Fall 2025
HIV/AIDS Epidemic in the Southeastern U.S.
By Rob Spahr
A flurry of cuts to federally funded HIV research and prevention programs—coupled with the removal of critical data from government databases—raise concerns that the United States may lose ground in its efforts to end the HIV/AIDS epidemic. Data clearly show the disease not only still poses a threat to public health and the economy domestically, but also that the Southern U.S. carries the highest disease burden.
AIDSVu, an interactive online mapping platform produced by Rollins School of Public Health with the support and collaboration of Gilead Sciences, Inc., visualizes the impact of the HIV epidemic on U.S. communities to help increase disease awareness and promote data-driven public health decision-making.
Number of Persons Newly Diagnosed with HIV, 2021
In 2021, the South comprised 38% of the U.S. population but represented over half (52%) of new HIV Diagnoses
CDC, AIDSVu
HIV/AIDS Cases on the Rise in Georgia and Atlanta
The Southeast accounts for only 38% of the U.S. population. However, AIDSVu shows the region accounted for more than half (52%) of the nation’s 37,966 new HIV diagnoses in 2022 at a rate of 18 new diagnoses per 100,000 people. This is the highest number of any U.S. region. Georgia had the highest rate among U.S. states with 27 new diagnosis per 100,000 people. DeKalb and Fulton counties were the two most impacted U.S. counties with new infection rates of 56 and 55 per 100,000, respectively.
Across the South, more than 130,000 people have died from HIV since 2008.
Patrick Sullivan, PhD, Charles Howard Candler Professor of Epidemiology and principal scientist for AIDSVu, said an intersection of factors contributes to the disproportionally high rates in the Southeast.
“The South unfortunately presents real challenges to HIV prevention in terms of poverty, health insurance, housing stability, and some aspects of transportation,” Sullivan says. “For example, the South had the highest poverty rate and the lowest median household income compared to every other region of the country in 2022, which are factors that complicate access to health care and prevention services.”
And instead of the areas of the Southeastern U.S. with the highest HIV transmissions benefiting the most from interventions like pre-exposure prophylaxis (PrEP), the opposite is occurring.
Barriers to Prevention
PrEPVu is an AIDSVu platform that collates PrEP utilization data to provide a reliable and consistent metric for PrEP users in counties and states nationwide. A PrEP-to-need ratio is used to measure the adequacy of PrEP coverage by determining how many of the people who acquired new HIV infections each year were on PrEP. The higher the PrEP-to-need ratio number, the better the preventative coverage. The South had the lowest PrEP-to-need ratio in the nation (11.6), less than half that of the Northeast (24.8) which had significantly fewer new HIV diagnoses (4,690) in 2024.
This imbalance is because preventative services like PrEP and HIV testing, as well as treatment for people living with HIV, are largely dependent on access to health insurance and the ability to physically get to places where those services are provided, Sullivan says.
In 2022, 14% of people in the South did not have health insurance—the highest percentage of any U.S. region.
“Among all the U.S. states, those that had expanded Medicaid programs were doing best with access to pre-exposure prophylaxis. For example, the PrEP-to-need ratio in 2024 was more than twice as high in states that had Medicaid expansion,” says Sullivan, adding seven of the 10 states that have not expanded Medicaid are in the South.
Failing to improve access to prevention resources upfront is costing the South even more in treatment expenses, Sullivan says, increasing the concern for any potential Medicaid rollbacks or reductions to preventive services covered by health insurance.
CDC Domestic HIV/AIDS Prevention and Research Funding by State, 2023
CDC estimates that approximately 9,000 HIV infections were averted by prevention efforts between 2017 and 2022, saving an estimated $5 billion in lifetime medical costs.
Centers For Disease Control and Prevention. "CDC Funding Profiles"
Expanding Access to Testing
Another Rollins-led program, Together TakeMeHome, has been successful in removing some of these barriers. As the nation’s largest HIV self-testing program, the CDC-funded initiative has distributed more than 900,000 self-tests across all 50 U.S. states and Puerto Rico since it launched in March 2023. More than a quarter of people who ordered the free HIV self-tests through Together TakeMeHome were checking their HIV status for the first time.
“Together TakeMeHome is also reaching more people where the HIV epidemic is most concentrated: the South,” says Travis Sanchez, DVM, research professor of epidemiology and executive director of Together TakeMeHome. “Nearly half of all orders for HIV self-tests were placed by people living in the South. Southern states also represent nine of the 10 states with the highest per-capita orders in this nationwide program.”
The avoidable nature of these consequences emphasizes the importance of making the data on HIV prevalence accessible and understandable to the public.
“People take in information about their health and about the health of their communities in different ways. Some people prefer to look at a spreadsheet with numbers, other people prefer to take in that information visually. So, it’s important that we make these kinds of data available to communities so everyone can be involved in our efforts to reduce the impacts of HIV in the South. AIDSVu is one way to do that visually,” Sullivan says.
He adds, “I think all of us who live in the South have an opportunity and a responsibility to understand what the epidemic looks like in our community. That’s important because we are our own best advocates for asking that services be provided in our communities that are in response to the magnitude of the health problem in our communities.”
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Rollins Magazine is published twice a year by the Rollins School of Public Health, a component of the Woodruff Health Sciences Center of Emory University, for alumni and friends of the school.