February 23, 2017
Researchers in the UNC Gillings School of Global Public Health have conducted a study identifying counties in the United States in which the prevalence of HIV is particularly high among women, as compared to men. The study, published online Feb. 16 in PLOS ONE, confirms what clinicians have known – that black women from poor areas in the South face a particularly high burden of HIV.
This study provides data that can be used in the development and implementation of targeted interventions appropriate for the unique characteristics of the affected population. These interventions can be aimed at locations with the highest need, thus maximizing their effectiveness and impact.
Alexander Breskin, MPH, doctoral student in epidemiology, is lead author of the study. His co-authors are Adaora A. Adimora, MD, MPH, professor of epidemiology at the Gillings School and of medicine at the UNC School of Medicine, and Daniel Westreich, PhD, associate professor of epidemiology.
In the first decade of the HIV epidemic, disparities in HIV incidence in the United States were clear, with racial and ethnic minorities and men who have sex with men (MSM) in large, coastal cities predominantly affected. The incidence rate in men was nearly 15 times the rate in women. Disparities in HIV incidence remain, but demographic and geographic characteristics of the HIV epidemic have changed substantially, with women in the South now experiencing a particularly high incidence of HIV.
Prior studies have determined that people living with HIV in the South have worse access to care, initiate treatment later, and have worse survival rates than those living in other regions of the United States. This study is the first to identify and describe the characteristics of regions defined by high HIV prevalence among women, compared with men. Using 2012 data from AIDSVu, a public dataset of HIV cases in the U.S., the researchers categorized counties by their decile of the ratio of female to male HIV prevalence. The demographic and socioeconomic characteristics of counties in the highest decile were compared to those of counties in the lower deciles.
The researchers found that most of the counties in the highest decile were located in the Deep South. These counties had a lower median income, higher percentage of people in poverty and lower percentage of people with a high-school education. Additionally, people with HIV in these counties were more likely to be non-Hispanic black. Identifying and describing these counties is important for developing public health interventions.
“The results of this study confirm what we’ve known for a long time,”Adimora said, “but the message is even more relevant now than ever. Poverty and other adverse social forces continue to be critical drivers of the HIV epidemic. Ending the nation’s HIV epidemic will require us to successfully address these forces.”