March 1, 2010

Metro area HIV cases clustered in downtown Atlanta

The HIV epidemic in metropolitan Atlanta is concentrated primarily in one geographic area or cluster consisting of 157 census tracts centralized in the downtown area. This area concentrates 60 percent of the city's HIV cases, according to research conducted by investigators in the Emory Center for AIDS Research (CFAR).

The prevalence rate of HIV within the cluster is 1.34 percent and is compatible with what the World Health Organization would describe as a "generalized epidemic," a term used for places with an HIV prevalence of over 1 percent. In comparison, outside the cluster the HIV prevalence is 0.32 percent.

The research was presented Feb. 18 at the 17th Conference on Retroviruses and Opportunistic Infections in San Francisco.

"Atlanta includes more than 60 percent of HIV cases in Georgia, but the distribution of the epidemic has not previously been explored," says author and presenter Paula Frew, assistant professor of medicine at Emory School of Medicine and a CFAR investigator.

The investigators assessed prevalent HIV cases in four metro area counties --Clayton, DeKalb, Fulton and Gwinnett -- to determine case distribution and the presence of service providers offering voluntary HIV testing and counseling services. They obtained HIV prevalence data, as of October 2007, from the Georgia Division of Public Health and matched it to census tracts. They also used data from the 2000 census to examine population characteristics such as poverty, race/ethnicity, and drug use.

The large Atlanta HIV cluster is characterized by a high prevalence of poverty, a greater percentage of African American residents, and high prevalence of behaviors that increase the risk of HIV exposure such as injection drug use and men having sex with men.

The investigators also found that 42 percent of HIV service providers in Atlanta are located in the cluster, which should facilitate prevention and treatment.

With more than 50,000 new HIV infections reported yearly in the United States, according to the Centers for Disease Control and Prevention, the HIV/AIDS epidemic continues to be a public health problem. The number of HIV/AIDS cases is increasing faster in the South compared to other areas of the country. According to Kaiser State Health Facts, Georgia ranks 9th in the nation in the number of HIV/AIDS cases with more than 3,000 new HIV infections diagnosed in 2007.

"Prevention efforts targeted to the populations living in this identified area, as well as efforts to address their specific needs, may be most beneficial in curtailing the epidemic within this cluster," Frew says.

Other authors of the study include Emory CFAR members Brooke Hixson, Saad B. Omer and Carlos del Rio.

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