Nearly all U.S. counties stricken with both high rates of HIV infection and poverty are in Southern states, according to a USA TODAY analysis of data from 43 states.
The study, which drew on data made available from Emory University's AIDSVu project, offers the clearest picture yet of the close kinship of low income and HIV/AIDS.
"This tells a story about heavily impacted regions across the South," says Patrick Sullivan, leader of the team at 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. "Seeing the data on a map helps you see things in a different way," Sullivan says.
The analysis highlights a vast geographic shift in the HIV epidemic in the USA in the three decades since the first cases of a deadly new disease were reported in gay men by the Centers for Disease Control and Prevention in 1981.
The virus has since made its way from big cities on both coasts into the U.S. heartland, becoming heavily entrenched among black men and women in pockets of poverty in 11 Southern states.
"It's clear the epidemic has emerged in ways that would have been difficult to predict from the early cases," Sullivan says.
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 that 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 analysis identified 175 counties that rank among the top 20% 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 Virgnia did not share their county-level data.
Among other findings:
Blacks on average were poorer than whites in 96% of the 175 counties with high HIV and poverty rates, according to Census data. In some counties, more than 40% of blacks live below the federal poverty line. Those counties also had the highest rates of HIV infection.
Of the top-ranking counties, only 11 had higher HIV infection rates among whites than blacks. They included Brooklyn and the Bronx and counties that encompass St. Louis and Philadelphia. The rest are in Arkansas, Mississippi, Texas, Virginia and Louisiana.
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