HIV Epidemic Similarities Between South Africa and Appalachia

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Although they are on opposite sides of the world, Appalachia and Sub-Saharan Africa share HIV similarities when it comes to stigma, geographic isolation and limited resource. However, their regional differences mean each area must be approached differently, according to the results of a project by the Community Education Group, an organization that provides healthcare resources to combat disease in underserved populations in Appalachia. The results were presented in July at the International AIDS 2024 Conference in Munich, Germany.

This project explored the connection between the high volume of HIV cases in Africa and Appalachia. It also explained how HIV was reduced using telemedicine and community outreach and how to maintain these successes going forward.

The Appalachian region consists of 14 states. It includes all of West Virginia and portions of Alabama, Georgia, Kentucky, North Carolina, Maryland, Mississippi, New York, Ohio, Pennsylvania, South Carolina, Tennessee and Virginia. Nearly 20% of residents in these areas live in poverty and almost 18% do not have internet access when compared with the rest of rural America, according to the Appalachian Regional Commission.

In Appalachia in 2022, there were 35,000 people with HIV. Five of the top 10 states with the highest HIV rates are in this region. Those states are Georgia, Mississippi, Maryland, South Carolina and North Carolina. A major contributor to HIV is these areas is injectable drugs. In Cabell County, West Virginia there was a 450% increase in cases and in Kanawha County, West Virginia there was a 110.7% increase.

In Africa in 2022, 25.6 million people were living with HIV with an estimated 20.9 million people receiving antiretroviral therapy.

The project approached each region differently and found that in Africa, telemedicine was the most effective tool to increase treatment adherence and HIV prevention. Treatment adherence improved by approximately 30% and patient follow up care improved 40% from using telemedicine.

Appalachian populations found that the deployment of community healthcare workers was the most beneficial approach because it led to a 25% increase in testing rates and a 20% increase of linkage to care within first year.

Future programs in these regions should continue to follow these pathways. In Africa, telemedicine access should be expanded to more rural areas and include features such as virtual reality consultations. In Appalachia, residents may benefit from even more community healthcare workers. Services could expand to encompass other diseases such as viral hepatitis and opioid addiction.

“The effectiveness of integrating technology and personal outreach in HIV/AIDS interventions underscores the need for continued innovation and community involvement in health strategies,” co-authors A. Toni Young and Kelli Keith, M.P.H., write in the abstract. "Future efforts should focus on expanding successful models, increasing community-led initiatives, and fostering global partnerships to address common challenges.”