Abstract #94  -  Changing the next 25 years of the HIV epidemic: linking contextual syndemics in the US as a method for the prevention of new infections in African American women in the South
Authors:   Presenting Author:   Prof Vickie Mays - University of California Los Angeles
Additional Authors:  Prof Susan Cochran,
Aim: Issues: Health planners in the United States have begun to evaluate the lessons learned from the HIV epidemic over the last 30 years in order to tailor new, more effective interventions to deal with the anticipated emergent aspects of the HIV epidemic. The hope is to prevent a duplication of our past experiences with this disease. The relentless increase in the incidence of HIV/AIDS in Black women in the South has resulted in prevalence rates similar to those seen among women in South Africa. If we do not take bold and innovative actions in the Southern States, we will in next 25 years have lost so many African American women that we here in the United States will have a set of conditions that mimic those in parts of Africa. The notion of a syndemic has been used to conceptualize the joint effects of HIV, stigma, and substance abuse among urban, affluent gay men in the U.S. (Stall et al., 2003). But, for African Americans intertwined patterns of joblessness, migration, poverty, racial and economic discrimination, barriers to education, the rise in the prison complex industry, sex ratio imbalance, and drug use are well known and chronic multiplicative risks. These contextual factors create a unique risk pool for African American women in the Southern region of the United States.
Method / Issue: Project: We identified a set of contextual factors in the literature using both pubmed and psychinfo. Each factor separately met the criteria of an epidemic in terms of its negative impact on HIV prevention and widespread occurrence within the Black population. We then geographically mapped these factors to reveal an overlay which we term an “HIV risk pool”. These include: 1) migration of African American males connected with gang/drug trade to the South from the Northeast and the drug trade corridor; 2) geographic concentration of incarceration facilities; 3) low levels of economic opportunities for low income African Americans; 4) sex ratio imbalance and marriage and relationship statuses; 5) inadequate health care infrastructure; 6) higher rates of residence in peri-urban areas and the stigma of HIV in these areas; 7) higher rates of STD’s. Using data compiled from the various Southern state regions, we then mapped these factors and HIV infection reporting using a Geographic Information Systems approach.
Results / Comments: Lessons learned: When visually graphed, patterns clearly emerge showing the geographic confluence of HIV risk factors in the Southern United States that have created a facilitating environment for the potentially explosive HIV epidemic that is simmering there. Traditionally health epidemics are solved within the public health arena. But the HIV epidemic in the United States requires trans federal, state and local initiatives that include Education, Labor, Public Safety, and Community Neighborhood Coalitions at a minimum. This comprehensive perspective has found traction in international HIV prevention efforts. We in the United State could learn from successful international models how to attack and manage “risk pool” syndemics.
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