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HIV & THE SOUTH
Despite our best efforts and significant successes, the South continues to be disproportionately impacted by HIV. According to the Centers for Disease Control and Prevention (CDC), “the South now experiences the greatest burden of HIV infection, illness, and deaths of any U.S. region, and lags far behind in providing quality HIV prevention and care to its citizens.” (1)
THE SOUTH IS HOME TO THE…
- MOST UNDIAGNOSED HIV
The South is home to more than one-half (52%) of the undiagnosed infections in the United States (2). Consequently, fewer Southerners living with HIV receive timely medical care or treatment, fewer have their virus suppressed, and a disproportionate number are missing out on the opportunity to preserve their health and avoid transmitting HIV to their partners.
AIDSVu Map: Rate of adults/adolescents living with an HIV or AIDS diagnosis per 100,000 population.
- MOST NEW HIV DIAGNOSES
In 2015, the South accounted for more than one-half (51%) of all HIV diagnoses despite representing little more than one-third (37%) of the U.S. population (3). That year, eight of the ten states with the highest rates of new HIV diagnoses were in the South: District of Columbia, Louisiana, Florida, Georgia, Maryland, Mississippi, Texas, and South Carolina. Today, 44% of all people living with HIV were diagnosed in the South (4).
The Obama Administration recognized the need to stem the widening HIV-related health disparities that impact the South. In its update to the National HIV/AIDS Strategy, the Administration set a goal of reducing disparities in the rate of new diagnoses by at least 15% among people living in the Southern United States (5). According to the recently released Indicators and Progress for the National HIV/AIDS Strategy: Update to 2020, the United States is not only missing its annual target for this indicator, but the country is losing ground. Between 2010, when the NHAS was first introduced, and 2014, the disparity in the rate of new HIV diagnoses between the South and the rest of the country widened (6).
- MOST GAY, BISEXUAL, AND SGL MEN LIVING WITH HIV
Within the South, HIV does not impact all southerners equally. Across the South, gay, bisexual, and same-gender-loving men are affected by HIV at rates that are orders of magnitude higher than for other Americans. A report in JMIR Public Health and Surveillance, authored by researchers at Emory University’s Rollins School of Public Health, provided the first state, city, and county estimates of the rate of MSM living with HIV. According to the report:
- There were six states where more than 15% of MSM were living with diagnosed HIV infection in 2012, all of which were in the South (Alabama, Arkansas, Georgia, Louisiana, Mississippi, and South Carolina).
- Of the 25 MSAs with the highest levels of MSM living with an HIV diagnosis, 21 were located in southern states.
- At least one in four MSM were living with an HIV diagnosis in the following MSAs: Jackson (MS), Columbia (SC), El Paso (TX), Augusta (GA), Baton Rouge (LA), and Washington (DC).
The burden of HIV is even more pronounced for gay, bisexual, and other same-gender-loving (SGL) men of color, who accounted for more than one-half of all new diagnoses in the South in 2015. Notably, two out of every three Black gay or bisexual men who were diagnosed with HIV in 2015 lived in the South (CDC HIV Surveillance Report, Vol. 27, 2015), and 51% lived in the Deep South.
- MOST BLACK WOMEN NEWLY DIAGNOSED WITH HIV
Significant disparities persist at the intersection of HIV, race, and gender in the South. While new data indicate declining HIV infections among women nationally, women of color continue to be disproportionately impacted by the disease, especially Black women in the South. Across the nation, the lifetime risk of HIV diagnosis among Black women is 1 in 48, compared to 1 in 880 for White women. In 2015, Black women accounted for 60% of new infections among women despite representing only 13% of the female population. Nearly two-thirds (63%) of these new diagnoses occurred in the South (CDC HIV Surveillance Report, Vol. 27, 2015), and the Deep South accounted for 48% of total new HIV diagnoses among Black women in 2015.
ONLINE TRAINING & E-LEARNING
Intentional Advocacy E-Learning Course
We partnered with the brilliant people at ETR to bring you free access to this new resource to support grassroots advocacy in the South. In this interactive e-learning course, you will:
- See the power of advocacy for southern organizations
- Explore ways to incorporate advocacy to strengthen the work you are already doing
- Review a tool to assess your organization’s capacity to engage in advocacy
- Have access to specific strategies that can be used in your setting
ADVOCACY TIPS AND TOOLS
TOOLS BY STATE
TOOLS BY ISSUE AREA
The Southern AIDS Coalition, in collaboration with its members and national partners, support, review, and synthesize the most accurate evidence related to the Southern HIV epidemic. We work with researchers, practitioners, advocates and policymakers to promote the use of evidence-based programming and research in policy decisions regarding the epidemic in the South.
