New HIV Case Rate in Metro Atlanta Third Highest in Nation

Ҵý’s Dr. Maisha Standifer explains that Atlanta and the South have long had among the highest rates of HIV, other sexually transmitted infections, and chronic diseases in general.

By Jim Gaines, The Atlanta Journal-Constitution

Dr. Maisha Standifer Dr. Maisha Standifer , PhD, MPH

Director, Population Health at Ҵý Satcher Health Leadership Institute

 

The 20-county Atlanta metro area had the third-highest rate of new HIV diagnoses among U.S. metro areas in 2021 — 1,562 new cases, a rate of 25.4 new diagnoses out of every 100,000 people in the metro area, according to Jeff Cheek, director of the Fulton County Department of HIV Elimination.

“That rate is two times greater than all other metropolitan areas and two and a half times higher than the rate nationwide,” said Cheek, citing the most recent data available from the Centers for Disease Control & Prevention.

The Atlanta area accounted for more than half of all 2,371 new HIV diagnoses in Georgia that year, according to the CDC.

Kimberly Boim, CDC press officer, provided data confirming Atlanta was behind only the metro areas of Miami and Memphis in new HIV diagnoses in 2021.

“Nationally the rate of new cases has been decreasing over the past years in most areas of the country, except in the South,” Cheek said. Florida and Texas saw spikes too, he said.

Atlanta and the South have long had among the highest rates of HIV, other sexually transmitted infections, and chronic diseases in general, said Maisha Standifer, PhD, MPH, director of Population Health at Ҵý School of Medicine’s Satcher Health Leadership Institute.

There are 40,931 people known to be living with HIV in metro Atlanta, a rate of 662.5 per 100,000 population, Cheek said. But rates by county vary widely, from 91 per 100,000 in Forsyth to 1,802 per 100,000 in Fulton — nearly 20 times Forsyth’s rate.

The U.S. overall had 382 people per 100,000 living with HIV in 2021, according to CDC data.

New HIV diagnoses in 2021 were down 12% from four years earlier, driven by a 34% drop among 13- to 24-year-old gay and bisexual males, the CDC announced in May.

But that still means 32,100 new infections nationwide in 2021. More than half of 2021′s new cases were in the South. About 1.2 million people in the U.S. have HIV, but more than 150,000 of them don’t know it, according to the CDC.

The decline in new infections was attributed to wider testing and treatment, and pre-exposure prophylaxis or PrEP, which is use of antiretroviral drugs to prevent infection. But all those factors remained less available to Black and Hispanic males, who continued to have higher infection rates than White males.

About 30% of the 1.2 million people likely to benefit from PrEP were actually getting antiretrovirals in 2021, more than doubling the 2017 number, according to the CDC. But that included “relatively few” Black or Hispanic people.

Black and Hispanic males accounted for most of the new infections, and half of new HIV infections among women were in Black women, the CDC said.

“Our epidemic is primarily African American,” Cheek said.

Available resources

Fulton County’s Department for HIV Elimination has improved its website to help people find care, get details on services, and see provider ratings based on medical data.

The department funds 23 regional agencies including nonprofits and health departments to help low-income, uninsured, or underinsured people impacted by HIV in metro Atlanta find core medical services. It also funds support services such as non-medical case management, childcare, transportation, and food banks.

Fulton County HIV programs serve about 17,000 people, Cheek said.

The focus of HIV prevention programs was on testing two years ago, when Joshua O’Neal first started as the county Board of Health’s director of sexual health, he said. But that misses many chances to prevent infection, so now the office provides a wide range of STD testing and engages people about HIV prevention, O’Neal said.

Health workers see a lot of HIV transmission from shared needles, so the Fulton board of health started the first government-based support program for people with substance abuse problems: clean syringes, fentanyl test strips, and help getting into treatment, O’Neal said.

“What we’re doing is expanding our approach to prevention, which is not necessarily the norm in Georgia,” he said.

HIV prevention groups in Georgia, unlike other places O’Neal has worked, can only rely on federal funds channeled through the state Department of Public Health, he said. And many senior positions are vacant at the state level, leading to a lack of leadership for local boards of health, O’Neal said.

Ҵý School of Medicine is uniquely positioned to educate future health care workers and scientists on that changing landscape, Standifer said. People tend to trust clinicians, so those who work with marginalized populations are crucial for breaking down that stigma, she said.

Roadblocks to care

Although HIV infection is no longer a death sentence, stigma lingers and that plays into policy efforts, Standifer said.

“We have to understand that many people who live in rural areas come to Atlanta for care,” she said.

Often people in rural areas are reluctant to talk about sex and STDs, or may not want to go for care to a local clinic where they may see someone they know, Standifer said. That’s why community health workers need to be present in churches, barbershops, and beauty salons, she said.

O’Neal said metro Atlanta has lots of HIV treatment and prevention options, but there is a “saturation of services” downtown and a huge lack south of Interstate 20.

“We’re seeing a lot of people under the age of 21 who are newly diagnosed and need support, and especially Black and brown communities,” he said.

Cost is also a factor. Generally, federal HIV prevention funds don’t pay for medication or treatment, O’Neal said. Even the board of health has to charge for services on an income-based sliding scale, he said.

“We very rarely see people with insurance. People with insurance prefer to go to other providers,” O’Neal said.

At the Neighborhood Union Health Center, however, O’Neal has started a program through a special CDC grant that offers all HIV programs for free, from testing through treatment.

For several years the department’s emphasis has been on getting people to understand the importance of getting treatment that will suppress their viral loads, Cheek said. The same antiretroviral drugs that suppress HIV can also keep someone from contracting the virus in the first place, but the department’s main revenue source — federal Ryan White funds — can’t be used for PrEP, he said.