The ongoing monitoring and control of infectious diseases such as HIV and syphilis remain critical public health priorities due to their substantial impact on individual health and broader society. These infections can lead to chronic illness, disability, and even death if left untreated, and their transmission can be influenced by a complex interplay of behavioral, social, and economic factors.

Shelby County has long been recognized as a region with a significant burden of HIV, even prior to the recent surge in cases. In 2018, approximately 6,716 individuals were living with HIV in Memphis Shelby County, with a disproportionate number among African Americans (87%) and males (69%). This pre-existing high prevalence underscores a historical vulnerability within the county.

Further emphasizing the severity of the situation, the Memphis Transitional Grant Area (TGA), which includes Shelby County, now holds the second-highest ranking nationally for the rate of new HIV infections among all metropolitan statistical areas in the United States, surpassed only by Miami, Florida. This alarming statistic highlights a concerning shift in the local HIV epidemic.  

Problem Statement: Recent data and reports indicate a concerning increase in the incidence of both HIV and syphilis within Shelby County. Since 2018, Shelby County has experienced a 36% increase in HIV rates, with an even more alarming 40% rise among individuals aged 15 to 19 years old between 2018 and 2023. Simultaneously, syphilis rates in Shelby County have surged by over 100% since 2018, with an even more dramatic increase of over 150% among the 15 to 19-year-old demographic during the same period. The magnitude of the increase in syphilis, particularly among adolescents, presents a significant public health challenge.

Significance of the Study: To identify the extent and underlying causes of this recent escalation in HIV and syphilis cases is paramount for informing effective public health interventions and guiding the strategic allocation of resources within Shelby County. Untreated syphilis can lead to severe long-term health complications, including neurological and cardiovascular damage, and can also increase the risk of HIV transmission. Furthermore, the rise in syphilis cases raises the risk of congenital syphilis, a condition that can have devastating consequences for newborns. Therefore, a thorough analysis of the epidemiological trends and contributing factors is crucial for developing targeted strategies to mitigate the impact of these epidemics.

Report Objectives: This report aims to provide a comprehensive epidemiological analysis of the current HIV and syphilis situation in Shelby County. The primary objectives include: quantifying the recent increases in HIV and syphilis incidence, particularly within the past year; investigating the potential reasons for these increases, including the impact of funding changes and socio-cultural factors; comparing the trends in Shelby County with regional and national data to provide context; and formulating evidence-based public health recommendations to address these escalating epidemics.

Epidemiological Analysis of HIV in Shelby County

Recent Trends in HIV Incidence: Examining the most recent data on new HIV infections in Shelby County reveals a complex and somewhat contradictory picture. According to Tennessee Department of Health Commissioner Dr. Ralph Alvarado, as reported in an article updated in September 2024, the number of newly diagnosed HIV infections in Shelby County decreased from 358 in 2022 to 329 in 2023.

This suggests a potential downward trend in overall new infections. However, this statement stands in contrast to earlier public releases from the department. Furthermore, preliminary data from the Tennessee Department of Health indicate a concerning trend within a specific age group: the infection rate for individuals aged 15 to 19 in Shelby County increased by approximately 50% from 2022 to 2023.

This substantial rise among teenagers contradicts the reported overall decrease and highlights a critical area of concern. Moreover, rates of new HIV cases among young people aged 15 to 24 years old in Shelby County are more than five times higher than the national average for the same age group. As of late 2023 or early 2024, approximately 7,500 people were living with HIV in Shelby County , indicating a significant ongoing burden of the virus within the community. The conflicting data regarding overall new infections versus the sharp increase in teenagers underscores the need for careful interpretation and further investigation into the specific dynamics of the epidemic within different age groups in Shelby County.

Long Term HIV trend in Shelby County

Looking beyond the most recent year, the longer-term trends for HIV in Shelby County paint a consistently concerning picture. Since 2018, the county has experienced a 36% increase in HIV rates. This sustained upward trajectory over several years establishes a clear pattern of increasing HIV incidence in the region. According to the Tennessee Department of Health, Shelby County has the highest rate of new HIV cases in the entire country , solidifying its designation as a national HIV “hotspot.”

In 2018, the number of people living with HIV in Memphis Shelby County was approximately 6,716. Comparing this to the current estimate of 7,500 suggests a continued rise in the overall prevalence of HIV in the county. Notably, in 2022, a significant proportion of all new HIV diagnoses in Tennessee (39%) occurred in Shelby County , highlighting the disproportionate impact of the HIV epidemic on this region within the state. These longer-term trends indicate a persistent and worsening HIV epidemic in Shelby County, demanding sustained and intensified public health efforts.

