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South Still Disproportionately Affected by HIV Despite Decline in Diagnoses

Dr. Meg Watson from the CDC reports updated information regarding the current rates and trends of HIV diagnoses in the South at 2018 CROI.

The Centers for Disease Control and Prevention (CDC) reports that 44% of individuals living with HIV are living in the southern region of the United States. In fact, diagnosis rates for individuals in the South are higher than for Americans overall. Without addressing the virus in this region, national prevention goals are not likely to be achieved.

In an oral abstract presentation delivered at the 25th Conference on Retroviruses and Opportunistic Infections (CROI), Meg Watson, MPH, from the CDC, provided updated information on the current rates and trends of HIV diagnoses in the South.

Dr. Watson and her colleagues analyzed data from the National HIV Surveillance System for individuals 13 years of age or older regarding diagnosis rates, counts, and trends for the time period of 2010 to 2015 by US Census region and in the South. Specifically, they looked at race/ethnicity, age at time of diagnosis, mode of transmission, and population size of the area of residence at the time of diagnosis.

“We calculated estimated annual percent change (EAPC) in diagnoses; significance was assessed at P<.05,” the study authors wrote. “Rates used US census data for denominators and were per 100,000 population.”

Within the study time period, diagnoses in individuals >13 years significantly declined in all regions of the United States, with the Northeast experiencing the steepest reduction. The EAPC for the Northeast region was -4.5, followed by the Midwest at -1.6, the South at -1.5, and finally, the West at -1.1.

Perhaps not surprisingly, the highest diagnoses rates for 2015 were in the South; in fact, 52% of the overall 39,393 HIV diagnoses that year occurred in the South. The EAPC for the South was 20.2, followed by the Northeast region at 13.6, the West at 11.7, and the Midwest at 9.0.

Although diagnosis rates increased among Hispanic/Latino individuals, American Indian/Alaska Natives, and Asian/Pacific Islanders, with Hispanic/Latino individuals making up one-fifth of the diagnoses, the investigators noted that rates of HIV diagnosis declined in the South among individuals of color and individuals of multiple races.

Furthermore, Dr. Watson and colleagues noted that diagnoses in the South associated with male-to-male sexual contact increased—about half of all new HIV diagnoses were associated with this mode of transmission—while there was a steep decline in diagnoses associated with injection drug use.

Overall, these data suggest that the southern region of the United States continues to be disproportionately affected by HIV. “Although decreasing diagnoses are encouraging, especially among blacks and in metropolitan statistical areas, continued disparities are cause for concern,” stated the study authors. “Increased, ongoing efforts to reach at-risk populations and addressing contextual factors unique to the region will be critical to reducing ongoing disparities and ultimately, to achieving national prevention goals."