The authors discussed several factors that could explain these results. Many Southern states have low investment in and consequently poor transportation infrastructure. Similarly, healthcare infrastructure and the number of HIV providers is also inadequate in many areas of the South. Also, disproportionate incarceration of Black men in the South disrupts social networks and contributes to increased poverty.
Importantly, many Southern states have opted not to expand Medicaid. Studies have shown that Medicaid expansion has resulted in significant decreases in all-cause mortality and delayed care, especially among minority groups and those living in poverty who are at highest risk for acquiring and dying of HIV infection.
“Current proposals to reform or repeal the Affordable Care Act may change federal reimbursements for Medicaid; research will be required to assess the effects of these future policies,” the authors emphasized.
• Neighborhood analysis of US women living with HIV or at risk for HIV infection found eligibility requirements for Medicaid and ADAP, lack of health insurance, high incarceration rates, and inadequate transportation and health infrastructure may explain the HIV epidemic in the South
• Addressing these structural barriers may improve HIV outcomes for people with HIV infection in the South
• Southern states that opted out of Medicaid expansion may exacerbate these disparities
• Reform and repeal of the Affordable Care Act may affect these disparities
1. Ludema C, Edmonds A, Cole SR, et al. Comparing neighborhood and state contexts for women living with and without HIV: understanding the Southern HIV epidemic. AIDS Care. 2018 Jul 1:1-8. doi: 10.1080/09540121.2018.1492696.