in the Deep South states that have failed to expand Medicaid and examines the politics and advocacy efforts surrounding the movement to bring Medicaid expansion to the South.

* http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/ 

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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. Continue reading

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Deep South States continue to drive the HIV epidemic in the US

SASI Releases: HIV/AIDS in the US Deep South: Trends from 2008-2013With six years of HIV/AIDS related data, new SASI Trends Report confirms that nine Deep South states are driving the HIV epidemic in the US.

The trends documented in SASI’s recent Report have been consistent over the last six years of data and indicate a critical need to strengthen efforts to reduce HIV transmission and mortality within the region. These trends may reflect barriers to timely HIV testing and treatment such as HIV-related stigma, lack of transportation and housing and inadequate availability of HIV medical providers. It is important that the Deep South region receive an equitable share of HIV care and prevention funding and that funding is distributed consistent with the geographic distribution of the epidemic.

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25 Bipartisan Members of Congress Urge CDC & White House to Expand HIV Prevention Funding for Rural & Suburban Areas in Deep South

See the Press Release below from Rep. Alma Adams (D-NC) announcing the request by 25 bipartisan members of Congress for expanded HIV prevention funding from the CDC for rural and smaller urban areas in the Deep South.

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SASI at the US Conference on AIDS

The Southern HIV/AIDS Strategy Initiative is excited to be working with the Southern AIDS Coalition to sponsor two events at this year’s US Conference on AIDS.

PLEASE JOIN US AT THESE EVENTS.

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Deep South Needs Prevention Resources to Address High Prevalence of Undiagnosed HIV in the Region

According to the recently released CDC Morbidity and Mortality Weekly Report (MMWR), Prevalence of Diagnosed and Undiagnosed HIV Infection – United States, 2008-2012persons who are unaware of their HIV+ status contribute to nearly one third of ongoing HIV transmission in the United States.[1]  “[The] data demonstrate[s] the need for interventions and public health strategies to reduce the prevalence of undiagnosed HIV infection.” The CDC reports that only 5 jurisdictions met the National HIV/AIDS Strategy objective of increasing the percentage of persons living with HIV who know their serostatus to ≥90% (Colorado, Connecticut, Delaware, Hawaii, and New York).  Only two jurisdictions met this goal for the important target population of MSM.

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Seventy-six organizations signed on to SASI’s letter to ONAP calling for increased HIV prevention funding to hard hit areas

Today, SASI and 75 national, regional, state and local organizations called on the White House Office of National AIDS Policy (ONAP) to expand the National HIV/AIDS Strategy (NHAS) to add the following critical actions necessary to further reduce HIV infections and to achieve an AIDS-free Generation in the United States:

  • Adopt a more effective and nuanced approach to HIV Prevention by ensuring that:
    • HIV prevention resources are also targeted to rural and suburban, under-served areas with high HIV diagnosis rates, high death rates, and low survival rates, among people diagnosed with HIV or AIDS;
    • HIV prevention efforts in rural and suburban areas are informed by the epidemic profile of each state and tailored geographically by the social and cultural context in each state;
    • HIV prevention efforts targeted to rural and suburban areas support and evaluate capacity to provide HIV prevention and care at the state, local and community-based organization levels.

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