Policies and politics that promote HIV infection in the Southern United States

Abstract

The United States is characterized by geographic disparities in health, including HIV infection. These disparities are greatest with respect to the South, a heterogeneous region that comprises 17 states and Washington, DC, and is home to 37% of the nation’s population [1]. The South’s worse health outcomes are not restricted to HIV infection. The region has the highest rates of chlamydia, gonorrhea, and syphilis [2]; obesity [3], age-adjusted all-cause mortality [4], and mortality due to heart disease, diabetes and cancer [3]. A number of key social, structural, and policy factors drive the poorer health and HIV status of Southerners [5,6]. The South is the poorest of the nation’s four regions, with the highest percentage of people living in poverty areas and the lowest median household incomes [7]. Southerners are less likely to have health insurance [8] – a reality that heightens the salience of the current debate concerning increases in healthcare coverage through Medicaid expansion and implementation of The Affordable Care Act. This article reviews the epidemiology of HIV infection in the South and key laws and policies that contribute to its HIV patterns.