Georgia is a south-eastern state in the United States, having a population of 10,519,475 in 2018. It is the south's second-most populous state. The largest group of people in the state is Whites (52%), followed by African-Americans (31%) and Hispanics/Latinos (9.8%). In 2018, the state had reportedly 54,600 people living with HIV (PLWH) with over 2500 new diagnoses that year. The state has repeatedly featured within the top ten list of US states having the highest rate of HIV diagnoses within the past ten years.
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The Centers for Disease Control and Prevention (CDC) reported that about 1 in 51 Georgians may be diagnosed with HIV some time in their life, which is quite concerning, especially if compared to other states like North Dakota where 1 in 670 people are expected to have HIV. Although the state comprises just 3.1% of the entire US populace, as per the year 2014 data, nearly 6.4%of all new HIV diagnoses and over 5% of PLWH were in Georgia.
Moreover, around 19% of PLWH are unaware of their status. Approximately 23% of Georgians were diagnosed with AIDS within three months of getting diagnosed with HIV in 2018. This results from late testing, as the patients harbored the virus for a very long period and did not receive appropriate treatment to prevent deterioration of their immune system.
CDC recommends that HIV testing be part of routine health care for every individual between 13 and 64. High-risk individuals must get tested once a year, as per the National HIV/AIDS Strategy (NHAS). Furthermore, pregnant women must get tested for HIV and STDs on their first prenatal visit, and ideally, repeat screening should be performed in the third trimester.
The government of Georgia has declared public health as its primary priority. In 2013, the state announced Universal Health Care Program (UHC), and in 2014 it approved a promising 2014-2020 State Concept of Health Care System of Georgia for UHC and Quality Control for the Protection of Patient's Rights. The state has acknowledged HIV/AIDS as one of the high-priority communicable diseases. The general spending on health care has also increased considerably over the years. For instance, from 4% in 2008, the funding was increased to 7% in 2014. With the Universal Health Program's introduction, the state's budgetary allocation increased substantially, recording around a 9% increase in 2016.
The Georgia Integrated HIV Prevention and Care Plan is developed to identify HIV prevention and care needs, barriers to testing, existing resources, jurisdictional gaps, and outlines of productive strategies to address the issues.
The plan aligns with the NHAS goals and utilizes the intent and principles of the HIV Care Continuum for needs assessment and service delivery. The three key areas of focus under this plan include enabling statewide coordination for needs assessment, integrating HIV Prevention and Care Plan, and monitoring the implementation and results of the prevention and care strategies.
Furthermore, the State of Georgia provides care and treatment services to poor, uninsured, and high-risk populations through Ryan White Part B. It is funded by the Health Resources and Services Administration (HRSA). CDC also supports prevention efforts for 157 out of 159 counties in Georgia and 16 out of 18 Public Health Districts.
CDC funds prevention programs in DeKalb and Fulton Counties, administered by the Fulton County Department of Health and Wellness. Moreover, the City of Atlanta Jurisdictional HIV Prevention Planning Group (JPPG) is responsible for offering recommendations for the High Impact HIV Prevention Program (HIPP) for Fulton County.
The Ryan White Part B Program provides funding for essential medical and supportive services for PLWH or AIDS across the state's 16 health districts. It also manages the Georgia AIDS Drug Assistance Program (ADAP) and the Health Insurance Continuation Program (HICP).
Furthermore, Ryan White Part B funds are used to educate the health care professionals and the general public about HIV/AIDS, the significance of early diagnoses, and monitoring of medical care and case management services quality.
The state's HIV testing program is developed and coordinated by the Georgia HIPP, providing training and capacity building opportunities to community partners and public health staff. Routine HIV testing is offered at all health clinic locations, and patients are encouraged to start preexposure prophylaxis (PrEP), which can prevent the risk of HIV transmission by 99%.
Georgia ranks number 3 in HIV risk and fourth for new HIV diagnoses in the US, according to a study from Health Testing Centers using the data from CDC. The state also has the highest rate of new diagnoses in the south-eastern US, with 30 people/100,000 diagnosed with HIV. One in six PLWH in the state is unaware of their condition, which increases the risk transmission to others tremendously, claims the Georgia Department of Public Health.
According to AIDSVu, the US South comprises more than half of all new HIV diagnoses, while in 2016, Georgia had approx. 51,350 PLWH. There were over 1,500 cases in Fulton County, and in DeKalb County, over 1,200 cases per 100,000 people were reported.
The situation worsened by 2018 as that year, nearly 55,000 people in Georgia were living with HIV, with over 2500 new diagnoses reported that year. Medical experts claim that factors like social stigma surrounding HIV testing and lackluster expansion of programs like the Medicaid program that would offer comprehensive health coverage to low-income people are the primary factors behind such an alarming increase.
In 2017, there were around 2,698 new diagnoses of HIV in the state, at a rate of 31.2/100,000 people aged 13 and above. In Georgia state, the rate of HIV diagnoses is the highest among males (over 75%) in comparison to females (24.2%). In 2016, around 68.5% PLWH were African-Americans, 7% were Hispanics/Latinos, and 19% were white.
The proportion of HIV infection rate across different ethnic groups in Georgia hasn't changed much over the years as in 2018, the infection rate for Blacks was 68%, 7.5% for Hispanics, and 18% for whites.
As per the year 2018 statistics, people between 45 and 54 years and senior citizens (people aged 55 or above) accounted for the largest share of HIV infection rates across all age groups, with 26% and 27.5% PLWH, respectively. The infection rate in people between ages 13 and 24 and adults between ages 25-44 was relatively low, with 4% and 20.9%, respectively.
Atlanta and the metro area are the worst affected regions in Georgia. Atlanta's HIV diagnosis rate was around eight times higher than the national average. Lack of health insurance, poverty, insufficient sex education, and stigma surrounding HIV has contributed greatly to intensifying the HIV crisis. The LGBTQ community is among the high-risk groups of people as their families have shunned them, and most of them end up on the street.
In many urban areas, these issues are commonplace. Still, it is particularly entrenched in Atlanta, where the virus is disproportionately impacting the African-American population, particularly MSM (men who have sex with men). The rate of black males living with HIV in Atlanta is five times higher than white males and 15 times higher for Black females than white females.
In 2018, around 71% of the total deaths reported among PLWH were males and 29% females. Out of these, 68% were African-Americans, 21% whites, and 3.6% were Hispanics/Latinos. Age-wise, the mortality rate was highest for people aged between 45-55 and above 55 years.