Nearly forty years ago, the first HIV/AIDS cases were reported in Los Angels, California and New York City, New York. Today, the HIV/AIDS epidemic has shifted to the urban areas of the southeastern United States (U.S.) (National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 2016). According to the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (2016), “the South now experiences the greatest burden of HIV infection, illness, and deaths of any U.S. region, and lags far behind in providing quality HIV prevention and care to its’ citizens.” While one-third of the population resides in the southern U.S., nearly half of all new HIV/AIDS diagnoses accounted for are amongst those living in this region. Additionally, 62% living within this population is African-American (Blake, Jones-Taylor, and Sowell, 2013 & Abara, Coleman, Fairchild, Gaddist, and White, 2013).
In 2011, selected southern states (i.e. Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas) and the rate of HIV diagnosis was 73.7 per 100,000 among African-Americans, in comparison to 24.8 per 100,000 among Hispanics/Latinos, and 8.8 per 100,000 among Whites (Sutton, Gray, Elmore, and Gaul, 2017). Of the ten states reported with the highest incidences of HIV rates, eight were located in the southern U.S.; accounting for 50% of the total incidences in the country. “In addition to geographic differences,” according to Blake et al. (2017), “the HIV epidemic has consistently reflected racial and ethnic disparities. More and more African-Americans living in the rural South are being disproportionately affected by HIV disease.” Blake et al. (2017) also mention that “southern states struggle with disparities in health care coverage, health status, and health care relative to other areas of the U.S. and that because of these inequities, people living in the southern region are more likely to be uninsured, less likely to have access to needed health services, and are more likely to experience chronic health conditions such as diabetes, cancer, and heart disease.”
Many socio-economic demographics such as race, gender, class, and sexual orientation, contribute towards health outcomes in the South (Nunn, 2014). Additional factors such as poverty, lack of access to quality health care, inadequate housing, low HIV testing rates, substance use, stigma, fear, discrimination, and homophobia also influence health outcomes (Blake et al., 2017). According to Nunn (2014) “the deeply engrained history of racism and discrimination in this region has had lasting effects that still resonate in the South. Social stratification and institutional inequalities still exist in the South and contribute to shortfalls in access to healthcare. Racial prejudice and the historical implications of segregation in the South are part of the complex and overlapping social health disparities that keep this area on the radar in the public health community.”
Many of those affected by HIV/AIDS living in the South are also desperately poor, live without access to running water, a car or home, and live miles from the nearest clinic (Wiltz, 2014). Southern states have also been known to have higher incidence rates of smoking, obesity, hypertension non-compliance, and lower rates of physical activity. Additionally, those living in the South have been known to lead the nation in the greatest amount of preventable deaths in heart disease, cancer, chronic lower respiratory disease, stroke, and unintentional injuries (Thompson, 2014).
The African-American population living in the South are affected by certain social determinants of health (SDOH), such as cultural, economic, and political elements, that contribute towards the vulnerability for HIV infection and the compliance towards HIV/AIDS prevention, treatment, and care (Melton, 2013). Sutton et al. (2017) also provide that “many Black communities affected by HIV in the southern U.S. are disproportionately affected by SDOH that have historical and political roots of injustice, poverty, racism, and unequal opportunities to access education and employment.” Additionally, income, home ownership, female head of household, urbanicity, and primary care providers are also SDOH that have influenced these particular health outcomes of African-Americans living in the Southern U.S. (Sutton et al., 2017).