SAC and SASI offer Recommendations fo Federal Implementation Plan of the NHAS, Update 2020
Birmingham, AL- This week, the Southern AIDS Coalition (SAC) and the Southern HIV/AIDS Strategy Initiative (SASI) presented a letter to the Director of the Office of National AIDS Policy. In the letter, the organizations offered comments to help inform the Federal Implementation Plan for the National HIV/AIDS Strategy: Update to 2020 in light of the epidemic in the Southern US.
Ryan White Patient Equity and Choice Act (H.R. 4260): A Community Perspective
Rep. Renee Ellmers [R-NC-2] introduced a house bill, “The Ryan White Patient Equity and Choice Act,” H.R. 4260, on March 14, 2014. As an organization working on behalf of people living with HIV in the South, the Southern AIDS Coalition has a number of concerns regarding the proposed legislation. The Ryan White Program is an essential lifeline for individuals and families infected and affected by HIV. It is through careful thought and a process of community input that an appropriate piece of legislation can be drafted to address disparities in HIV treatment and care and continue to provide comprehensive services to all people living with HIV.
HOPWA Modernization Proposal: Need for Community Consensus
The President’s FY 2015 budget proposal, released in March 2014, included an outline of the update to the HOPWA program. The proposal included a number of significant changes, namely a momentous change to the HOPWA funding formula. The Southern AIDS Coalition has long supported an update to the HOPWA funding formula that would be based on living HIV/AIDS cases, but it is vitally important to gain community consensus on how to implement changes fairly and without destabilizing existing HIV/AIDS housing programs.
Southern States Manifesto: Update 2012
Numerous political, social, and health care issues affect men and women living with and fighting HIV in the South. The Southern States Manifesto: Update 2012 provides a detailed analysis of the current and complex issues that plague this region in crisis. With the Manifesto, SAC hopes to bring light and understanding to these issues and further encourage all individuals to use the Southern States Manifesto: Update 2012 as a tool and a resource to participate in HIV advocacy efforts at the local, state, and national level.
2009 – 2010 HIV/AIDS Health Care Policy Brief and Recommendations
The timing of The Southern AIDS Coalition’s release of 2009 – 2010 HIV/AIDS Health Care Policy Brief and Recommendations coincides with the monumental effort to enact health care reform in the United States within the context of major state and federal budget shortfalls and deficits. Southern states face a nearly $20 billion collective shortfall for fiscal year 2010 and as a result most states are predicting major Medicaid cuts in the near future.
The Potential Impact of Health Care Reform on HIV in the South
The Southern AIDS Coalition (SAC) supports Health Care Reform that 1) results in resources and systems focused to reduce new HIV infections; 2) provides treatment, care, and housing for those living with HIV; and 3) covers all Americans. The response to HIV disease requires proven, evidence-based public health approaches to coordinate payers and providers in the provision of prevention, care, treatment, and housing interventions that maximize individual health and minimize societal cost. SAC’s approach to Health Care Reform starts with the need to amass adequate resources for the Southern region to meet the many demands of those living with or at risk of HIV infection.
AIDS and Behavior
Peer-reviewed article titled “HIV Prevalence Rates Among Men Who Have Sex with Men in the Southern United States: Population-Based Estimates by Race/Ethnicity.” States across the U.S. lack effective ways to quantify HIV prevalence rates among men who have sex with men (MSM). We estimated population-based HIV prevalence rates among MSM in the 17 southern states by race/ethnicity. State-level analysis of racial/ethnic-specific MSM HIV prevalence rates referenced in this article can help guide resource allocation and assist advocacy efforts.
Southern States Manifesto 2008
The Update 2008 describes what HIV looks like in the South, six years after the Southern AIDS Coalition’s first efforts brought the organization together in a dynamic way to achieve mutually desired public health outcomes through a collaboration of community and government. The report is released after the conclusion of the first year of the Ryan White HIV/AIDS Treatment Modernization Act of 2006 and of the CDC testing guidelines, Re-vised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings. These two important policy events, along with the continued burgeoning need in the South, present an opportunity to coalesce these critical and new advances to focus on very accomplish-able goals.
