A report conducted by USA Today found that nearly all U.S. counties that have high rates of HIV/AIDS cases are south of the Mason-Dixon line. The newspaper used data that was collected by Emory's Rollins School of Public Health that produced AIDSVu, the first effort to use state-of-the-art methods to map HIV infection rates by county.
Reporters Steve Sternberg and Jack Gillum wrote that the epidemic, while still prevalent in big cities on the East and West coasts, is "becoming heavily entrenched among Black men and women in pockets of poverty in 11 Southern states."
Harold Henderson, an HIV expert at the University of Mississippi, says Southern states suffer from a host of health issues, including HIV, for reasons that extend from poverty to a lack of education and fragile families. He added that many children in the South lack sufficient sex education.
"The age when kids first become sexually active is pretty young in the Deep South," he says. "That has a lot to do with the fact parents don't do a good job of [educating their kids about sex]. And if you happen to live in a broken home, with drug use and poverty involved, you may not be getting the parental supervision you need."
The new analysis identified 175 counties that rank among the top 20 percent for both HIV and poverty, all but six in the South. Two of the six are the boroughs of Brooklyn and the Bronx in New York City. Seven states — Alaska, Idaho, North Dakota, Ohio, South Dakota, Vermont and West Virginia — did not share their county-level data.
The report also found that African-Americans on average were poorer than whites in 96 percent of the 175 counties with high HIV and poverty rates, according to Census data. In some counties, more than 40 percent of blacks live below the federal poverty line, and those same counties had some of the highest rates of HIV infection in the U.S.
Poverty and HIV also play hand in hand when it comes to the difficulty of connecting those who have been just diagnosed with HIV with medical care and social services. Unfortunately, 25 percent of newly diagnosed Americans are not successfully linked to HIV care within six to 12 months of their diagnosis, and between 10 to 20 percent of patients remained unengaged in care three to five years later. Linking folks to care is crucial in not only bettering the lives of people who are living with HIV, but by getting them on treatment, which brings their viral load down, making it harder for HIV to be transmitted to other people.
To understand what creates these barriers to getting treatment and support, the Centers for Disease Control and Prevention conducted a small study qualitative study of 42 people. The study found that people who had never accessed medical care before testing HIV-positive and who lived close to or below the poverty line were seriously unhappy with the post-test counseling they received and believed that the doctors lacked compassion, were not helpful and were rarely available. Researchers also found that participants thought that their counseling lacked quality, that they were given incorrect information that ushered in mistrust of the medical system and that they were not happy with the lack of follow-up they were promised.
These experiences serve as further barriers that discourage people from trusting the information being given to them and seeking treatment, support and care.
Of the participants, 79 percent of people had been diagnosed between five and 10 months prior to the study; 21 were diagnosed up to 19 months beforehand; two-thirds were African-American; almost half were under the age of 30; 71 percent were male; 50 percent earned less than $15,000 a year; and only 10 percent earned more than $40,000.
This study, which is part of a larger CDC study called Never in Care Pilot Project, has a downfall—there was no comparison group. So for people who had accessed medical assistance prior, there was no data about their experiences with post-test counseling.
Larger results from the entire study are expected to be out soon.
(Photo: Antony Njuguna/Reuters)