Demographic Breakdown of HIV Cases

The demographic breakdown of HIV cases in Shelby County reveals particularly alarming trends among younger individuals. Between 2018 and 2023, HIV rates among 15 to 19-year-olds in the county increased by a staggering 40%. This substantial rise in HIV among teenagers is a critical public health concern.

Furthermore, in 2018, new HIV rates among individuals aged 15 to 19 and 20 to 24 were already three times higher in Shelby County compared to other cities. This disparity has since worsened, with rates of new HIV cases among 15 to 24-year-olds in Shelby County now being more than five times higher than the national average for the same age group.

In 2018, the majority of people living with HIV in Shelby County were African Americans (87%) and males (69%). While more recent comprehensive demographic data is not readily available in the provided snippets, a 2022 overview indicates that 71.6% of HIV cases in Shelby County were among males and 80.7% were among Black individuals, with 338 new diagnoses in that year.

\This data confirms the continued disproportionate impact of the HIV epidemic on these demographic groups. The stark increase in HIV among teenagers and the persistent racial disparities underscore the urgent need for targeted prevention and intervention strategies.

• Table 1: Summary of HIV Rate Changes in Shelby County

Epidemiological Analysis of Syphilis in Shelby County

Recent Trends in Syphilis Incidence

Data indicates a concerning upward trend in syphilis infections within Shelby County in recent times. The Shelby County Health Department has observed an increase in recent syphilis infections, particularly among individuals aged 14 to 35.

Furthermore, estimates from the Tennessee Department of Health reveal that syphilis rates in Shelby County have more than doubled, increasing by over 100% since 2018. The situation is particularly severe among teenagers, with syphilis rates in the 15 to 19-year-old age group showing an alarming increase of over 150% between 2018 and 2023.

This exponential rise in syphilis incidence, especially within the adolescent population, signifies a significant public health crisis in Shelby County.

Longer-Term Syphilis Trends: The dramatic increase in syphilis rates in Shelby County is not a recent phenomenon but rather the continuation of a concerning longer-term trend. As previously mentioned, syphilis rates have more than doubled since 2018.

This substantial and sustained increase over the past six years underscores the severity of the syphilis epidemic in the county. Regional data for the Memphis Metropolitan Statistical Area (MSA) also reflects this trend, with recent 5-year data showing increases in the incidence rates of several STIs, including syphilis. Notably, the Memphis MSA consistently experiences higher STI incidence rates compared to the U.S. MSA total.

Data from 2019 indicated that the Shelby region already had the highest rate of reported cases of total syphilis in Tennessee, with 99.1 cases per 100,000 population. Even further back, in 2003, Shelby County’s rate of primary and secondary syphilis (8.4 cases per 100,000 population) was already 3.4 times the U.S. rate (2.5 cases per 100,000 population). This historical context reveals a long-standing challenge in controlling syphilis within Shelby County, with the recent surge representing a significant worsening of an existing problem. 

Demographic Breakdown of Syphilis Cases: Similar to the trends observed with HIV, the demographic breakdown of syphilis cases in Shelby County highlights a particularly concerning rise among younger individuals. As noted earlier, syphilis rates among 15 to 19-year-olds have increased by over 150% between 2018 and 2023.

The increase is also significant among individuals aged 14 to 35 , indicating a broad impact across young and middle adulthood. Historical data from 2003 revealed a significant racial disparity in primary and secondary syphilis rates in Shelby County, with the rate among Black individuals being 11.7 times that of White individuals.

While more recent comprehensive demographic data for syphilis in Shelby County is not explicitly available in the provided snippets, this historical disparity likely persists and warrants consideration in current public health responses. The dramatic increase in syphilis among teenagers, coupled with the historical racial disparities, underscores the need for targeted and equitable interventions. 

Table 2: Summary of Syphilis Rate Changes in Shelby County

Factors Contributing to the Increase of HIV

Impact of Funding Cuts: The Shelby County Health Department faced a significant setback when it forfeited over $3 million in federal HIV prevention funding over the past five years due to unspent funds. These funds, provided by the Centers for Disease Control and Prevention (CDC), could have been utilized for essential activities such as HIV testing, hiring public health personnel, and conducting contact tracing – all crucial components in controlling the spread of both HIV and syphilis.

Furthermore, Tennessee Governor Bill Lee announced a decision to forgo all future CDC HIV prevention funding, a move widely interpreted as politically motivated. While the state has subsequently allocated its own funding for HIV prevention efforts, including $1.7 million for Shelby County this year, with $885,000 spent so far , the loss of federal funding and the transition to state funding could have created disruptions and reduced the overall resources available for combating these epidemics.

