HIV/AIDS and Variables Literature Review
Urban Populations
In 2006, the highest rate of HIV cases in Texas occurred in Harris, Dallas, Bexar, Travis and Tarrant counties, all of which are urban areas (Texas Department of State Health Services, 2010). Cities contain large population densities and concentrated groups of people, which can increase the chances of contracting a communicable disease. Many people live, work, and socialize in urban areas, and the movement of people can easily spread HIV/AIDS in cities. Poverty in urban areas can often lead to informal settlements, where health status is often compromised due to poor sanitation and nutrition. Vulnerable groups living in cities and towns include vulnerable children, young men and women, and the unemployed (The World Bank, 2010).
Race/Ethnicity
In 2006, African Americans made up 43% of HIV case reports, a staggering 54.2 cases per 100,000, making the rate five times higher than for Whites or Hispanics. The rate for Whites in Texas in 2006 was 8.9 cases per 100,000 and 9.5 per 100,000 for Hispanics (Texas Department of State Health Services, 2010). Blacks comprised the biggest percentage of diagnoses of HIV infection among youths and teens, ages 13-24 years, in 37 of the 50 states from 2005-2008 (CDC: HIV Surveillance in Adolescents and Young Adults). In 2008, 17% of youths and teens with HIV infections were Hispanic or White, while a shocking 64% were Black (CDC, 2011). In 2008, HIV infection rates among ages 13-19 years were highest in Mississippi (18.1 per 100,000), Georgia (17.6 per 100,000), Louisiana (17.0 per 100,000), and Florida (16.3 per 100,000), all states that have high percentages of Blacks. It is safe to say that Blacks have been disproportionally affected by the HIV pandemic.
Level of Education
When the pandemic first made its appearance in the 1980’s, many studies found a direct positive correlation between level of education and HIV/AIDS rates. Children between the ages of 15-24 were termed as the “window of hope,” where education could prevent the spread of HIV (Kim, 2006). The World Bank (2010) considers education to be a huge preventative of youths and teens from contracting HIV and AIDS. Research shows that HIV prevention information education reduces vulnerability of risky activities, such as unsafe sex, which in turn could cause a decrease in rates. Yet, much of the research conducted on the rate of HIV/AIDS among youths and teens and level of education has not established a causal link between the two. Many believe that education will develop personal value systems that will facilitate self-protection, promoting behaviors that will lower the risk (Kim, 2006). In 2002, the World Bank stated that education affects long term behavioral change and protects against HIV infection, particularly for women (Kim, 2006). Many believe that schools provide an environment in which the students are better able to protect themselves. Evidence from the 1990’s suggested that higher education is correlated with higher rates of HIV/AIDS. Current evidence is showing that more highly educated people are protecting themselves more than less educated people. This is becoming a greater concern for Texas which currently ranks 25th in the country for teens not in school and not high school graduates and 21st for teens not attending school and not working (Sessions, 2007).
Socioeconomic Factors
Socioeconomic factors are very important as well. Low income families often are poorly educated and are more likely than others to engage in crime and drug use. Disease control can be challenging in counties with low income families, due to a lack of development of public health infrastructure. Low income families are more likely to have problems paying for HIV testing and antiretroviral medication.
From 1995-2004, Texas had the largest percentage of uninsured children in the United States in terms of private and public insurance (Annie E. Casey Foundation, 2010; Center for Public Policy Priorities, 2010). As of 2010, Texas had an astounding 23% of children living in poverty, compared with the national rate at 18%, giving Texas the seventh highest child poverty rate in the nation. Children living in poverty are more likely to have less access to healthcare and little, if any, insurance to cover health costs, due to the income status of the parent(s) or guardian(s).
