This document provides a community profile of HIV/AIDS in Metro Atlanta, focusing on Fulton and Dekalb Counties. It identifies relevant geographic, demographic, and socioeconomic characteristics of the area. HIV prevalence and rates of STIs like chlamydia are significantly higher in these counties compared to national averages. African Americans and the LGBT community are disproportionately affected. The document analyzes how factors like poverty, lack of healthcare access, and stigma likely contribute to the high disease burden. It concludes that HIV/AIDS is one of the most pressing public health issues facing Metro Atlanta due to its complex risk factors.

1. 1
Community Portfolio of HIV/AIDS within
Atlanta, Georgia
Spring 2016
Akel, Mary
If any portion of this paper is used for reports or other publications, please use the following
reference: Akel, M. & Parrish, B. (2016). Community Profile of HIV/AIDS within Atlanta,
Georgia. Unpublished paper.

2. 2
Community Profile of Metro Atlanta, Fulton and Dekalb Counties, Georgia
Identification of Relevant Geographic Characteristics
The Atlanta Metropolitan Statistical Area (MSA) is a densely settled region that encompasses
over five million people across 28 Georgia Counties.1
Atlanta is one of the largest urban centers
in the Southeastern U.S. and a hub of African American culture.2-4
In the early 1900s, it became
home to several elite black colleges, the Civil Rights movement, and prosperous black middle
and upper classes.5
Atlanta’s geographical placement within the nation is notorious for its
religious undertones, socioeconomic trends, and unique cultural norms.6
These Southern
attributes along with the complexity of a racially diverse urban environment play a major role in
creating complex public health issues within the Metro Atlanta area.7
Identification of Relevant Demographic Characteristics
In 2014, the population of inner perimeter Atlanta was approximately 465,002.8
While gender
distribution is equally spread, Atlanta is racially unbalanced with 54% of the population
identified as African American, 38.4% as Caucasian, and 5.2% as Latino.8
Atlanta ranks 19th
among MSAs for percent of the population identified as LGBT and 9th
for number of same-sex
couples per 1,000 households.9
Furthermore, African Americans make up a higher proportion of
the LGBT population in the South compared to any other region of the US.10
These
demographics are both independently related and correlated with disproportionate health
burdens.11, 12
Identification of Relevant Socioeconomic Characteristics
The Metro Atlanta area is comprised of DeKalb and Fulton Counties. Among DeKalb and Fulton
County residents, 32% and 37%, respectively, live at or below 250 percent of the Federal
Poverty Level (FPL); additionally, 23% of DeKalb and 19% of Fulton County individuals are
uninsured.13
The unemployment rate for both counties in 2015 was 5.2%, slightly higher than the
national average of 4.8%, and a 2013 Census Report found 6,664 individuals living on the street
in the Metro Atlanta, DeKalb, and Fulton County areas combined.14, 15
Homeless individuals are
disproportionately more likely to be adult, African American men, a population that is also at
higher risk for poor health indicators and susceptibility to disease.16, 17

