Introduction to the Special Section on Geography

After 30 years HIV has killed more than 500,000 Americans and millions of people worldwide and remains an incurable infection. Prevention efforts and treatment advances have helped reduce new infections and allowed people with HIV to live longer, healthier lives. But, like HIV itself, these advances have not been uniformly experienced by different race/ethnic groups or peoples. In fact, the HIV disease burden in certain places and among certain peoples resembles the African HIV crisis.

In 2011, more than 1.1 million people are living with HIV in the U.S., and approximately one in five of those (21%) are unaware of their infections. African Americans face the most severe burden of HIV/AIDS in the United States. While comprising approximately 14 percent of the U.S. population, they account for 46% of people living with HIV in the U.S. and 45% of new infections.  Today, the most infections are among people under 30, but HIV does not affect all groups uniformly. The rate of new HIV infections for Black men is about 6 times as high as that of White men, and about 3 times that of Hispanic men. The HIV incidence rate for Black women is nearly 15 times as high as that of White women, and nearly 4 times that of Hispanic women. Among Hispanics, the rate of new HIV infections among men is more than double that of White men and the rate among women is nearly 4 times that of white women.

Unfortunately, far too many Americans underestimate their risk of infection or believe HIV is no longer a serious health threat. That is why the work by these 4 young scholars is so refreshing.

Jonathan Rodriguez, examining HIV among the Texas population aged 25-49, concludes that significant correlations exist between HIV/AIDS and unemployment, education, and race/ethnic groups. Djenabou Barry’s paper similarly confirms the importance of socioeconomic variables and race/ethnicity as risk determinants of breast cancer mortality. Meagan Hatton, examining HIV rate among youths and teens, ages 13-24 concludes that higher HIV/AIDS rates occur in counties with high percent Black population, high percent urban population, high chlamydia rates, high percentage of people with a bachelor’s degree or higher, and high percentage of single-parent households.

Jessie Ho, examining pediatric and maternal HIV in Texas Border Counties and Urban Areas concluded that although the Texas border counties have much lower rates of HIV than do the urban areas, such as Dallas Fort-Worth Metroplex and Houston, females in border counties have the youngest age at HIV diagnosis, and much higher pediatric HIV rates. Jessie’s work clearly confirms that poor access to HIV screening and treatment, as pervades the Texas Colonias, imperils not only poor women, but their unborn children as well. Jessie’s excellent paper was a regional finalist in the Young Epidemiology Scholarship competition.

Altogether these papers have one simple message–the distribution of diseases such as HIV and breast cancer is not uniform, nor is it random. Vulnerability to disease is inevitably tied to specific places.  Socioeconomic characteristics of place including access to health care are important determinants of risk and vulnerability. In terms of disease and health, it matters where you live.