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We Can't End AIDS Without Ending the Epidemic in the Rural Deep South

Tuesday Aug 29, 2017

A first-of-its-kind report draws sharp contrasts between at-risk signifiers and HIV/AIDS indicators, such as care and services for HIV/AIDS in rural Louisiana vs. New Orleans and Baton Rouge.

Louisiana ranks first in the U.S. in new HIV infections, with 15% of those living in rural areas. Yet this report reveals metropolitan solutions for HIV/AIDS are not making a difference in rural Louisiana. It is a first step toward identifying rural-appropriate solutions for people living with HIV/AIDS in this critical region and has implications for HIV/AIDS prevention and care throughout the deep South.

Set to be released in advance of the U.S. Conference on AIDS Sept 7-10, HIV/AIDS in Metropolitan vs. Rural Louisiana: One State, Two Epidemics, was produced by HEROES (www.heroesla.org). Analyzing data from Louisiana's own Department of Health, the report shows that compared to those living in New Orleans or Baton Rouge, rural residents in Louisiana are:

  • Exposed to more risk factors for HIV, including higher rates of persistent poverty, STD infection, and triple the rates of incarceration
  • Have far fewer HIV/AIDS-specific resources-only a single choice for HIV testing within a 640-square mile area
  • Far more likely for young people between 13 and 24 to receive an HIV positive test result
  • Showing a much higher rate of having AIDS at time of diagnosis, for all ages
  • Facing AIDS mortality rates 1.6 times higher than metropolitan area residents

    The report also shows that while Louisiana had an overall decline in new AIDS diagnoses from 2014 to 2015 (14%) and Baton Rouge and New Orleans showed a decrease of 1.3%, in rural areas overall new AIDS diagnoses increased by .7%

    HIV/AIDS in Metropolitan vs. Rural Louisiana: One State, Two Epidemics

  • The South had 52 percent of new AIDS diagnoses in the U.S. in 2015 and the highest rate of HIV diagnoses
    Louisiana ranked first in new HIV infections overall
  • This report compares risk factors for new infections, mortality, late diagnosis, and other issues influencing the HIV/AIDS epidemic outside of major cities in Louisiana as a first step toward finding rural-appropriate solutions for people living with HIV/AIDS in the deep South
  • The regions studied were the metropolitan areas of New Orleans and Baton Rouge and the nonmetropolitan, rural region in the state's northeast corner
  • Risk factors for HIV include stigma, racial disparity, education, poverty, incarceration, and sexually transmitted disease (STD) rates.
    The rural region compared to New Orleans and Baton Rouge regions have:
  • a significantly lower percentage of adults with bachelor's degrees
  • a higher proportion of people living in poverty, with 75 percent of parishes rated "poverty persistent"
  • a significantly higher rate of incarceration
    higher rates of STD infection in African Americans

    HIV TESTING

  • Young people ages 13-24 are more likely to test HIV positive in the rural region (33%) than in New Orleans (25%) or Baton Rouge (29%)
  • For all age groups, rates of AIDS at time of diagnosis are higher in the rural region (27%) than in New Orleans (18%) and Baton Rouge (22%)
  • An average 10% higher rate of AIDS at time of diagnosis in the rural region remains constant during the 12 months following a positive HIV test, so these rural "later testers" will experience more opportunistic infections, resistance to treatment regimens, and higher medical costs

    HIV/AIDS RESOURCE DISTRIBUTION

  • Fewer HIV related resources, such as HIV testing sites and PrEP services, are available in the rural region compared to New Orleans and Baton Rouge regions
  • Travel distances to access services in the rural region are far greater than in metropolitan regions -- people in many rural parts have only one choice for HIV testing within a 640-square mile area

    UNMET NEED FOR CARE

  • The rural region has a higher proportion of people with HIV/AIDS without any healthcare compared to an overall rate across the three regions
  • A compromised continuum of HIV care results in a lower proportion of patients able to achieve viral suppression in the rural region (51%) than in New Orleans (59%) and Baton Rouge (58%)

    HIV-RELATED MORTALITY RATES

  • Northern Louisiana regions (Shreveport, Monroe*, Alexandria) had the highest HIV-related mortality rates from 2009-2011, with rates about 1.6 times that of the New Orleans, Hammond/Slidell, and Lafayette regions.
    After 2011, the Louisiana DOH no longer published this data.
    *Of these three, Monroe is the only rural region

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