3. 3
Comparison of Characteristics to Surrounding Communities, State, and National Statistics
A socio-demographic comparison of Atlanta to both the surrounding state of Georgia and the rest
of the nation highlights significant differences in many areas. A higher proportion of Atlanta’s
population is below the FPL, unemployed, and uninsured compared to statewide and national
figures.8, 14
Furthermore, Georgia ranks 36th
in the nation for health care access, and
approximately 650,000 residents lack basic health resources in the Atlanta MSA alone.18
Racially
Atlanta is more diverse than the national population; over half of the Atlanta MSA identifies as
Black or African American in 2010 compared to just 12.6% nationwide.8
Identified Health Issues in Metro Atlanta
Community Health Status Indicators (CHSI) for 2012 recorded syphilis rates for both Fulton and
DeKalb Counties that were much higher than the national average.19, 20
Similar trends held true
for rates of gonorrhea in both counties, citing 329.8 per 100,000 persons in Fulton County and
266.9 per 100,000 persons in DeKalb County.19, 20
Most startling, however, is the rate of persons
living with diagnosed HIV in these areas. In 2011, Fulton County reported 1365.9 HIV
diagnoses per 100,000 persons and DeKalb County recorded 1203.8 per 100,000 persons
compared to a rate of 105.5 per 100,000 persons nationwide.19, 20
Pre-existing STIs as well as
income level are two factors that influence an individual’s risk of HIV infection.21, 22
Health Indicator #1: Pre-existing STI’s are proven to increase a person’s risk of HIV
infection.21, 23
The prevalence of chlamydia among DeKalb and Fulton County residents
in 2014 was 642.5 per 100,000 persons and 668.0 per 100,000 persons, respectively.24
Health Indicator #2: Income level reflects health care access, and lack of health resources
is a strong predictor of disease.22
The total percentage of Metro Atlanta residents living
below FPL between 2009-2013 was 25.0%. 8
Evaluation of Health Issues and Indicators Based on Detailed Characteristics
In 2013, Atlanta was one of the top five MSAs with the highest rates of HIV diagnoses.25
Both
Fulton and DeKalb Counties had HIV prevalence rates at least three times higher than the
statewide average in 2013.26
Georgia was also ranked 9th
among the 50 states for rates of
chlamydia infection.27
Chlamydia prevalence for DeKalb and Fulton Counties were even higher,
reporting at about 1.25 times the statewide statistic.24
The percentage of people living in poverty

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in the Atlanta MSA is higher than the 2014 national poverty rate of 14.8%, and African
American, LGBT individuals inhabit a significant proportion of the population relative to other
urban areas. 8, 9, 28
Men who have sex with other men (MSM) are more severely affected by
HIV/AIDS and other STIs compared to any other demographic group in the U.S.29
MSM who
identify with a marginalized racial group or occupy a lower economic status are at even higher
risk for poor health outcomes.30
Literature Supporting the Link Between Health Issues and Indicators
Pre-existing STI’s are proven to increase one’s risk for contracting HIV.23
STIs not only indicate
risky sexual behaviors, but are also proven to biologically alter a person’s risk of infection.21, 31
When left untreated, non-ulcerative STIs such as chlamydia and gonorrhea can significantly
increase risk of HIV infection and are most common among low-income individuals who have
little access to health insurance or clinical care. 21, 22, 32
Identify the Disease Most in Need of Attention in Metro Atlanta
The significant number of HIV risk factors affecting communities in the Atlanta MSA highlights
HIV/AIDS as one of the most urgent public health issues. Figure 1 shows that HIV prevalence
has steadily risen in this area over the last decade.33
Conclusion
Given its racial diversity, prevalent LGBT population, Southern ideology, and socioeconomic
disparities, Metro Atlanta faces complex public health burdens. However, the issue of HIV/AIDS
Figure 1. HIV Prevalence over time in Fulton County, GA
Source: Fulton County Task Force On HIV/Aids33

