HIV Epidemic in the South Reaches Crisis Proportion

southern hivaids strategy initiative



 The Southeastern United States is experiencing the highest rate of new HIV/AIDS infections, says the executive summary of a research report released Tuesday by The Southern HIV/AIDS Strategy Initiative (SASI).

The report takes a close look at nine southern states that have been particularly hard hit by the epidemic in recent years:  Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and (East) Texas.

“With the highest rates of both new HIV diagnoses and HIV-related deaths in the country, as well as poor social determinants of health and high poverty rates, the South faces an urgent need for resources to fight the epidemic now,” said Carolyn McAllaster, director of the Duke AIDS Legal Project and SASI project director.  “We cannot afford to be complacent.”

SASI was launched earlier this year by the Duke AIDS Legal Project to advocate for increased federal resources to stop the spread of HIV in the South.

According to newly released research commissioned by SASI and compiled by the Duke Center for Health Policy and Inequalities Research, 35 percent of new HIV infections in 2009 were in the targeted states, which contain only 22 percent of the U.S. population. North Carolina is one of eight southern states with the highest rates of new HIV diagnoses in the U.S. The targeted states also lead the nation in new AIDS diagnoses rates.

Nine of the 10 states with the highest rates of death due to HIV in the country are in the South, according to the report.  All nine states targeted in the report are among the 15 states with the highest death rates.  North Carolina is one of these states.

The data also indicates that 99.5 percent of people on waiting lists for the AIDS Drug Assistance Programs live in the South.

SASI and the Duke Center will make the full report available in December.

“When people living with HIV/AIDS cannot get the care and medications they need, they risk serious illness and even death,” said Dr. Michelle Ogle, an infectious diseases physician practicing in Henderson, N.C. 


The Southern HIV/AIDS Strategy Initiative is a broad-based coalition of HIV/AIDS Advocates and their supporters led by the Duke AIDS Legal Project and a steering committee of HIV/AIDS experts from nine southern states.  With support from the Ford Foundation, SASI is developing research-based policy and strategy recommendations to call attention to the HIV/AIDS crisis faced by Southern states and to advocate for increased federal resources.

The Duke AIDS Legal Project, which has been providing free legal assistance to low-income HIV-infected clients since 1996, offers law students the opportunity to develop practical lawyering skills through direct representation of clients under close attorney supervision. The project’s activities are conducted as part of the school’s academic mission and do not represent an official endorsement or policy of Duke University.


Surveillance data from the Centers for Disease Control and Prevention (CDC) regarding HIV and AIDS in the United States indicate a significant and disproportionate impact of HIV on the Southern United States. These data indicate both a greater impact in Southern states in terms of the proportion of the population affected in the region as well as a disproportionate share of the overall number of individuals with HIV in the US. The following 2009 data from the CDC provide evidence of the disproportionate burden of new HIV infections (which include all new infections reported regardless of stage of HIV disease) and of new AIDS diagnoses in the South:

  • The rate of new HIV infections per 100,000 population was the highest in the Southern US, indicating that this region had the greatest proportion of residents testing positive for HIV in 2009.
  •  Eight of the 10 US states with the highest rates of new HIV infections were located in the South.
  • Half of newly reported HIV infections were in the South although the South accounted for only 37% of the US population.
  • The South accounted for nearly half (46%) of new AIDS diagnoses and the AIDS diagnosis rate in the Southern region was only second to the AIDS diagnosis rate in the Northeast region. An AIDS diagnosis indicates progression of HIV and is uniformly determined either by a lab test such as a CD4 test or by having certain AIDS defining medical conditions.
  • Eight of the 10 US states with the highest rates of new AIDS diagnoses were in the South.

Data from the CDC regarding number and rates of people living with HIV at year end 2008 (also referred to as HIV prevalence) provide evidence of the disproportionate effect of the disease in the US South: HIV prevalence data indicate that 43% of people living with HIV in the US reside in the Southern region.

  • The Southern region has the second highest HIV prevalence rate per 100,000 population.
  • The Northeastern region continues to have the highest HIV prevalence rate primarily due to the high prevalence rates in New York and New Jersey – states where the epidemic began and where people have been living with the disease for long periods of time.
  • AIDS prevalence is also high in many Southern states, as Southern states/District of Columbia represent 6 of the 10 areas with the highest AIDS prevalence rates.

REPORT: HIV/AIDS Epidemic in the South Reaches Crisis Proportions in Last Decade 

This report was led by long-term researchers into the HIV epidemic in the Deep South, Drs. Susan Reif and Kathyrn Whetten with support from Elena Wilson and Andrew Goodall.