Spatial Clustering of HIV Prevalence in Atlanta, Georgia and Population Characteristics Associated with Case Concentrations
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We assessed prevalent HIV cases in Atlanta to examine case distribution trends and population characteristics at the census tract level that may be associated with clustering effects. We calculated cluster characteristics (area and internal HIV prevalence) via Kuldorff's spatial scan method. Subsequent logistic regression analyses were performed to analyze sociodemographics associated with inclusion in a cluster. Organizations offering voluntary HIV testing and counseling services were identified and we assessed average travel time to access these services. One large cluster centralized in downtown Atlanta was identified that contains 60% of prevalent HIV cases. The prevalence rate within the cluster was 1.34% compared to 0.32% outside the cluster. Clustered tracts were associated with higher levels of poverty (OR = 1.19), lower density of multi-racial residents (OR = 1.85), injection drug use (OR = 1.99), men having sex with men (OR = 3.01), and men having sex with men and IV drug use (OR = 1.6). Forty-two percent (N = 11) of identified HIV service providers in Atlanta are located in the cluster with an average travel time of 13 minutes via car to access these services (SD = 9.24). The HIV epidemic in Atlanta is concentrated in one large cluster characterized by poverty, men who have sex with men (MSM), and IV drug usage. Prevention efforts targeted to the population living in this area as well as efforts to address the specific needs of these populations may be most beneficial in curtailing the epidemic within the identified cluster.
KeywordsHIV/AIDS HIV prevalence Spatial cluster detection Geographic mapping
We thank Jennifer Taussig, Richard Dunville, and the HIV Epidemiology Unit at the Georgia Department of Community Health for assistance with data preparation. We also thank Emily McCollum for her valuable assistance reviewing the manuscript. Special thanks to our partner agencies for their support of this study including AID Atlanta, National AIDS Education and Services for Minorities (NAESM), SisterLove, Someone Cares, and Stand, Inc.
Sources of Support
This study was supported by the Emory Center for AIDS Research (P30 AI050409), Global Health Institute, the Emory Vaccine Center (U19 AI057266), and the Emory HIV/AIDS Clinical Trials Unit (U01 AI069418).
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