February 3, 2012
The National HIV/AIDS Strategy has provided the nation with a long-overdue framework for a population-based approach to HIV prevention and a more coordinated national response. But faced with funding reductions, HIV/AIDS professionals are now challenged to employ technology more effectively, including using not just the traditional HIV-surveillance data but increasingly a new technology: geographic information systems (GIS).
Similar to the global positioning system, or GPS, feature in a cellphone or automobile, GIS maps a neighborhood's key characteristics, such as its businesses and transportation infrastructure, but allows users to connect them with HIV-surveillance data, such as a community's HIV prevalence, to help organizations fine-tune their battle against the epidemic.
"Because HIV surveillance does not collect data on education, income and other personal information, we cannot assess if there are disparities in HIV infection, for example, among people of different education or income levels," says Fangchao Ma, M.D., Ph.D., an HIV/AIDS-evaluation administrator with Illinois' health department. "However, the U.S. census provides detailed information on these factors at the census-tract level."
GIS allows users to bring these two pieces of information together, a process called geo-mapping. "With geo-mapping, we can assess impacts of these factors on HIV infection," adds Dr. Ma, whose research clearly depicted the health disparities in Illinois' epidemic, such as the relationship between the state's concentration of poverty in Chicago and its HIV prevalence.
"Dr. Ma's study results showed the disparities . . . in such a clear way that even skeptics were moved to action--addressing social determinants of health as a central issue in the fight against AIDS," says Edwin Corbin-Gutierrez, youth-empowerment manager at the Center on Halsted, a LGBT community center in Chicago, and co-chair of the epidemiology and needs-assessment committee of Illinois' HIV-prevention community-planning group.
New users begin by listing their HIV-testing organization through the National Prevention Information Network (pdf). Once part of that database, the organization will be depicted in GIS services such as the Atlas of the Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, which contains HIV, viral hepatitis, sexually transmitted disease and tuberculosis data; and AIDSVu, the GIS run by the Rollins School of Public Health at Emory University in conjunction with the CDC.
"Users then can visualize the data in many ways--think maps, reports and charts--that reveal relationships, patterns and trends in the area and make them easy to analyze and evaluate," says Jenevieve Opoku, a behavioral scientist with the District of Columbia Department of Health.
Let's say that a Ryan White-grant-funded community-based organization (CBO) in an impoverished neighborhood is having difficulty retaining its young MSM clients in care. Geo-mapping might show that the agency is not located near public transportation, the closest pharmacy is four miles away or assaults against young MSM are prevalent along the route between public transportation and the agency--all of which could undermine the organization's efforts.
"GIS can help map where the gaps of services might be and where to plan to add more local facilities for young Black men to receive care and treatment," says Yaa Simpson, a community epidemiologist and bioethicist at The Association of Clinical Trials Services.
The technology can also help AIDS-service organizations strengthen their grant applications or better target the resources and services that they already offer. For instance, GIS maps in grant applications might illustrate an organization's understanding of places in greatest need of certain services or the existence of heavily affected areas that are not currently well served.
Experts suggest that CBOs employ geo-mapping by using an integrated interagency approach that encourages collaboration among prevention, care and treatment, research and surveillance organizations; brings together an entire community; and maximizes the number and diversity of those involved.
Justin M. Wooley has been an HIV/AIDS-awareness advocate since 1996.