Single-parent households are common in Texas and other states in America. Texas ranks 29th in the nation in percentage of children living in single-parent families (Sessions, 2007). Single-parents are often overextended with care giving responsibilities, working to provide income, managing household duties, and, in most cases, having little or no time to promote family functioning. This can lead the children of these single-parent households to feel isolated and often vulnerable, becoming more at risk of engaging in risky behaviors such as unsafe sex and illicit drug use. Research shows that teenagers living without biological fathers are more likely to experience problems with sexual health and are more likely to become teenage parents (Civitas, 2002). Single-parent households are more likely to lack parental supervision and guidance, something that many argue can lead to youths and teens contracting HIV at an early age. Single-parent households also have fewer income-earners in the home, which is a huge contributor to children living in poverty.
Unsafe Sex
Unsafe sex among youths and teens is a common occurrence. Sex-education programs have been implemented worldwide, yet STDs and teen births are increasing. Studies have shown that those with STDs are at a higher risk of contracting HIV/AIDS (CDC, 2008). For example, chlamydia has been associated with increasing HIV infection, and as of 2007, chlamydia rates in Texas rose to 365 cases per 100,000 (CDC, 2010). Research shows that education on STD’s can be successful in reducing the number of sexual partners, delaying first sexual encounters, reducing the risk of getting pregnant, reducing HIV infection risks, and, in general, promoting good decision making in terms of relationships and sexual behavior. However, Texas does not require sex education in schools, and when taught, the state must follow federal definition of abstinence-only education (CDC, 2007).
As of July 2010, Texas ranked 48th in the country for teen birth rates, certainly a concern for the state (Associated Press, 2010). Some argue that the federal abstinence-only education actually increases the likelihood of teen pregnancies because they are illogical in today’s modern world. Authorized by the United States Congress in 1997 and finished in 2007, a national study concluded that the abstinence-only sex education has no significant correlation with keeping teens from having sex and engaging in sexual activity, nor does it increase or decrease condom usage if they do have sex (Sessions, 2007). When engaging in sexual activities, the chance of contracting STDs increases as well as the possibility of becoming pregnant, even when using protection. Abstinence is the only way to guarantee a clean sexual health status, but it is apparent that teens are engaging more in sexual activities, so preventative measures should be employed. Studies have also shown that only 40% of teen mothers in Texas graduate from high school, therefore education on safe-sex practices should be considered to increase the percentages of teen mothers who complete high school as education is the key to the future for teen mothers as well as their children (Texas Freedom Network, 2010).
Description and Explanation of the Geography of HIV/AIDS in Youths and Teens in Texas
The highest rates of HIV/AIDS appeared in Dallas, Harris, Jefferson, Houston, Throckmorton, Anderson, and Gregg counties, which are all urban counties that include metropolitan cities. Refer to Figure 1. All four of these counties are shown in the highest quintile. They are located in the eastern region of Texas and HIV/AIDS rates among these counties varied between 402-985 cases per 100,000.
Cases for relatively high rates, ranging from 224-402 cases per 100,000 occur in the south, east, and north regions of Texas. In the south, counties with high HIV/AIDS rates include Willacy, La Salle, Kinney, and Bexar, which have no close proximity to any of the four counties that have the highest rates. In the east, counties with relatively high rates include Travis (located near Bexar County), Colorado (next to Austin and Waller counties), Waller (borders Harris), Grimes (borders Waller), Walker (borders Grimes), Cherokee (borders Anderson and proximity to Houston and Gregg), San Augustine (in proximity to Houston), Wharton (borders Ft. Bend), Ft. Bend (borders Harris), Robertson (vicinity to Anderson), Angelina (borders Houston), Lamar (vicinity to Dallas), Collin (borders Dallas), Travis (vicinity to Bexar), Galveston (borders Harris), and Marion (borders Gregg). In the north counties with relatively high rates include Sherman, Potter, and Carson counties. In the north central region counties with relatively high rates include Tarrant (borders Dallas) and Throckmorton (in proximity to Tarrant). These counties for the most part bordered a county that had the same rate or a moderate rate and were in proximity to a major city or one of the four counties with the highest rates.
Cases for moderate rates (range from 125-224 cases per 100,000) consist of 54 counties and location varies and includes regions in the west, northwest, south along the border, east, northeast, and north central Texas. These counties for the most part bordered a county that had the same rate or higher and were in proximity to a major city or one of the four counties with the highest rates.