For all the problems public health officials in Baton Rouge and New Orleans encounter in combating high rates of HIV/AIDS, new research shows that pulling down the disease's rates in rural Louisiana could be even more difficult.
While Louisiana as a whole has seen a decline in the number of new HIV infections, the number of new infections has risen slightly in rural Louisiana. Also, people newly diagnosed with the disease in rural parts of the state are more likely to have seen its effects escalate to an AIDS diagnosis.
A new study from the HIV advocacy group Heroes, based in the north Louisiana town of Columbia in Caldwell Parish, tracks the disparities between HIV in metropolitan areas and rural areas of the state.
Linda Meredith, the Heroes research and development director who wrote the report, argues that Louisiana is fighting two separate HIV epidemics in its cities and less populated areas.
When Ernesto Finales heard in 2013 about a once-a-day pill that could prevent him from acqui…
Baton Rouge and New Orleans consistently rank in the top three cities nationwide for the highest HIV and AIDS rates per capita.
The Heroes report compares HIV statistics in those two cities against the rural, northeastern corner of the state that covers Caldwell, Ouachita, Richland, Tensas and other parishes.
Rural regions throughout the state account for more than 15 percent of Louisiana's HIV and AIDS cases, Meredith's research shows, using data from the most recent years available. Louisiana cannot solve its HIV epidemic without focusing on those regions, she said.
"Thirty-plus years into the epidemic and still, the stats in the rural areas are about the same or primarily worse," said Monica Johnson, the founder and executive director of Heroes. "Nobody was ever able to take a look at it like this."
Twenty-seven percent of people newly diagnosed with HIV in 2014 in the northeastern corner of the state had already progressed to an AIDS diagnosis, the report shows. Within a year of being diagnosed with HIV, the percentage of people who progressed to AIDS rose to 34 percent in that region.
Baton Rouge and New Orleans saw lower numbers in that respect, though they were still not stellar. In Baton Rouge, 22 percent of people newly diagnosed with HIV had already progressed to AIDS, and 26 percent turned into AIDS diagnoses within a year. In New Orleans, 18 percent of new diagnoses had progressed to AIDS, while 23 percent reached AIDS within a year.
Scientific advances for HIV/AIDS have exploded in recent years, and doctors have new ways bo…
Health care resources for treating and preventing the spread of HIV are also harder to come by in rural areas, which makes detecting and treating HIV before it becomes AIDS even more difficult.
Only one health care provider in the northeastern corner of the state receives federal Ryan White funding to treat people with HIV and AIDS. The Baton Rouge area has at least four Ryan White providers, while the New Orleans region has six, according to the report.
A treatment called PrEP has been hailed by public health experts and HIV activists as a way to help prevent the spread of HIV. It greatly cuts the chances that someone who does not have the disease will acquire it, even if they are frequently having sex or sharing needles with someone who does have HIV.
Baton Rouge has four providers offering PrEP treatment, while New Orleans has 11, according to the report. But the northeastern part of the state has only one PrEP provider.
Both Johnson and Meredith cited a stigma about HIV that permeates rural communities and can make educating people about it a difficult task. Public health leaders in Baton Rouge have said stigma is one of their biggest challenges in fighting the disease.
But while the stigma may have slightly lessened in urban areas over the past few decades, Johnson said it has barely changed in the area where she works. Johnson has been HIV-positive for more than 30 years. She lost her son, Vaurice, when he was 3½ years old in 1993 as he battled complications from HIV.
The conflict between Mayor-President Sharon Weston Broome's office and the AIDS Healthcare F…
She recalled how she received phone calls telling her to leave town, how people would walk to the other side of the street when they saw her coming, and how schools tried to keep out her young son.
Decades later, some people are still afraid to be seen with her, fearing they may be perceived as having HIV.
"I've had clients who I've seen in my office, I've seen them in group before and they know me, but if they see me in a public setting like the mall, they would say they don't want me to speak to them," Johnson said.
Young people between ages 13 and 24 in 2015 made up the largest percentage of those newly diagnosed with the disease in the northeastern corner of the state. In Baton Rouge and New Orleans, the largest percentage of those being diagnosed in 2015 was between ages 25 and 34.
The state's northeastern corner also has a higher percentage of people living with HIV but not receiving care, the report shows. Thirty-one percent of the HIV population in that region were not receiving care in 2014.
On the other hand, 28 percent of people living with HIV in 2014 in New Orleans and 23 percent of those in Baton Rouge were not receiving care, the report says.
The prevalence of HIV/AIDS in the Baton Rouge area puts the disease at the forefront of publ…
Viral suppression — a means of reducing the virus or suppressing its strength — is also particularly important for HIV patients, as it makes them less likely to spread the disease to others and it makes those who have HIV healthier.
But just 51 percent of people in the northeastern corner of the state received such treatment in 2015, according to the report, compared with 59 percent of the HIV population in New Orleans and 58 percent in Baton Rouge.
Johnson and Meredith will distribute their report at the 2017 U.S. Conference on AIDS from Sept. 7 to 10 in Washington, D.C. They hope it may lead to solutions and lead people in other deep South states to conduct more research about HIV in rural areas.