Southern states in the U.S. had the nation’s lowest five-year survival rate among patients diagnosed with HIV or AIDS in 2003 to 2004, research published in the Journal of Community Health indicates.

“This research documents the dire consequences that having an HIV diagnosis in the Deep South region has for too many individuals,” said Carolyn McAllaster, of the Southern HIV/AIDS Strategy Initiative at Duke University in Durham, North Carolina in a university press release.

A group of nine states — Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas — had a disproportionately high number of HIV diagnosis and case fatality rates. To provide additional information about the HIV burden in these states, Susan Rief, PhD, of Duke University, and colleagues used CDC HIV surveillance data to examine characteristics of individuals diagnosed with HIV.

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In 2011, the targeted states had a higher HIV diagnosis rate (24.5/100,000 population) compared with the United States overall 18.0/100,000) and higher proportions of patients diagnosed with HIV who were black, female, younger, and living in suburban and rural areas compared with other regions. The nine states had lower HIV and AIDS survival proportions (0.85, 0.73, respectively) compared with the United States overall (0.86, 0.77, respectively) and the highest death rate among patients living with HIV of any region in the United States.

Regional differences, however, did not account for the higher death rate among patients with HIV in the targeted states, indicating that other reasons may contribute to the disparity. A number of factors, including poverty, lower levels of education, and racism, may likely contribute to the differences in outcomes among HIV-positive patients residing in these nine southern states.

“Clearly greater investment and focus are required to address the unique nature of the HIV/AIDS epidemic in the South,” Reif said in a press release.


  1. Rief S et al. Journal of Community Health. 2015; doi: 10.1007/s10900-014-9979-7