Deep South Infrastructure Reports

February, 2016: HIV Infrastructure Study-Jacksonville, FLSusan S. Reif, Kristen Sullivan, Carolyn McAllaster, Miriam Berger.

SASI’s latest HIV Infrastructure Study focuses on Jacksonville, Florida, a metropolitan statistical area (MSA) that ranks second among MSAs in the US for HIV diagnosis rates of African American males (170.7 per 100,000) and sixth for HIV diagnoses among African American females (72.2 per 100,000).

The Study identified significant community strengths including strong collaborations between HIV providers, generally available HIV medical care and HIV testing. Despite these strengths, the Report identifies the following as barriers to HIV Care & Prevention in Jacksonville:

  • Deep and multi-faceted stigma
  • Lack of transportation
  • Lack of affordable housing options
  • Lack of comprehensive sex education programs
  • Need for additional funding for case management
  • Few advocacy opportunities for PLWH

Some of the recommendations made by Study participants include:

  • Increased resources for support services including case management and transportation
  • Increased resources for affordable housing options
  • Increased PrEP availability
  • Enhanced partnerships with the faith community
  • Creation of advocacy opportunities for PLWH
  • Community prevention and education efforts


November, 2015:  HIV Infrastructure Study: Cincinnati, OHSusan S. Reif, Elena Wilson, Carolyn McAllaster, Miriam Berger.

SASI has released its Infrastructure Study focused on Cincinnati, Ohio. As a metropolitan statistical area (MSA) with similar demographic characteristics to the high HIV impact MSAs being studied by SASI, but with less pronounced HIV/AIDS statistics, Cincinnati was chosen to be a control MSA for the SASI Infrastructure Study.


July, 2015: HIV Infrastructure Study: Jackson, MississippiSusan S. Reif, Elena Wilson, Carolyn McAllaster, Miriam Berger.

SASI is releasing its latest Infrastructure Study focusing on HIV care and prevention in Jackson, Mississippi at the ViiV Accelerate! Jackson Convening on July 29, 2015.

In partnership with many community organizations, the ACCELERATE! Jackson Community Convening will help connect local leaders, including government officials, health officials, education and academic centers, AIDS service organizations, community-based organizations, health centers and community advocates, and provide a platform to:

  • Share and learn about existing efforts to address HIV and support those impacted by HIV in Jackson.
  • Engage in a discussion of the findings from the Southern HIV/AIDS Strategy Initiative’s (SASI) Report on HIV prevention and care infrastructure in the Jackson area.
  • Learn about ViiV Healthcare’s ACCELERATE! Jackson Initiative supporting black men who have sex with men, including progress to date and next steps.

Why Focus on Jackson?

  • Jackson has the 8th highest rate of new HIV diagnoses among major US metropolitan areas;
  • Jackson was ranked 2nd among metropolitan areas in AIDS diagnosis rates in 2013;
  • In the city of Jackson, 48% of HIV diagnoses in 2010 were among African American men who have sex with men (MSM);
  • In Mississippi, of those diagnosed with AIDS, 32% had died within 5 years.

Strengths Identified in Jackson:

  • Committed care and prevention providers and organizations;
  • Strong collaborations between some organizations and some medical providers;
  • An active AIDS Training Network;
  • Innovative HIV housing program;
  • Only clinic specializing in LGBT health care in Mississippi;
  • Innovative faith-based program in minority churches.

Gaps and Barriers to Addressing HIV in the Community:

  • Few transportation resources;
  • Lack of affordable housing;
  • Pervasive HIV-related stigma;
  • Lack of adequate behavioral health services;
  • Substantial poverty;
  • Little funding for prevention;
  • Lack of political will to address HIV;
  • Need for stronger community collaborations;
  • Need for advocacy training and opportunities for PLWHA.

The Report made the following recommendations based on input from study participants:

  • Improve linkage and retention in care for PLWHA through use of state surveillance data;
  • Strengthen the state Housing Opportunities for People with AIDS (HOPWA) program;
  • Increase transportation resources;
  • Increase HIV knowledge among general and high-risk populations;
  • Provide greater resources for education and partnerships in the African American faith community around HIV;
  • Enhance the HIV services infrastructure in the Jackson MSA with better coordination and collaboration;
  • Strengthen advocacy training and opportunities for PLWHA and their allies.


May, 2015: HIV Infrastructure Study: Birmingham, AlabamaSusan S. Reif, Kristen Sullivan, Carolyn McAllaster, & Miriam Berger.

SASI has released its latest Infrastructure Study in a series of reports examining HIV-related prevention and care infrastructure and community characteristics of Deep South metropolitan statistical areas (MSAs). Birmingham was chosen as one of the study contrast MSAs because it has similar demographic characteristics to the more high HIV impact MSAs but less pronounced HIV/AIDS statistics. The Birmingham MSA has AIDS diagnosis rates much lower than other Deep South state MSAs.

