Ole Miss study maps county HIV prevention gaps across the South

Why the map matters in Oxford

A new University of Mississippi study is less about counting HIV cases than about showing where prevention starts to fail. For Lafayette County, that matters because the local safety net is narrow: the Lafayette County Health Department in Oxford is listed as an HIV, STI and viral hepatitis testing site, but it requires an appointment, and PrEP still depends on seeing a health care provider for a prescription.

That distinction matters in a county of about 59,843 people. If testing, prevention counseling and medication follow-up do not line up cleanly, residents can end up with a negative test but no clear next step, or with a diagnosis and no easy path to suppression. The study’s point is that gaps are not only about whether services exist, but whether they are accessible enough to keep people moving through care.

How the prevention gap index works

The research team built what it calls a Prevention Gap Index, or PGI, to compare the burden of HIV with the availability of key prevention and care tools. The index combines standardized HIV prevalence with standardized measures of PrEP utilization, viral suppression and the density of listed HIV testing locations, creating a county-by-county picture of where prevention resources may fall short of need.

That approach is important because a community can carry a heavy HIV burden and still have too few testing sites, too little PrEP use or too many people falling out of treatment. Precious Patrick Edet, an instructional assistant professor of public health, said the team wanted to understand “not just where HIV is most common, but where need and prevention resources are out of balance.” Ruaa Al Juboori described the index as a county scorecard that compares how many people are living with HIV against the prevention and care resources available around them.

The study covered 877 counties across the nine Deep South states of Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas. Across that region, testing site density averaged 7.40 per 100,000 people, and the mean PGI was 0.01, showing that the overall picture hides sharp local variation from county to county.

What the numbers say about Mississippi and the South

The broader Southern context is stark. The South accounted for nearly half of estimated new HIV infections in the United States in 2022, and Mississippi carried the third-highest rate of new HIV infections in the nation, behind Washington, D.C. and Georgia. In other words, the region is already the center of the epidemic, and Mississippi remains one of the places where prevention and care have the most work to do.

CDC estimates that 11,900 people are living with HIV in Mississippi. In 2022, 82.7% of Mississippians with HIV knew their status, but only 33.6% of people with diagnosed HIV were virally suppressed, far below the national suppression level of 65.1%. That gap tells a story beyond diagnosis: too many people are finding out they have HIV but not staying connected closely enough to treatment to bring the virus under control.

The state’s prevention pipeline shows the same tension. CDC-funded HIV testing programs in Mississippi identified 3,021 people eligible for PrEP in 2022, while CDC awarded $6.7 million in fiscal year 2024 to health departments and community-based organizations in the state for HIV prevention and care, including $1.9 million in Ending the HIV Epidemic funding. Those dollars matter, but the study suggests they need to be placed where the county-level gaps are widest, not just where the numbers are easiest to see.

Where the gaps are most likely to hit hardest

The PGI was not randomly distributed. It was positively associated with the percentage of non-Hispanic Black residents and negatively associated with income, social association measures and some college education, reinforcing the role of structural inequality in HIV risk and service gaps. The study also points to the same forces the CDC names nationally: stigma, poverty and limited access to high-quality health care.

That means the counties most likely to score high on the gap index are not simply places with more HIV. They are places where fewer resources, weaker social infrastructure and deeper inequities make it harder to test early, start PrEP, stay on treatment and reach viral suppression. The public health lesson is that HIV prevention is tied to the strength of local systems, not just individual behavior.

The index also proved useful in a practical way. Among counties with available new-diagnosis data, PGI correlated with diagnoses at Spearman rho of 0.51 and classified high-diagnosis counties well, with an AUC of 0.819. In plain terms, the scorecard tracked real HIV burden closely enough to help guide where education, outreach, testing and treatment investments should go next.

What Lafayette County residents can use now

For people in Lafayette County, the clearest starting point is the county health department in Oxford. Mississippi State Department of Health says HIV testing is available at any county health department and through partnerships with clinics, correctional facilities, academic institutions and community-based organizations, which means the county office is only one piece of a wider network.

PrEP is a separate step. The state’s PrEP guidance directs HIV-negative people to talk with a health care provider about a prescription, so a negative test alone does not finish the job. For someone trying to avoid a gap between testing and prevention, that means asking immediately what comes after the test, where follow-up happens and how quickly a provider can be reached if the result is negative and PrEP is the next goal.

Residents trying to navigate local prevention can think in three steps:

• Get tested through the Lafayette County Health Department or another county health department.
• If HIV-negative and at risk, ask a provider about PrEP right away.
• Make sure there is a plan for follow-up care, because prevention only works when people can stay connected to services.

What local leaders should take from the study

The study gives Mississippi and county leaders a more precise tool than raw case counts alone. It shows where testing sites are thin, where PrEP use may lag and where viral suppression is weakest, which is exactly the kind of map needed to direct outreach and treatment dollars more effectively.

For Lafayette County and neighboring Mississippi counties, that could mean more deliberate testing access, stronger links from testing to PrEP prescriptions and better support for keeping people in care after diagnosis. The new index does not replace local clinics or public health departments; it shows where they need reinforcement most, and that is the difference between a paper network and a system residents can actually use.