Atlanta remains a hotspot for new AIDS/HIV cases

How did metro Atlanta become an epicenter of new HIV/AIDS cases?

AIDS in Georgia

Illustration by Matt Love

For years, Georgia has been near the top of states with the highest rates of HIV/AIDS cases. In parts of Atlanta and the metro region, rates are as much as eight times the national average, and researchers say they rival levels found in some developing countries.

How did metro Atlanta become an epicenter of the HIV/AIDS epidemic?
Blame poverty, lack of health insurance, inadequate sex education, and stigma—particularly for young LGBTQ+ people who are shunned by their families and end up on the street. These problems exist in many urban areas; however, Atlanta is also majority Black, and the virus is disproportionately affecting Black people—especially young Black men who have sex with men. According to AIDSvu, a database produced in partnership with Emory University, the rate of Black men living with HIV in Atlanta is five times that of white men. For Black women, it’s 15 times greater.

Why is there such a disparity in infection rates?
According to a 2014 Emory University study that focused on metro Atlanta, young Black and young Hispanic men who have sex with men don’t have more sexual partners and don’t engage in riskier sex. However, they are more likely to live in poverty, have poor health literacy, not have health insurance, and lack access to condoms or medication that can prevent the onset of infection after possible exposure to HIV. “When you see something that’s persistent for this long, it’s not about individuals,” says Aaron Siegler, an associate professor at Emory University’s Rollins School of Public Health. “It’s about the system.”

What can be done?
To prevent new cases, Fulton, DeKalb, and Clayton counties offer routine HIV testing at health clinic locations and encourage clients to begin preexposure prophylaxis. Commonly called PrEP, the daily pill regimen reduces the risk of HIV transmission by 99 percent when used correctly. According to a recent study conducted by Siegler and his colleagues, states that expanded Medicaid and provide financial assistance for PrEP had a 90 percent higher participation rate than those that didn’t. Georgia Republicans, however, have thus far resisted extending the federal healthcare program to more people living on low incomes.

I’ve heard PrEP is successful, especially in other cities like San Francisco.
According to several studies, more than half of gay and bisexual men in San Francisco take PrEP, and between 2013 (the year after the medicine was approved for use) and 2016, new infections dropped by 43 percent. But that’s partly because San Francisco has made PrEP a fundamental part of its HIV strategy and showed support by funding “navigators” who connect people with low- or no-cost assistance or even offer funding assistance themselves. AID Atlanta and county health departments offer navigation services, but the more resources local governments and nonprofits can provide—not to mention leadership in ending the stigma around seeking care—the better. “We have the tools at our disposal,” says Siegler. “And the question is, do we have the will to bring them to bear?

This article appears in our October 2020 issue.