1242. Defining the Rural and Urban HIV Epidemic in South Carolina
Session: Oral Abstract Session: HIV: Detection, Linkage, and Utilization
Saturday, October 5, 2013: 11:30 AM
Room: The Moscone Center: 250-262
Background: The HIV/AIDS epidemic in the U.S has shifted to the South where a large portion of the infected population lives in the rural areas. This epidemiologic characterization adds to the existing literature because it uses a rural urban commuting area (RUCA)-based definition of rural instead of the customary county-based definitions, it is population-based including individuals who are not-in-care and,  is updated with individuals diagnosed after the revised CDC 2006 HIV testing guidelines.

Methods: The South Carolina (SC) enhanced HIV/AIDS Reporting System (eHARS) and geocoding data were linked to determine rural or urban residence for all HIV-infected individuals newly diagnosed between 1/1/2005 -12/31/2010. SC state law requires reporting of all CD4 cells and HIV viral load (VL) values which are maintained in eHARS.  Each individual was assigned a rural or urban status using the RUCA definition of urban areas.  Descriptive and bivariate statistics were used to compare socio-demographic data, CD4 count and VL at diagnosis, and time to AIDS diagnosis between rural and urban populations.

Results: There were 4667 residents of SC newly diagnosed with HIV from 1/1/2005 to 12/31/2010. Of these 72.3% were male and 27.1% of the new diagnoses occurred in residents of rural areas. In rural areas, individuals newly diagnosed with HIV were more likely to be female compared with urban areas (30.6% vs. 26.6%, p= .0061); and to have contracted HIV through heterosexual contact (30.2% vs. 22.9%, p= .0001). Individuals residing in rural areas were more likely than urban residents to have AIDS at diagnosis or within 1 year of diagnosis (46% vs 40.8%, p=0.06). There were more African American (AA) HIV-infected individuals overall (71.3%) but whereas AA were more likely to be urban residents, Caucasians were likely to be rural residents (p<0.001).

Conclusion: In SC 27% of the new HIV diagnoses occur in residents of rural areas. The late stage at diagnosis in rural residents suggests long periods of infection leading to increased risk of transmission to uninfected sexual and drug-using partners.  More research and targeted interventions are needed to improve awareness and earlier HIV diagnosis for rural residents so that these individuals can benefit from treatment as prevention.

Babatunde Edun, MD1, Rishi Chakraborty, Ph.D.1, Wayne Duffus, MD, PhD2, Kirk Shull3, Terri Stephens, MPH4 and Sharon Weissman, MD5, (1)University of South Carolina, Columbia, SC, (2)Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, (3)Department of Health and Environmental Control South Carolina, Columbia, SC, (4)SC Department of Health & Environment Control, Columbia, SC, (5)Medicine, University of South Carolina, Columbia, SC


B. Edun, None

R. Chakraborty, None

W. Duffus, None

K. Shull, None

T. Stephens, None

S. Weissman, None

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