Schedule:
Friday, January 17, 2025
Grand Ballroom C, Level 2 (Sheraton Grand Seattle)
* noted as presenting author
Justin McDaniel, PhD, Associate Professor of Public Health, Southern Illinois University at Carbondale, Carbondale, IL
Heather Graham, Graduate Research Assistant, The University of Alabama School of Counseling Education, Tuscaloosa, AL
Ellen Robertson, PhD, Project Director, University of Alabama, School of Political Science, AL
Julianne Wallace, Assistant Professor, School of Human Sciences, Southern Illinois University, Carbondale, IL, USA., Carbondale, IL
Shanna McIntosh, Project Director, The University of Alabama School od Political Science, Tuscaloosa, AL
David Albright, PhD, University Distinguished Research Professor & Hill Crest Foundation Endowed Chair in Mental Health Research, University of Alabama, Tuscaloosa, AL
Background and Purpose: Decades after the identification of the human immunodeficiency virus, new diagnoses are disproportionately concentrated in U.S. Deep South states like Alabama. In Alabama specifically, rates of transmission in rural regions of the state are so elevated that Alabama has been identified as one of seven U.S. states prioritized for targeted HIV prevention and intervention research and funding. Although poorly understood, existing research points to the formation of HIV transmission "hotspots" associated with social and structural factors. However, gaps remain in understanding factors contributing to their creation, particularly in the rural Deep South. This study aims to address this gap by examining the associations between social and county-level determinants of health and the prevalence of HIV hotspots in Alabama, utilizing geospatial analytic techniques and Medicaid utilization data.
Methods: This cross-sectional study utilized Medicaid utilization data from all 67 counties in Alabama. Administrative claims data from 2016 to 2020 were analyzed to identify individuals with HIV, and various area-level variables were examined, including educational attainment, poverty levels, and urbanicity. Geospatial analysis techniques, including choropleth mapping and local indicators of spatial association, were employed to identify and characterize geographic hotspots of HIV transmission.
Findings: Eleven counties were identified with HIV rates exceeding 100 per 100,000 adult Medicaid recipients, three of which were identified as hotspots. Hotspots were identified in rural regions of the state and were significantly associated with lower educational attainment and less severe poverty compared to other areas in the state.
Conclusion and Implications: Findings contribute to the ongoing efforts to combat the HIV epidemic in the Deep South, particularly in rural regions of the state. Results deepen understanding of the relationship between social and structural determinants of health and the formation of HIV hotspots in Alabama. Results also highlight the need for collaborative interdisciplinary research between social work and public health to address social and structural determinants of health. These goals align with core social work values of social justice and equality.
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