When researchers looked at HIV data in Alabama, they found that 11 of the state’s 67 counties had elevated HIV rates and three were severe hot spots, according to AL.com and a study by the University of Alabama.

Researchers hope that by looking at these HIV data they can identify characteristics and social determinants of health that will help them develop strategies and target resources to lower the HIV rates.

Perry, Dallas and Lowndes counties were deemed hot spots, with HIV rates more than double the state’s average. All three counties are in the so-called Black Belt, a region where the rich soil was once home to many cotton plantations and, today, is home to a large African-American population. (The majority of residents in the three counties are Black.)

Perhaps this isn’t surprising since African Americans are disproportionately affected by HIV and the South is considered the epicenter of today’s HIV epidemic in the United States.

But researchers did find that Black Belt counties with the highest HIV rates were not the poorest or the least educated in the state; however, those factors did play a role. “Being an HIV hot spot was significantly associated with relatively low educational attainment and less severe poverty than other areas in the state,” the researchers wrote.

Karen Johnson, PhD, an assistant professor at the University of Alabama’s School of Social Work and a visiting scholar at Yale University, led the research. In contextualizing the HIV data for AL.com readers, Johnson explained that stigma and lack of access to preventive drugs and treatment are linked to higher HIV rates, as is a history of mistrust between Black Americans and health care providers.

“It is not uncommon for someone in the Black Belt who is living with HIV to travel hours to try to get HIV medication,” she told AL.com, “not because they couldn’t get medication closer to home, but because of the stigma associated with it.”

She also pointed out that HIV rates and characteristics can vary from region to region in the South. In Alabama, HIV rates are highest in rural counties, while in Mississippi, for example, they’re highest in urban areas.

For the study, researchers looked at data on Medicaid, the free state and federal program that covers health costs for low-income individuals. Nationwide, the rate of HIV Medicaid claims is 11.5 for every 100,000 people on Medicaid. In Alabama, the average is 67.9 per 100,000, according to AL.com. Researchers found that 11 counties in Alabama had over 100 HIV claims per 100,000 Medicaid recipients. HIV Medicaid claims for the three hot spots were:

  • Dallas County: 224.72 per 100,000
  • Lowndes County: 139.81 per 100,000
  • Perry County: 178.2 per 100,000

To learn more, see “HIV and African Americans,” which is part of the POZ series on HIV in Specific Populations. It reads in part:

Throughout the United States, Black people bear the greatest burden of HIV. While African Americans make up 13% of the U.S. population, they account for 42% of all new HIV diagnoses, with a total of about 15,300 new cases reported in 2019, according to the Centers for Disease Control and Prevention (CDC). Stated another way, Black people are about eight times more likely than white people and about twice as likely as Latinos to be diagnosed with HIV. Of the estimated 1.2 million Americans currently living with HIV, about 40% are Black.

Among Black men, those who have sex with men account for the largest proportion of new HIV diagnoses. Just over a quarter of all newly diagnosed people in 2018 were Black gay, bisexual and same-gender-loving men. What’s more, over half of newly diagnosed young gay and bi men ages 13 to 24 are African American.

Black women make up about 60% of all new HIV diagnoses among women; their most common risk factors are heterosexual contact and injection drug use. Adequate data are lacking for transgender people, but Black trans women appear to have a disproportionately high HIV rate.

The CDC [Centers for Disease Control and Prevention] estimates that six out of seven African Americans living with HIV have been tested and are aware of their status. Testing is important because people who know their status can start antiretroviral treatment, which halts disease progression and prevents HIV transmission, as people who achieve an undetectable viral load do not transmit the virus through sex.