The Southern HIV/AIDS Strategy Initiative (SASI) focuses much of our research on the nine Deep South states that account for only 28% of the U.S. population, but nearly 40% of national HIV diagnoses. Recent research by SASI and the U.S. Centers for Disease Control and Prevention (CDC) found that those living with HIV in the Deep South states are dying at higher rates than in any other region of the country. So why would the CDC choose to restrict eligibility for high-impact prevention funding for community based organizations (CBOs) to those located in designated large metropolitan statistical areas (MSAs), even though much of the Southern epidemic is rural and suburban?
This policy holds back crucial funding for a region that has experienced disproportionately high HIV diagnosis and death rates outside of major cities. Indeed, the SASI/CDC research report found that living outside a large urban area at the time of HIV diagnosis significantly predicted greater death rates among persons living with HIV in the Deep South.
Several Deep South states have a significantly higher percentage of their HIV burden outside of large urban areas, as shown by the map below. Overwhelmingly, these are areas that are ineligible for direct CBO funding under their funding regulations for the grant program PS15-1502, which supports comprehensive high-impact HIV prevention projects for CBOs. SASI's research shows that PS15-1502 will have a disparate impact on prevention funding in the Deep South states, creating a funding shortfall that is not made up by increased prevention funding to state health departments.
If the same eligibility criteria had been applied to previous CBO funding announcements, Southern CBOs would have lost out on a total of $3.8 million in 2004 and $2.5 million in 2010. Because the disease burden in several Deep South states is located outside eligible MSAs, many CBOs that had previously received direct prevention funding were barred from applying for funding under PS15-1502.
SASI supports the allocation of significant HIV prevention resources to the large urban areas where the HIV burden is highest, but we are concerned about going too far in a one-size-fits-all approach that leaves insufficient funding to address critical prevention needs in other, less urban areas of the country. SASI and 75 other national, regional and state organizations have signed on to a letter calling on the White Office of National AIDS Policy (ONAP) to expand the National HIV/AIDS Strategy (NHAS) to add the following critical actions necessary to further reduce HIV infections and to achieve an AIDS-free generation in the U.S.:
- Adopt a more effective and nuanced approach to HIV prevention by ensuring that:
- HIV prevention resources are targeted to rural and suburban, under-served areas with high HIV diagnosis rates, high death rates and low survival rates, among people diagnosed with HIV or AIDS.
- HIV prevention efforts in rural and suburban areas are informed by the epidemic profile of each state and tailored geographically by the social and cultural context in each state.
- HIV prevention efforts targeted to rural and suburban areas support and evaluate capacity to provide HIV prevention and care at the state, local and CBO levels.
Reduced prevention funding for CBOs -- the very groups that are uniquely positioned to reach communities at risk for HIV -- will only serve to increase the HIV burden in regions outside the large urban areas where the HIV diagnosis rates and death rates are high.
Carolyn McAllaster is a clinical professor of law at Duke University School of Law and is the founder and director of the Duke AIDS Legal Project and the Duke HIV/AIDS Policy Clinic. She is the project director of the Southern HIV/AIDS Strategy Initiative (SASI) and immediate past co-chair of the North Carolina AIDS Action Network. Professor McAllaster is the author of several articles or chapters in books, including "Legal Issues for HIV-Infected Children" in Textbook of Pediatric HIV Care (2005) and co-author of "Issues in Family Law for People with HIV" in AIDS and the Law_, 4th ed. (current Supplement, 2013), "Family Court Proceedings" in the_ American Bar Association HIV and AIDS Benchbook_, and a recent article in_ AIDS Care Journal_, "HIV/AIDS in the Southern United States: A Disproportionate Epidemic."_