摘要：We examine epidemiological and demographic data documenting the HIV/AIDS epidemic in the Deep South region of the United States. These data document substantial increases in AIDS cases in the Deep South from 2000 to 2003. In contrast, other US regions are experiencing stable rates or small increases in new AIDS cases. Furthermore, the AIDS epidemic in the Deep South is more concentrated than in other regions among African Americans, women, and rural residents. The Deep South also has some of the highest levels of poverty and uninsured individuals, factors that complicate the prevention and treatment of HIV infection. Further research is needed to determine the cause of the disproportionate rise in AIDS incidence and to develop effective means of preventing HIV infection and providing care of those infected in this region. THE US CENSUS BUREAU defines the Southern region of the United States as encompassing 16 states and the District of Columbia (Delaware, Maryland, West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Arkansas, Tennessee, Kentucky, Louisiana, Texas, Oklahoma, and Washington, DC) 1 ; the region extends from Delaware to Florida and from the East Coast to Texas. Six of these Southern states have demographically similar HIV/AIDS epidemics. These states (Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina) also constitute the Deep South. 2 The Deep South is historically defined as those Southern states that actively promoted slavery and whose agricultural and economic base was in cotton. 2 This region is currently disproportionately affected by the HIV/AIDS epidemic. From 2000 to 2003, the number of new reported AIDS cases increased 35.6% in the Deep South, and only 4.0% in the other Southern states 3 , 4 and 5.2% nationally (excluding the Deep South states). Incident AIDS cases decreased 0.4% in the Northeast, increased 1.7% in the Midwest, and increased 19.3% in the West, most of which was fueled by a 25.7% increase in California. 3 , 4 AIDS incidence rates are the most practical statistic to use for comparisons, because states are mandated to report AIDS cases; the reporting of HIV infection is voluntary so not all states provide this data. However, tracking new cases of HIV infection in addition to new AIDS cases is critical to defining the current epidemic because these 2 measures reflect different aspects of the epidemic. AIDS incidence includes individuals testing positive for the first time who meet the criteria for AIDS and previously diagnosed individuals who have progressed to AIDS. In contrast, the incidence of HIV infection includes individuals testing positive for HIV who do not meet the criteria for AIDS. HIV infection incidence trends among the 36 states that collected information on new HIV infection cases in 2003 suggest that the Deep South continues to be disproportionately affected by the spreading epidemic. 5 In 2003, the rate of HIV infection per 100 000 population was 11.6 for the United States as a whole. In contrast, the rate of HIV infection per 100 000 was 14.7 for the Deep South, excluding Georgia. (Georgia was excluded because HIV reporting was initiated in Georgia in 2003 and the numbers were artificially low at 52 new cases. 5 ) Compared with other regions of the country, it is clear that the HIV/AIDS epidemic is spreading rapidly in the Deep South. Furthermore, the Deep South has some of the highest death rates from AIDS in the country. All 6 Deep South states are among the 15 states with the highest AIDS death rates per 100 000 population. 4 , 5 Because of these factors, it is critical to acquire an understanding of the epidemic in the Deep South. This knowledge is a necessary first step in determining effective methods for improving the situation.