Southern States Manifesto 2002
The first-ever, Southern States Manifesto, is the result of input based on the collective expertise and experience of each of the HIV/AIDS/STD directors and their community based partners in thirteen Southern states and the District of Columbia. The Manifesto was published at a time that over the previous decade, the HIV/AIDS and STD epidemics continued to increase in every southern locality, particularly among poor, disenfranchised, and minority populations. Southern state governments and localities, struggling to find resources for disease prevention, and care and treatment for the growing number of individuals living with HIV/AIDS and/or STDs, outlined the barriers and an urgent call to action of federal, state, and local leaders to recognize the disparate impact of HIV and STDs in the South.
2017 Letter to Key Southern Senators Working on Health Care Reform
More than 90 regional, state, and local organizations joined SAC and SASI to urge our Senators to consider the needs of Southerners living with HIV as they prepare to advance health care reform in the Senate. This letter outlines five key principles that we believe are necessary to ensure access to life-saving treatment and care for all people living with HIV.
Ending the Epidemic FAQs
For the first time ever, we have evidence-based tools in HIV treatment and prevention that are so effective that they could conceivably end the most deadly infectious disease epidemic in modern history. Many communities across the country are doing the work to create ambitious and bold plans to drive HIV and AIDS below epidemic levels. Here are some of the most frequently asked questions in that work.
Comment on HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs
We applaud the efforts of HHS to lower drug prices and reduce out-of-pocket costs. These goals are particularly important for people living with chronic diseases who rely on medications for their survival. It is critical, however, that people living with HIV have uninterrupted access to their HIV medications for their own health and to prevent the spread of HIV to others. We therefore urge HHS to (1) maintain antiretrovirals as a protected class on the Medicare Part D formulary; and (2) provide access to antiretrovirals without pre-authorization or other utilization barriers within Medicare Part D.
The Southern AIDS Coalition keeps our presentations archived for reference. Click on the provided links to download the presentation.
Southern AIDS Coalition and Southern HIV/AIDS Strategy Initiative Host Southern HIV Plenary at 2015 USCA.
September 21, 2015
The Southern AIDS Coalition (SAC) and the Southern HIV/AIDS Strategy Initiative (SASI) presented a plenary on HIV in the South at #2015USCA. Held Saturday, Sept 12, 2015 in Washington, DC. Moderated by Kathie Hiers, the talk featured: Dr. Shanell McGoy, Director of HIV/STD, Tennessee Department of Health and Vice Chair, National Association of State and Territorial AIDS Directors; Cedric Sturdevant, Project Coordinator, My Brother’s Keeper, Jackson, Mississippi; Monica Johnson, Founder and CEO, HEROES, Northeast Louisiana; Robert Greenwald, Clinical Director of Law, Harvard Law School and Director, Harvard Law School Center for Health Law and Policy Innovation; and Robert Suttle, Assistance Director, SERO Project.
HOPWA Modernization Proposal: Need for Community Input and Consensus
May 22, 2014
Join the National AIDS Housing Coalition (NAHC), the Southern AIDS Coalition, Southern HIV/AIDS Strategy Initiative, and HIV Prevention Justice Alliance for a community discussion on the modernization proposal for the Housing for Persons with AIDS Program (HOPWA).
The President’s FY 2015 budget proposal, released in March, included an outline of the update to the HOPWA program. The proposal included significant changes, such as the addition of new short-and medium-term housing interventions, assistance for homeless persons, and increased administrative fees. Additionally, the update included a momentous change to the HOPWA funding formula.
While the HIV/AIDS housing community has long supported a change to the HOPWA funding formula that would be based on living HIV/AIDS cases, it is vitally important to gain community consensus on how to implement changes fairly and without destabilizing existing HIV/AIDS housing programs.
Partners from NAHC, AIDS Alabama, AIDS Project Los Angeles, and AIDS United will share an overview of the HOPWA legislation, present community perspectives from differing jurisdictions, and provide context of the current political landscape. The webinar will end with a Q&A session and opportunity for comment, with the goal of building community input and consensus on a fair and equitable way to implement changes to the HOPWA funding formula.
Webinar on Marketplaces and Ryan White for States Not Expanding Medicaid
February 26, 2014
Is your state one of these 24 NOT expanding Medicaid to cover all low-income people? (Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Wyoming). If so, this webinar is for you!
This free webinar is designed for case managers, peer navigators, planning council members and anyone else working on the front lines of the HIV epidemic, working in the states where Medicaid is not expanding.
