Wednesday, January 18, 2017

What has AIDSVu Taught us About the State of HIV in America?


January 17 2017
 
 
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AIDSvu launched in 2010, and the site is updated annually, usually just in time for National HIV Testing Day.

AIDSVu is an interactive, user friendly, online map that allows users to visualize how HIV is impacting different regions of the U.S. It also offers the data (collected by the Centers for Disease Control and Prevention and state, county, and local health departments) to those who want to use it for research or reporting. The map also shows what disparities continue to color the epidemic, the current state of HIV testing, and where to get tested in each state. Users can also filter the data by race/ethnicity, sex, or age; and see how HIV rates are related to factors like poverty and education. 
 
The site was created by Center for AIDS Research at Emory University and Rollins School of Public Health at Emory University in partnership with the pharma giant Gilead Sciences. I recently spoke with epidemiologist, Dr. James Sullivan, the chief researcher of the site, about how the data has (and will) inform views and policy; especially as we face strong headwinds from a potentially hostile Trump Administration.

Sullivan has 22 years of experience in HIV epidemiology and prevention in men who have sex with men, in the United States and in international settings. He worked in the CDC for 12 years, including serving as an Epidemic Intelligence Service Officer, a branch chief, and Acting Deputy Division Director in the Division of HIV AIDS Prevention. He's also served as the associate director of scientific support for the National Institutes of Health-funded HIV Vaccine Trials Network.

What makes AIDSVu so invaluable right now?

We live in a time when the HIV epidemic is less visible and there’s less urgency to take action.  Our idea is that people understand data in different ways and maps are an easy, user friendly way to access this information. The maps are important because they display down to a granular level, the details of the epidemic in the United States. Although it may be less visible, the number is growing and the maps are one way to help people understand that HIV is an important and growing problem where they live.

Since AIDSVu debuted, what's the most shocking thing that you've learned that you didn't anticipate?

The persistent and profound impact of HIV in the Southern U.S. continues to concern me. The maps make it clear that the Southern epidemic is severe and widespread, effecting both urban and rural areas. In epidemiology we think a lot about this idea of disparities. Look at what’s going on in the southern U.S. which is only home to 37 percent of the country’s population, yet contains over 50 percent of new diagnoses. The south in general is quite heavily impacted; in terms of infection rates, five of the top five cities are in the south. The present data suggests that the important determinants for infection rates are directly correlated to poverty and low income areas and low coverages of health insurance which often co-occur. These areas also see less access to health information and STI screening. 

What's been something that the data has confirmed?

The health disparities of communities of color impacted by HIV — especially by African-Americans and other Black Americans. We've always known these disparities existed, but looking at side-by-side maps of White HIV rates versus Black HIV rates illustrates those disparities in a striking way. I hope that looking at the race-specific rate maps will motivate people to ask what we can do better to reduce these disparities. 

Plus has found that the data provided confirms certain suspicions, (i.e. that HIV tracks along certain racial and poverty zip codes). 

Yes, that's correct, but the correlations are complex. The AIDSVu maps help visualize the correlation between HIV prevalence and factors like poverty, income inequality, education, and health insurance. 

Who is benefiting and what agencies are using the data the most?

We hear from a broad base of users about how having easy access to the data and maps helps their work in a variety of ways. Those users range from people in community-based organizations who use maps in educational materials and testing/prevention outreach to academic researchers who use the data for statistical analyses or policy reports.

What is your ultimate hope that the compilation of this data will lead to?

Ultimately, I hope that the site leads to concrete policy changes. Infection rates among injection drug use have been declining, despite the rise of a heroin epidemic. New rates among gay men have been steady, and overall new diagnoses are down 11 percent.  But among youth 13-24, rates are up 11 percent, and among gay men in the same age bracket they are up 27 percent. I believe that one way to combat these rates is to offer HIV screening at every opportunity that anyone interacts with the healthcare system. One of the policy changes that I hope the site will foster is routine HIV screening in the same way you get screened for diabetes or anything else when you see the doctor. When they test your blood for sugar or diabetes, the doctor doesn’t ask you how many donuts you’ve eaten the last week. Unlike with STI and HIV tests where they ask you about sexual partners or “risky” activity. By making it a part of routine tests, we will de-stigmatize HIV testing for good.

Read more articles from PLUS, here.
 
 

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