Two recent studies show the staggering reach of HIV in metro Atlanta, documenting how the region leads other large urban areas in HIV diagnoses and how as many as 1 in 2 gay men in some counties are HIV-positive.

The South – and its mix of poverty, unemployment, lack of education and health insurance – has long been a hotbed for HIV. And Georgia – along with metro Atlanta – are among the leaders in HIV rates in study after study.

A new report from the Big Cities Health Coalition highlights the problem – again. Among 28 large urban areas studied, Atlanta's rate of HIV diagnoses was the second highest, behind only Washington, D.C. The region's rate is also five times higher than the national average, according to the Atlanta Business Chronicle.

HIV diagnoses rate in Atlanta (72.5 out of 100,000) was higher than every other city studied, with the exception of Washington, D.C. (91.4 out of 100,000). The U.S. average is 13.4 percent.

Other indicators in the coalition's report were just as startling:

  • Atlanta had the highest AIDS diagnoses rate of all the cities studied but Washington, D.C. The national average is 8 AIDS cases per 100,000 people. The rate in Atlanta and Fulton County is 30.4, with Washington, D.C. at 48.9.
  • Atlanta's HIV-related mortality rate is nearly four times the national average and the second-highest of cities included in the study. Atlanta's rate is 8.1 per 100,000 people, compared to a U.S. average of 2.1. Long Beach, Calif., ranked highest with a rate of 16.7 HIV-related deaths per 100,000 people.
  • The rate of people living with HIV/AIDS in Atlanta and Fulton is 1,613.3 per 100,000 people – nearly six times the national rate of 295.1. That's third behind Washington, D.C. (2,714) and San Francisco (1,903.4).

What drives those high rates in Atlanta and Fulton County? A study from the Rollins School of Public Heath shed new light on HIV rates among gay men on a county-by-county level – the first time that's ever been done. Via Emory Magazine:

Although the South is generally known as a hot zone for HIV/AIDS, the Emory study, led by Eli Rosenberg (top image), assistant professor of epidemiology at Rollins, was the first to break down HIV rates for MSM by state, county, and metropolitan area.

“The US Census does not capture MSM or gay men, so we couldn’t calculate the rates,” says Rosenberg. “The CDC had produced a national number [of infected MSM], but there was no subnational number. Everything below that was darkness. When we wanted to look at states and counties, we were at a loss.”

But what Rosenberg's study showed was, well, staggering in the South and a handful of metro Atlanta counties. 

According to Rosenberg’s research, six US states exceeded the national average of MSM diagnosed with HIV in 2012—and all of them were in the South. Of the top 25 metros in terms of prevalence, 21 were south of the Ohio River. And the frequency surpassed 25 percent in five of those cities—Jackson, Mississippi (39.5 percent); Columbia, South Carolina (29.6); El Paso, Texas (28.5); Augusta, Georgia (26.5); and Baton Rouge, Louisiana (25.4).

And while Atlanta, which includes Sandy Springs and Roswell, scored a relatively low 16.4 percent of MSM with HIV, Rosenberg is quick to offer perspective, saying that although the rate is 10 percent higher in Augusta, the Atlanta metro area has 18 times more cases—its percentage is diluted by all of the outlying counties lumped into the region. A closer look reveals that Atlanta metro counties show a significant uptick in prevalence—with Clayton County at 49 percent, DeKalb at 24 percent, and Fulton at 22 percent.

Researchers also pointed to what drives those high rates. Via Emory Magazine:

Carlos del Rio, the Hubert Professor of Global Health and Medicine specializing in infectious diseases and codirect or of the Emory Center for AIDS Research (CFAR), says Rosenberg is on the right track.

“It is clear that the major drivers of HIV infection are poverty, unemployment, lack of education and health insurance,” del Rio says. “Addressing HIV in the South requires us also to address the social determinants of health. If you add stigma, discrimination, and racism, you have a perfect milieu for high HIV rates.”

Earlier this year, a study from the Centers for Disease Control & Prevention showed that gay black and Latin men are at strikingly higher risk to be diagnosed with HIV in their lifetime than white men who have sex with men. Among men who have sex with men, 1 in 2 black men and 1 in 4 Latino men will be diagnosed with HIV during their life – compared to 1 in 11 for white men who have sex with men, according to the analysis. 

Overall, 1 in 6 men who have sex with men will be diagnosed with HIV in the lifetime, according to the CDC.

Fulton has launched an ambitious effort to eradicate HIV in the county, as well as a clinic that provides PrEP. Meanwhile, Emory researchers continue to search for an HIV vaccine, efforts that were bolstered earlier this year with a $35.6 million grant to "shock and kill" HIV.

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