Mostly True
HIV/AIDS is "dramatically on the rise in the U.S. South."

Elton John on Tuesday, October 13th, 2015 in CNN

Elton John right: South focus of HIV alarm

A scene from the documentary deepsouth shows a candlelight vigil at an annual HIV retreat in rural Louisiana. Many of the people living with HIV/AIDS in the South are very poor. Fear of being ostracized keeps some away from the care they need.

Celebrity just keeps elbowing its way into the 2016 presidential race.

It could be argued that it started with Donald Trump. The man known best to many Americans as the star of the long-running "Apprentice" reality TV show jumped into the presidential race in June and into first place in the crowded field of Republican contenders.

And it continued last week in advance of the first Democratic debate. That’s when CNN decided to ask some of the rich and famous what question they’d like to put to candidates Hillary Clinton, Bernie Sanders, Martin O’Malley, Jim Webb and Lincoln Chafee.

Celebrities Katy Perry and Margaret Cho said they’d pose questions about LGBT rights and the abortion/Planned Parenthood funding flap. Other headliners said they would press the candidates on the hot-button issues of gun control, jobs for the middle class and medical marijuana.

Atlanta’s own part-time celebrity-in-residence --  Sir Elton John -- said his question to the candidates would be about his personal passion, the fight against HIV/AIDS.

"In spite of great progress, HIV/AIDS is actually dramatically on the rise in the U.S. South. What would you do as president to help stop this epidemic, particularly among minority communities?" John said he’d ask.

According to the Centers for Disease Control and Prevention in Atlanta, about 1.2 million Americans are living with HIV, and about 12.8 percent of them don’t know they’re infected.

HIV/AIDS didn’t wind up a discussion point in the first Democratic debate. But PolitiFact Georgia decided John had a point worth checking.

Is HIV/AIDS dramatically on the rise in the South?

We began our fact-check by contacting the Elton John AIDS Foundation in New York City, asking for evidence backing up John’s statement. The foundation was quick to respond, sending us, among other things, a link to a story that appeared in The Washington Post in September 2014 under the headline "Southern States are now epicenter of HIV/AIDS in the U.S."

The article quoted Rainey Campbell, then-executive director of the nonprofit Southern AIDS Coalition, as saying Southern states now have the highest rates of new HIV diagnoses, the largest percentage of people living with the disease and the most people dying from it.

The foundation also sent a link to a report by the Southern HIV/AIDS Strategy Initiative (SASI) from November 2012, examining HIV epidemiology in the South using 2010 data from the CDC and other government agencies.

The report focused on nine states in the South that were identified as "particularly affected by HIV"  -- Georgia, Alabama, Florida, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas.

The targeted states had the highest rates of HIV diagnoses in the United States -- 23.8 per 100,000 -- according to the CDC data, the report found. The South, the report said, makes up a third of the country’s population, but is home to more than half of the new HIV diagnoses.

Nine of the 10 metropolitan areas with the highest HIV incidence rates, and seven of the 10 with the highest AIDS incidence rates, were in the targeted states, according to the report.

We decided to check in ourselves with the Atlanta-based CDC to see if we could learn more.

Ranking regions by the rate of new HIV diagnoses, the South is highest with 24,323 new cases, or a ratio of 20.5 per 100,00 population, based on the latest data available from 2013.

Next highest is the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont), with 8,908 new HIV diagnoses, or 15.9 per 100,000 population.

The West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming) is next with 8,013 new diagnoses, or 10.8 per 100,000 population.

And the last is the Midwest (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota and Wisconsin) with 6,109 new diagnosis, 9 per 100,000 population, according to the CDC.

So clearly the South has a big problem.

But we still weren’t sure whether any of this proved that HIV/AIDS was rising dramatically in the South. Couldn’t it be that other regions are doing a better job with education/treatment? Nic Carlisle, executive director of the Southern AIDS Coalition, said it’s likely "a combination of both."

The most recent CDC surveillance report shows the country was making moderate progress until 2011, when the number of new diagnosis started moving in the wrong direction again -- with only the West showing a decrease in 2012-2013, Carlisle said.

The increases were 3.4 percent in the Midwest, 3.2 percent in the Northeast, but substantially greater -- 7.5 percent for the South in 2012-2013, he said.

"True, we’ve have made remarkable progress in addressing the HIV epidemic in the United States. Treatment advances have transformed what was once a fatal diagnosis into a chronic disease for many," Carlisle said.

"Unfortunately, while the rest of the country reaps the benefits of this progress, the South is in danger of being left behind."

Even the Obama administration recognizes the need to stem the widening HIV-related health disparities that plague the South. In its update to the National HIV/AIDS Strategy (NHAS), the administration set a goal of reducing disparities in the rate of new diagnoses by at least 15 percent among persons living in the Southern United States, Carlisle said.

Patrick Sullivan, a professor at Emory University’s Rollins School of Public Health who has spent much of his career on HIV/AIDS research, said it’s true that the Southern U.S. is disproportionately impacted by HIV.

The increases in new diagnoses in the South are occurring only in specific subgroups, Sullivan said.  

"When we look more specifically at HIV diagnoses among young, 13-24 year old, gay, bisexual, and other men who have sex with men (MSM) in the South, the story is different: according to CDC data, there was a 25 percent increase in new HIV diagnoses in young gay men in the South between 2008 and 2013. For epidemiologists, this is indeed a dramatic increase," he said.

"Finally, even when considering the lack of increases in HIV diagnoses in the South overall, it’s important to note that new HIV infections and new HIV diagnoses in the U.S. have both been stubbornly stable at around 45,000 to 50,000 cases each year," Sullivan said. "And in this context, the lack of substantial decreases in new HIV infections is also a dramatic public health problem."

The Elton John AIDS Foundation has made 31 grants worth a combined $1.4 million aimed at addressing the South's HIV/AIDS epidemic.

These includes grants worth $315,000 given out earlier this year, in partnership with The Elizabeth Taylor AIDS Foundation, to six organizations. The Equality Foundation of Georgia and the Racial Justice Action Center, both in Atlanta, were among the latest grant recipients

Our ruling

CDC data support the claim of superstar and part-time Atlanta resident Elton John that the South is the region most dramatically affected by the HIV epidemic. Whether that’s because cases are rising in the South or declining in other regions, or a combination of both, is not entirely a clear. Data from 2012-13 shows new HIV diagnoses on the rise in most parts of the country, with the largest -- a 7.5 percent increase -- in the South.   

John’s overarching point is that the South has seen an increase in AIDS/HIV, greater than any other region in the nation.  The data supports that.

You can quibble about whether there is enough of a trend line to term this a dramatic jump in cases. That takes his statement down a notch on the Truth-O-Meter.

We rate John’s statement Mostly True.