In the Journals

HIV/AIDS diagnoses, fatality rates highest in South

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January 21, 2015

People living in nine Southern states had higher HIV/AIDS diagnoses and fatality rates than residents of any other region in the United States, according to data recently published in the Journal of Community Health.

Researchers observed CDC demographic data of patients living with HIV/AIDS, aged 13 years and older, from December 2010 through December 2011. Patients with HIV or AIDS in 2003-2004 also were observed to determine 5-year survival probabilities and rates. Data from the US Census Bureau were used to calculate HIV diagnosis and prevalence rates per 100,000 population. The states included: Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas.

“A group of Southern states are disproportionally affected by HIV and share certain characteristics, such as overall poor health of the population, high poverty rates, and negative health outcomes for those infected with HIV,” researcher Susan Reif, PhD, MSW, of the Center for Health Policy and Inequalities Research at Duke University, and colleagues wrote.

Thirty-eight percent of patients diagnosed with HIV in the US lived in these states, whereas the nine states comprise only 28% of the US population. Southern states had a higher HIV diagnosis rate per 100,000 population than the national rate (24.5 vs. 18), as well as a higher diagnosed percentage in women (23.3% vs 20.9%), blacks (56.5% vs 46.6%), and residents aged 13 to 24 years (23.3% vs 21.4%). These states also had more HIV diagnoses in urban (29.6 vs 22.5), suburban (18.6 vs 11.1) and rural (14.4 vs. 7.3) areas, and higher HIV death rates (27.3 vs. 24) compared with other regions. Similar results were found after age, sex, type of transmission and area population size were adjusted for targeted vs. nontargeted states (RR=0.83; 95% CI, 0.79-0.87).

Patients had a lower 5-year HIV survival rate in the South (0.85) vs. the other regions (0.86), and a lower 5-year AIDS survival rate (0.73 vs 0.77), revealing that 27% of patients in the South who were diagnosed with AIDS died within 5 years. Louisiana had the lowest survival rate for HIV (0.81) and AIDS (0.67).

Researchers said sex, race/ethnicity, transmission risk, population area, and age did not explain why the death rates of HIV were higher in the South. They suggested that other unaddressed factors, such as income, education, insurance coverage, and complex levels of HIV stigma and racism, may be factors.

“These differences are crucial to consider when creating strategies to address HIV/AIDS in this region,” Reif said in a press release. “Clearly greater investment and focus are required to address the unique nature of the HIV/AIDS epidemic in the South.”

Disclosure: The study is supported through a Ford Foundation grant by the AIDS Legal Project at Duke University.