Critical for States to Improve Performance
While CDC has expanded and strengthened its support for HIV prevention in the South, success ultimately depends on a variety of prevention partners, including policymakers, at the state, county, and municipal levels. States should consider taking aggressive steps to improve prevention and care outcomes and make more rapid progress toward goals established by the National HIV/AIDS Strategy.
In particular, areas for southern states to consider focusing on include:
- Achieving viral suppression for all residents diagnosed with HIV, which is critical to improving health outcomes and slowing transmission. For example:
- Immediately linking people newly diagnosed with HIV to care and providing them with HIV treatment -- ideally with a starter pack of medication on the same day they receive their diagnosis.
- Pursuing innovative strategies for residents who were previously diagnosed but are not in care. States could pursue innovative strategies to identify and re-engage these individuals and help them obtain effective treatment. CDC's Data to Care strategy, which has been pursued in Louisiana under the LaPHIE program, and in a number of other states, provides a proven model that states could follow.
- Continuing to forge close partnerships with health care providers in their communities. Health departments and CBOs could pursue this strategy for all people living with HIV.
- Improving early diagnosis of acute HIV infection, in part through adoption of antigen/antibody combination HIV tests in all settings. Given that late diagnosis is associated with higher mortality, strengthening HIV testing efforts could help significatly reduce the South's disproportionate death rates among people living with HIV.
- Promoting PrEP as an option for people at highest risk of HIV infection. CDC estimates that many Americans -- including 25 percent of sexually active adult gay and bisexual men, nearly 20 percent of adults who inject drugs, and less than 1 percent of heterosexually active adults -- could benefit fom PrEP.10
- Providing complete reporting of lab data, including viral load and CD4 cell counts, which are critical to monitoring progress and directing resources to meet the greatest needs.
- Strengthening HIV education and awareness, particularly among young people and in communities most affected by HIV. In addition to accurate school-based HIV education, communities can implement HIV awareness campaigns, including elements of CDC's various Act Against AIDS campaigns.
More broadly, to address disparities in the southern states it will be important to work toward unfettered access to quality health care, particularly among people of color, gay and bisexual men, and transgender people. This could be accomplished through a variety of methods, including addressing issues related to insurance coverage, co-pays, and deductibles.
While the challenges to effective HIV prevention in the South remain significant, they are surmountable with the HIV prevention tools available today. By fully embracing the latest advances and committing to the highest standards of prevention and care, southern states can ensure a healthier future for millions of people living with or at risk for HIV.
* As defined by the U.S. Census Bureau, the South region includes: Alabama, Arkansas, Delaware, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
- Centers for Disease Control and Prevention (CDC). HIV Surveillance Report, 2014; vol. 26. Published December 2015.
- U.S. Census Bureau. Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2014. Accessed November 13, 2015.
- Reif S, Pence BW, Hall I. HIV Diagnoses, Prevalence and Outcomes in Nine Southern States. J Community Health. 2015;40(4):642-51.
- CDC. State HIV Prevention Progress Report, 2010-2013. Published December 2015.
- Department of Health & Human Services, Office on Women's Health. Health Disparities Profiles, 2014.
- Kaiser Family Foundation: The Kaiser Commission on Medicaid and the Uninsured. Key Facts about the Uninsured Population. Accessed November 25, 2015.
- Valdiserri RO. HIV/AIDS Stigma: An Impediment to Public Health. Am J Public Health. 2002;92(3):341-34.
- CDC and Association of Public Health Laboratories (APHL). Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations. Published June 27, 2014.
- CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data -- United States and 6 dependent areas -- 2013. HIV Surveillance Supplemental Report 2015;20(No. 2). Published July 2015. Accessed November 20, 2015.
- CDC. Vital Signs: Estimated Percentages and Number of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition -- United States, 2015. MMWR 2015;64(Early Release);1-6.