Tennessee Department of Health Commissioner Dr. Ralph Alvarado attributed the unspent federal funds to understaffing at the Shelby County Health Department and bureaucratic hurdles within the CDC. This suggests systemic issues that may have hampered the health department’s ability to effectively utilize available resources for STI prevention and control.

Additionally, community-based organizations like Friends for Life reportedly feared losing significant funding (around $1.5 million) due to the state’s decision , which could further weaken the local response to the rising rates of HIV and syphilis. The reduction in federal funding and the potential instability caused by the state’s decision likely contributed to a diminished capacity for prevention, testing, and outreach efforts, thereby facilitating the increase in both HIV and syphilis cases.

Role of Sexual Health Education and Awareness: The importance of sexual health education and awareness in preventing the spread of HIV and other sexually transmitted infections cannot be overstated. A local news report highlighted the necessity of advocating for increased awareness, testing, and comprehensive sex education to reduce HIV infections in Shelby County, particularly among young people aged 15 to 24.

The alarming rise in both HIV and syphilis within this age group strongly suggests that there may be significant gaps or inadequacies in the sexual health education provided to young people in the county. The Daily also pointed to stigma surrounding STIs and limited sex education as contributing factors to the increase in teen HIV cases in Shelby County, mentioning bias against condoms and the influence of dating apps as potential elements in the spread.

These factors are also highly relevant to the transmission of syphilis. Insufficient or ineffective sexual health education can lead to a lack of knowledge about transmission risks, prevention methods, and the importance of regular STD/STI testing, potentially contributing to increased risky sexual behaviors and the subsequent rise in HIV and syphilis infections.

Cultural and Social Factors: Broader cultural and social factors play a significant role in shaping sexual health behaviors and influencing the transmission of STIs. The CDC’s 2023 STI Surveillance Report emphasizes that social inequity often leads to health inequity, manifesting as disparities in STI rates, with adolescents and young adults, men who have sex with men (MSM), and racial and ethnic minority populations being disproportionately affected. These national trends likely have parallels in Shelby County.

A 2016-2018 report on HIV and STIs in Memphis indicated that male-to-male sexual contact was the most frequently reported transmission risk among individuals diagnosed with primary and secondary syphilis in Tennessee during that period , highlighting the importance of targeted prevention efforts for this population. Furthermore, research has shown a strong link between HIV and syphilis co-infection, particularly among MSM in Shelby County, with individuals diagnosed with syphilis being at a significantly higher risk of subsequently acquiring HIV.

This interconnectedness suggests that an increase in syphilis cases could potentially fuel the HIV epidemic, and vice versa. Factors such as socioeconomic disparities, stigma associated with STIs, prevailing social norms around sexual behavior, and the characteristics of sexual networks within the community all likely contribute to the complex dynamics of the HIV and syphilis epidemics in Shelby County.

Impact of COVID-19 Pandemic: The COVID-19 pandemic has also likely played a role in the increase of HIV and syphilis cases in Shelby County. A spokesperson for the Tennessee Department of Health noted that the lingering impact of the pandemic over the past four years led to the reassignment of sexual health workers, limiting HIV investigations funded by grants. This disruption in public health services likely also affected efforts to control syphilis.

The CDC’s 2019 STI Surveillance Report highlighted that the pandemic exposed weaknesses in public health preparedness and resulted in adjustments to resource allocation within health departments, potentially impacting STI testing and prevention services. Reduced access to healthcare facilities, clinic closures, and the diversion of public health resources to address the COVID-19 pandemic likely led to a decrease in STI screenings, delayed diagnoses, and interruptions in prevention programs, creating conditions that could facilitate the increased transmission of HIV and syphilis. 

Comparison with Regional and National Data

Comparing the HIV and syphilis rates in Shelby County with those at the state and national levels underscores the severity of the situation. Rates of new HIV cases among young people aged 15 to 24 years in Shelby County are more than five times higher than the national average for the same age group.

In 2022, the HIV prevalence rate per 100,000 population in Shelby County (901) was significantly higher than in Tennessee (324) and the Southern United States (466), and the rate of new HIV diagnoses was also elevated in Shelby County (45) compared to the state (14) and the region (18). Similarly, in 2022, the syphilis rate per 100,000 population in Shelby County (901) was substantially higher than in Tennessee (324) and the South (466).

The national ranking of the Memphis TGA in terms of new HIV infections has worsened significantly, moving from 8th in 2018 to 2nd currently. Historical data from 2003 already indicated that Shelby County’s syphilis rate was 3.4 times the U.S. rate , and in 2019, the Shelby region had the highest syphilis rate in Tennessee. These comparisons clearly demonstrate that Shelby County is facing an HIV and syphilis epidemic that is significantly more severe than both state and national averages, with its national standing for HIV incidence showing a concerning decline. 

