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This study from South Carolina shows that HIV prevalence is notably higher among Black individuals, and those living in urban areas face a slightly greater risk of contracting the infection.

The spread of sexually transmitted infections (STIs) has increased dramatically over the past 10 years, reaching an all-time high in 2019. STIs are not distributed equally among ethnic or racial groups, with minority populations at greater risk. There are also striking ethnic and racial disparities in HIV prevalence. HIV incidence rates are eight times higher in Black populations than in White populations. 

These disparities have much to do with existing social and structural inequities. A study published in the Journal of Community Health aimed to explore this divide among people of various racial groups based on whether they live in urban or rural areas. Understanding this divide is vital to HIV prevention.

Significant Ethnical and Rural/Urban Divide in HIV Incidence

This study was conducted using Medicaid claims data from South Carolina. For the purpose of the study, investigators used data for the previous 2 fiscal years. They included all individuals with at least one Medicaid claim during the study period. The study mainly focused on chlamydia, gonorrhea, syphilis, and HIV claims.

Data analysis revealed that the total prevalence of HIV was 0.8%, and the average age of HIV patients was 45.8, which was much higher compared to those diagnosed with other STDs. Thus, for example, the average age of patients diagnosed with gonorrhea was 22.4 years. There was not any significant difference between the genders, with HIV slightly more likely to be diagnosed in women. 

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Of all the patients included in the study, 42.6% were Black. However, 56.4% of all those diagnosed were Black individuals, whereas this rate was just 8.2% in non-Hispanic White patients. In the study, 66.6% of patients were residents of urban areas. However, 69.1% of all those diagnosed with HIV were from urban areas. This confirms that those living in urban areas were more likely to be diagnosed with HIV.

The Bottom Line

To prevent HIV, it is vital to understand the urban/rural and racial divide. This is possibly the most up-to-date study on the topic in the southern states. The study confirmed a significantly higher incidence of HIV in Black people and found that those living in urban areas were at slightly greater risk of contracting HIV infection. One limitation of the study was that it used claims data, which may underestimate prevalence rates due to provider uncertainty of diagnoses prior to further testing. The data also contained large amounts of missing race/ethnicity data, which limited the number of race/ethnicity categories.



Giannouchos, T. V., Crouch, E., Merrell, M. A., Brown, M. J., Harrison, S. E., & Pearson, W. S. (2022). Racial, ethnic, and Rural/Urban disparities in HIV and sexually transmitted infections in South Carolina. Journal of Community Health, 48(1), 152–159. https://doi.org/10.1007/s10900-022-01165-6