Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

Abstract

Examining the current incidence rates of HIV and STIs among racial and ethnic minority and rural residents is crucial to inform and expand initiatives and outreach efforts to address disparities and minimize the health impact of these diseases. A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period (July 2019-June 2021) in South Carolina. Our main outcomes of interest were claims for chlamydia, gonorrhea, syphilis, and HIV. Any beneficiary with at least one claim for a relevant diagnosis throughout the study period was considered to have one of these diseases. Descriptive analyses and multivariable regression models were used to estimate the association between STIs, HIV, race and ethnicity, and rurality. Overall, 158,731 Medicaid beneficiaries had at least one medical claim during the study period. Most were female (86.6%), resided in urban areas (66.6%), and were of non-Hispanic Black race/ethnicity (42.6%). In total, 6.3% of beneficiaries had at least one encounter for chlamydia, 3.2% for gonorrhea, 0.5% for syphilis, and 0.8% for HIV. In multivariable models, chlamydia, gonorrhea, and HIV claims were significantly associated with non-Hispanic Black or other minority race/ethnicity compared to non-Hispanic white race/ethnicity. Rural residents were more likely to have a claim associated with chlamydia and gonorrhea compared to urban residents. The opposite was observed for syphilis and HIV. Providing updated evidence on disparities in STIs and HIV among racial/ethnic minority and rural populations in a southern state is essential for shaping state Medicaid policies to address health disparities.

Identifying the Need for and Availability of Evidence-Based Care for Sexually Transmitted Infections in Rural Primary Care Clinics

“…This study examines the supply-side characteristics related to providing STI and HIV testing and treatment services among rural primary care clinics in SC-a southern state with large populations of rural and racial and ethnic minoritized individuals. 19 The findings from this study, namely, that rural clinics have limited STI and HIV testing, especially for high-risk populations, are consistent with previous studies examining STI care in primary care settings. [11][12][13] Reducing the rural burden of STIs and HIV will require policy and practice-related decisions on resource allocation and public health prevention programming at state and local levels.…”

“…As a primary payer of STI services, which now total more than $16 billion in direct costs, the Medicaid program has an especially important role in addressing the STI epidemic. 19,24 Although a Medicaid nonexpansion state, SC provides family planning services-to include STI and HIV testing and treatmentto both men and women that meet income eligibility requirements. 25 However, prepandemic costs for STI testing among Medicaid participants in SC were found to be highest overall in emergency department settings.…”

“…Findings from this study may also facilitate policy decisions by state Medicaid agencies regarding STI testing and treatment services. As a primary payer of STI services, which now total more than $16 billion in direct costs, the Medicaid program has an especially important role in addressing the STI epidemic 19,24 . Although a Medicaid nonexpansion state, SC provides family planning services—to include STI and HIV testing and treatment—to both men and women that meet income eligibility requirements 25 .…”

“…18 South Carolina (SC) is a rural state that consistently ranks in the top 5 states in the United States for chlamydia and gonorrhea cases and has been identified as a state with substantial rural burden of HIV in the federal Ending the HIV Epidemic initiative. 19,20 Thus, the purpose of this study was to examine the need for, and availability of, health care services associated with STI and HIV care for high-risk rural populations in SC. Identifying and ultimately improving access to high-quality preventive and treatment services for STI and HIV in this state will inform practice and policy stakeholders across the US health care delivery system.…”

“…South Carolina (SC) is a rural state that consistently ranks in the top 5 states in the United States for chlamydia and gonorrhea cases and has been identified as a state with substantial rural burden of HIV in the federal Ending the HIV Epidemic initiative 19,20 . Thus, the purpose of this study was to examine the need for, and availability of, health care services associated with STI and HIV care for high-risk rural populations in SC.…”