Public Health Implications and Recommendations

Implications of Rising Rates: The rising rates of HIV and syphilis in Shelby County have significant public health implications. An increased pool of infected individuals, particularly if unaware of their status or not receiving adequate treatment, elevates the potential for further HIV transmission within the community. Untreated syphilis poses serious health risks, including neurological and cardiovascular complications, and also increases the likelihood of HIV transmission.

The alarming rise in syphilis also increases the risk of congenital syphilis, which can lead to severe health problems or even death in newborns. The increased incidence of these infections will undoubtedly place a greater strain on the local healthcare system and public health resources in Shelby County, demanding more testing, treatment, and care services. Furthermore, these epidemics carry broader social and economic costs, including lost productivity, increased healthcare expenditures, and a negative impact on overall community well-being.

Evidence-Based Recommendations: To effectively address the escalating HIV and syphilis epidemics in Shelby County, a comprehensive and evidence-based public health response is urgently needed. This response should include:

• • Increased Funding and Resource Allocation: A significant increase in local and state funding must be allocated to HIV and syphilis prevention, testing, treatment, and outreach programs in Shelby County, especially to compensate for the loss of federal funds. These resources should be strategically directed towards evidence-based interventions and tailored to meet the specific needs of the most affected populations.
  • Enhanced Sexual Health Education: Comprehensive and age-appropriate sexual health education must be implemented in all schools and community settings within Shelby County. This education should address the stigma surrounding STIs, promote safe sex practices, including consistent and correct condom use, increase awareness about HIV and syphilis transmission and prevention, and emphasize the importance of regular testing.
  • Expanded Access to Testing and Treatment: Access to free, confidential, and easily available HIV and syphilis testing sites should be significantly expanded throughout Shelby County. This includes increasing the number of fixed testing locations, deploying mobile testing units to reach underserved communities, conducting community-based testing events, and actively promoting the availability of free in-home HIV test kits. Individuals diagnosed with HIV or syphilis must be promptly linked to effective treatment and care services, including partner notification to prevent further transmission.
  • Targeted Interventions for High-Risk Populations: Culturally competent and tailored prevention and outreach programs should be developed and implemented specifically for adolescents and young adults, as well as other disproportionately affected communities such as African Americans and MSM. These programs should address the unique risk factors and social determinants of health within these communities.
  • Strengthening Public Health Infrastructure: Addressing the issues of understaffing and bureaucratic hurdles within the Shelby County Health Department is crucial to enhance its capacity for effective disease surveillance, investigation (including robust contact tracing efforts), and the efficient utilization of available resources for STI control.
  • Community Engagement and Collaboration: Strong collaborations must be fostered and strengthened between the Shelby County Health Department, community-based organizations, healthcare providers (including hospitals and clinics), faith-based organizations, and community leaders to develop and implement a coordinated and comprehensive response to the rising rates of HIV and syphilis.
  • Reconsideration and Expansion of Opt-Out Testing Policies: The Shelby County Health Department’s proposed “opt-out” HIV testing policy in hospitals should be fully implemented and its potential expansion to other healthcare settings, such as primary care clinics and emergency departments, should be actively explored. Implementing routine screening policies for syphilis in appropriate settings should also be considered as a strategy to increase early detection and treatment.
  • Data Monitoring and Evaluation: Robust systems for the continuous monitoring of HIV and syphilis incidence and prevalence rates in Shelby County must be established, along with rigorous evaluation of the effectiveness of all implemented interventions. This data-driven approach is essential for adapting strategies and ensuring that resources are allocated efficiently to the most impactful programs.

Conclusion

The epidemiological data presented in this report clearly indicates a significant and concerning rise in the rates of both HIV and syphilis in Shelby County, with a particularly alarming increase observed among teenagers and young adults. The contributing factors to this surge are multifaceted, likely involving the loss of crucial federal funding for HIV prevention, potential shortcomings in sexual health education and awareness within the community, and broader socio-cultural influences, possibly compounded by the disruptions caused by the COVID-19 pandemic.

The comparison with regional and national data underscores the severity of the situation in Shelby County, highlighting its status as a national epicenter for these epidemics. Addressing this escalating public health crisis demands an urgent, comprehensive, and adequately funded response. It is imperative that public health officials, policymakers, healthcare providers, community organizations, and individual residents of Shelby County work collaboratively and commit to implementing evidence-based strategies to reverse these dangerous trends and protect the health and well-being of the community.