  • in 2011, the Birmingham MSA ranked 66th among MSAs for AIDS diagnoses and had an AIDS diagnosis rate lower than the overall US average;
  • In contrast, other Deep South MSAs including Baton Rouge, Jackson, Jacksonville, Memphis, and New Orleans were all in the top ten AIDS diagnosis rates among MSAs in 2011.

According to the Report:

  • 44% of new HIV diagnoses in the Birmingham MSA were among African American MSMdouble the national average;
  • The HIV diagnosis rate among females (26.7) was more than double the rate nationally (12.6) in 2010.

The Report identified the following strengths in the Birmingham MSA:

  • Collaborative networks of care providers and AIDS Services Organizations;
  • Strong HIV advocacy;
  • State of the art medical care;
  • Holistic medical and social services
  • Committed HIV care & prevention professionals;
  • HIV-specific housing.

The following barriers to HIV Care & Prevention in Birmingham were identified in the Report:

  • Lack of adequate transportation;
  • Lack of comprehensive sexual education;
  • High levels of HIV-related stigma;
  • High poverty rates;
  • Need for increased prevention funding;
  • Need for increased housing opportunities.

Given the necessary resources, the networks in Birmingham are well  positioned to significantly expand implementation of evidence-based prevention interventions while maintaining treatment as prevention with the goal of significantly reducing the incidence of HIV in the Birmingham MSA.


November, 2014: HIV Infrastructure Study: Columbia, SCSusan S. Reif, Elena Wilson, & Carolyn McAllaster.

The latest SASI Infrastructure Study, HIV Infrastructure Study: Columbia, SC was released at the annual South Carolina HIV/STD and Viral Hepatitis Conference in Columbia, SC.

Columbia is the largest city and the capital of South Carolina.

According to the Report and despite the fact that South Carolina has a robust AIDS Drug Assistance Program that pays for medications for uninsured HIV+ persons earning up to 300% of the federal poverty level AND reimburses for insurance premiums, copays, and deductibles for insured HIV+ persons earning up to 550% of the federal poverty level,

  •  36% of persons living with HIV/AIDS in South Carolina were  not in care. (2013 HIV Epidemiological Profile of South Carolina)
  • Columbia had the 10th highest death rates for HIV+ men and women in the United States in 2011.
  • In 2011, Columbia ranked 7th in the country in HIV diagnoses among 13-24 year old males.

The Report identifies the following as some of the barriers to HIV Care & Prevention in Columbia:

  • Lack of transportation
  • Pervasive Stigma
  • Few trained HIV medical providers in the more remotes areas of the Columbia Metropolitan Area
  • Lack of political will
  • Inadequate funding for prevention.

Some suggested strategies identified in the Report for addressing the HIV epidemic in Columbia include:

  • Establishment of a telemedicine program to address lack of transportation and medical care in more remote areas;
  • Co-location of HIV care with other services to combat stigma;’
  • Increased educational efforts for PLWHA, health care professionals, churches, and community to address stigma.


September 18, 2014: SASI HIV Infrastructure Study: Baton Rouge, Susan S. Reif, Elena Wilson, Carolyn McAllaster, & Casteel Scherger.

SASI researcher, Kristen Sullivan, and SASI Steering Committee member, Sharon Decuir (of Baton Rouge, LA) released and discussed the SASI HIV Infrastructure Study: Baton Rouge at the SPEAK UP! National Summit for Women Living with HIV in Ft. Walton Beach, Florida.

According to the Report:

  • Baton Rouge had the highest AIDS diagnosis rate of any US metropolitan area in 2011;
  • Baton Rouge had the highest HIV diagnosis rate among females overall of any US metropolitan area in 2010;
  • 34.5% of new diagnoses occurred among women in Baton Rouge in 2010;
  • Only 70% of those diagnosed with AIDS in Baton Rouge survived for 3 years after diagnosis in the years 2002-2006.

Despite community strengths that include generally available HIV medical care, committeed HIV advocates and service providers, new funding for programs focused on the epidemic among people of color, and the use of Ryan White funds to purchase insurance for PLWHA through the Affordable Care Act, significant barriers to prevention and care remain:

  • Pervasive stigma and discrimination that drives the epidemic into the shadows and leads to reluctance for HIV testing, prevention and treatement;
  • Lack of state prevention funding accompanied by the lack of comprehensive and highly visible prevention efforts;
  • Lack of tranportation options;
  • Limited mental health and substance abuse treatment options;
  • Lack of affordable housing.

The Report identifies the following strategies needed to address the epidemic in Baton Rouge: Additional resources for prevention and comprehensive prevention efforts that raise the visibility of the disease and address stigma as well as greater interagency collaboration, consumer participation in prevention and care planning, and greater resources for HIV case management, transportation, mental health, housing, and legal services.


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