The number of new HIV cases in Missouri is on the rise — and a disproportionately large number are in rural counties.
The Centers for Disease Control and Prevention has identified Missouri as one of seven states with a “substantial rural burden” — noting that it has more than 75 cases and 10 percent or more of diagnoses in rural areas. Public health researchers say the concentration of cases likely is due to several factors, including lack of access to health care.
Statewide, there are nearly 13,000 people living with HIV.
Many are on antiretroviral therapy, a drug regimen that allows HIV-infected people to live longer and reduces their risk of passing the virus to others.
But in rural parts of the state, it’s often more difficult for people to gain access to HIV testing and treatment, said Bill Powderly, director of the Washington University School of Medicine Institute for Public Health.
“Particularly in rural communities, access to care is uneven,” he said Friday at the 7th Annual Global Health & Infectious Disease Conference at Wash U. “You may have to go a long distance to find providers who are knowledgeable about HIV. If you’re poorer, that’s a challenge.”
People who don’t know they have HIV may also unknowingly spread the infection to others, creating a snowball effect.
In recent years, state officials say the number of people diagnosed with HIV in Missouri has jumped by more than 10 percent, from 486 new cases in 2013 to 517 in 2016, the most recent data available.
The CDC has identified 13 Missouri counties at risk of an HIV or hepatitis C outbreak. Many are in the south central part of the state.
They include Bates, Cedar, St. Francois, Hickory, Wayne, Ozark, Wright, Iron, Madison, Reynolds, Ripley, Crawford and Washington counties.
Trends in HIV infections: Who is most at risk?
Besides geographic differences in HIV diagnoses, the distribution of infections also is uneven across populations of people.
Those most at risk of contracting HIV are racial minorities and men who have sex with men, said Ericka Hayes, associate professor of pediatrics at Washington University School of Medicine.
Nationwide, African-Americans accounted for 43 percent of HIV diagnoses in 2017 but comprise only 13 percent of the U.S. population.
Latinos accounted for 26 percent of new HIV cases and 18 percent of the U.S. population.
One of the most alarming trends, said Hayes, is the high percentage of new HIV infections among adolescents and young adults of color.
About 1 in 5 new HIV diagnoses in the United States are young adults ages 13 to 24 — most of whom are African-American and Latino males.
The CDC estimates there are about 60,300 youth ages 13 to 24 are living with HIV nationwide, but half of them don’t know they’re infected.
That’s likely because many adolescents aren’t getting tested for HIV, Hayes said.
“It’s just not on their radar, they don’t perceive themselves to be at risk of getting HIV infection,” said Hayes, who also appeared Friday at the Global Health & Infectious Disease Conference.
To improve HIV screening and treatment among adolescents, she said, providers need to consider the needs of their patients.
“They can’t be taking three days off of work in a week to go to appointments,” Hayes said. “So why can we not consolidate that care, so we’re decreasing the barriers to them accessing what they need and ensuring that they get it?”
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