During this 90-minute webinar policy experts from the Southern HIV/AIDS Strategy Initiative and the Harvard Law School Center for Health Law and Policy Innovation will cover several topics, including:
- Accessing Navigators and other supports to avoid consumer scams
- Selecting the best private health insurance plan
- “Vigorously pursuing” ACA insurance yet remaining on the Ryan White program if that is the best course of action for you (or your client)
- Spotting and reporting problems with marketplace insurance to support ongoing advocacy and improve coverage for people living with HIV
Strategies for States Not Expanding Medicaid – The New Basics of Health Reform for Frontline HIV Workers
November 14, 2013
Are you a case manager, peer navigator, planning council member, or other person working on the front lines of the HIV epidemic? This free webinar is for you!
Is your state one of these 25 that is NOT expanding Medicaid to cover all low-income people? Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire3, North Carolina, Ohio, Oklahoma, Pennsylvania1, South Carolina, South Dakota, Tennessee1, Texas, Utah, Virginia, Wisconsin, Wyoming. Visit Kaiser state Medicaid expansion map.
We’ll cover maximizing marketplace coverage, the role of the Ryan White Program and ADAPs, and advocacy strategies to ensure Medicaid expansion moves forward.
What Happens Next? Health Reform Strategies for States Not Yet Expanding Medicaid in 2014
May 14, 2013
As many states, particularly in the South, have elected to not expand Medicaid under the Affordable Care Act, HIV service providers are left wondering how to cover thousands of currently uninsured PLWHA. This webinar provides an overview of how to leverage other pieces of the ACA to fill access and affordability gaps, an update on existing Medicaid reforms, and a discussion of private insurance reforms.
Amy Killelea, the Senior Manager of Health Care Access at the National Alliance of State and Territorial AIDS Directors (NASTAD), will give a presentation highlighting potential opportunities for non-Medicaid expansion states. The webinar presentation will be followed by a question and answer session.
Improving Access to HIV/AIDS Care in the Rural South: Alleviating Structural Barriers Using Telemedicine
July 23, 2013
The release of the “HIV Treatment Cascade” in March 2011 revealed that nearly 3 out of 4 people living with HIV in the U.S. have failed to successfully navigate the HIV continuum of care. In the South, two thirds of HIV+ individuals live in rural areas and often face many socio-economic barriers that prevent them from receiving proper care. A new initiative, The Access to Care Initiative: Telemedicine, aims to change that. Presenters discuss this new technology and provide insight from the point-of-view of the organizational director, physician and project manager. Program Faculty Include: Prashanth Bhat, MD, HIV/AIDS Specialist, Medical AIDS Outreach of Alabama, Inc., Mary Elizabeth Marr, Chief Executive Officer, AIDS Action Coalition, and Sandra Percival, Telemedicine and Distance Learning Initiatives Program Director, Medical AIDS Outreach of Alabama, Inc.
USCA 2013 Host Committee Seminar – HIV/AIDS: A Southern Epidemic
September 8, 2013
When considering HIV treatment, research, and outcomes in the United States, it is clear that there is a regional disparity impacting the South. The South is the epicenter for HIV disease. Data from the Centers for Disease Control and Prevention (CDC) indicates that the South has the most people living with HIV/AIDS and the highest HIV diagnosis rate of any US region. In addition to the highest infection and mortality rates, the South has the highest rates of sexually transmitted infections (STIs), the greatest poverty, the greatest number of people without health insurance, the least access to health care, and the fastest growing epidemic in the nation. These statistics are fueled by a number of underlying factors, including stigma, discrimination, racial and ethnic disparities, aggressive homophobia, and poor social determinants. The seminar will be rooted in the theme, “the perfect storm,” with the following learning objectives: 1. Gain an in-depth understanding of the epidemiology of HIV in the South; 2. Analyze the impact of health care access (lack of) with a discussion of funding disparities and emphasis on rural areas in the South; 3. Realize the importance and impact of health disparities among minorities in the South and the link between health disparities and HIV prevalence; 4. Examine stigma and criminalization as it translates to barriers in HIV treatment and prevention; 5. Strategize and share best practices for identifying opportunities, creating coordinated interventions, and the importance of collaborations between community-based organizations, advocates, and organizations outside the field of HIV/AIDS.
Seminar Presenters Include: Debbie Wendell , PhD, MPH (LA Office of Public Health), Travis Sanchez, DVM, MPH (Emory University), Leandro Mena, MD (University of Mississippi Medical Center), Erik Valera (Latino Commission on AIDS, Latinos in the Deep South Project), Kathie Hiers (AIDS Alabama), Steve Rygiel, Esq. (Aiding Alabama Legal Program, Birmingham AIDS Outreach)