From UNC-Chapel Hill: Policies and politics that promote HIV infection in the Southern United States

AIDS. 2014 Feb 19. [Epub ahead of print]

Policies and politics that promote HIV infection in the Southern United States.

Adimora AA1, Ramirez C, Schoenbach VJ, Cohen MS.

Author information

• 1aSchool of Medicine bUNC Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA.

Abstract

The South has the highest rates of HIV infection, HIV-related mortality, and many other adverse health outcomes in the United States. A number of social, structural, and policy factors drive the poorer health and HIV status of Southerners relative to other Americans. The South's worse health partly reflects its larger proportion of African Americans, who experience disadvantages in health in all US regions, due to poverty and racial discrimination. But after adjustment for race/ethnicity, HIV case-fatality rates for nearly all Southern states are double those of the state with the lowest rate. Challenges to HIV prevention and care in the region include its large rural population combined with a shortage of providers with expertise in HIV treatment, lingering distrust of the healthcare system, homophobia, and stigma toward people with HIV infection. Moreover, government policies, facilitated by restrictions on voting, often reduce access to HIV prevention and care through Medicaid, antiretroviral drugs, sex education, and syringe exchange programs. Many Southern states have pursued - and continue to pursue - policies that impede earlier detection and treatment. These policies directly and indirectly fuel the increased HIV incidence, morbidity, and mortality that characterize the region and arguably represent a human rights violation.