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can be met by targeting measurable indicators, namely pre-existing STIs and income level.
Epidemiology Profile of HIV/AIDS in Metro Atlanta, DeKalb and Fulton Counties, Georgia
Background on HIV/AIDS
HIV (Human Immunodeficiency Virus) originated when SIV (Simian Immunodeficiency Virus)
was transmitted across species from non-human primates. 34
The virus attacks specialized immune cells in the
human body, destroying them until they are no longer able to fight off further infections; this condition is commonly referred to as Acquired
Immunodeficiency Syndrome, or AIDS.35, 36
HIV is transmitted via mucous membrane contact with body fluids
of infected individuals, occurring most often during unprotected anal or vaginal sex.37, 38
HIV can
be asymptomatic or produce very generalized symptoms; as a result, diagnostic testing is the
only method of screening for the virus. 39, 40
Nearly a third of HIV transmissions occurred in 2012
because individuals were unaware of their status.41
Since 2005, HIV prevalence rates have
steadily declined nationwide; however, it remains one of the largest health burdens for the
African American community.42
While only 12% of the US population identifies as Black, this
demographic contributes to 44% of new HIV/AIDS diagnoses.42
Epidemiological Profile of HIV/AIDS in Metro Atlanta
Over half of those living with HIV in Atlanta identify as African American.43
The HIV rate
among African American males in Atlanta is 4.1 times greater than that of White males.44
This
disparity is even more pronounced among females with African American women experiencing
14.3 times the rate of HIV infection relative to White females.44
LGBT populations are also
disproportionately affected by high rates of infection.29
At the end of 2012, DeKalb and Fulton
Counties reported that 83.7% and 78.5% of HIV cases, respectively, among males were
attributed to MSM contact.45
A further examination of Atlanta by zip code shows that those areas
with highest HIV rates also have the highest percentages of people living in poverty.43
Description of HIV/AIDS Using Epidemiological Data
Incidence: The HIV incidence rate, defined as number of new diagnoses within a specific
period of time, in the Atlanta MSA was 42.5 per 100,000 persons for 2013.46
Prevalence: The rate of persons in 2012 living with HIV in the Atlanta MSA was 584.4
per 100,000.46
Morbidity: Comorbidities highly associated with HIV infection include susceptibility to

6. 6
other STIs such as gonorrhea, chlamydia, and syphilis.21, 23
In 2013, Metro Atlanta had a
chlamydia prevalence of 301/100,000 population, a gonorrhea rate of 99.9/100,000
population, and a syphilis rate of 14.5/100,000 population.47-49
Mortality: The number of males in Metro Atlanta who died in 2012 while living with a
diagnosed HIV infection was 14.2 per 100,000 persons.46
Among females, the number
was 4.8 per 100,000 persons.46
Comparison of Local Epidemiological Data to National, State, and Local Data
The national prevalence of HIV diagnosis in 2012 was estimated at 467 infections per 100,000
persons.41
Data from 2011 indicates that DeKalb and Fulton Counties individually had estimated
HIV prevalence rates of 1203.8 per 100,000 persons and 1365.9 per 100,000 persons,
respectively.19, 20
In 2014, approximately 27.4 new HIV diagnoses occurred per 100,000 in the
U.S. as a whole compared to 42.5 per 100,000 new diagnoses in the Atlanta MSA.46, 50
Additionally, the mortality rate for males in Atlanta living with diagnosed HIV was 1.5 times
that of the national statistic in 2013.46, 50
Visual Depiction of HIV/AIDS
The figure below illustrates the distribution of HIV diagnoses in the Atlanta MSA by race.43
HIV/AIDS disproportionately affects African Americans in Metro Atlanta and statewide.43
/
Impact of HIV/AIDS on Metro Atlanta
High rates of HIV infections can stunt economic growth by slowing or even reversing the labor
Source: Georgia Department of Public Health 43
Figure 2. Distribution of HIV Diagnoses by Race in Metro Atlanta, 2011

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supply as well as dwindling long-term investments as a result of increased HIV/AIDS health
expenditures.51
The greatest burden of HIV/AIDS may also selectively affect low-income
populations, further halting economic growth and deepening poverty in these areas.51
High rates
of HIV coupled with a deficiency of widely available HIV screening programs and services has
led to increased mortality rates. Estimated survival times after a single AIDS-defining episode
can range from 3-51 months.52
However, it takes at least 8 to 10 years to develop AIDS after an
initial HIV infection.52
Atlanta in particular has a high percentage of late HIV diagnoses; in 2012,
29.4% of patients developed AIDS within the first 12 months of initial HIV diagnoses.44
Evidence Supporting Long Term Attention to HIV/AIDS
Currently, Atlanta is attempting to widen the availability of HIV screening. In 2013 Grady
Hospital became the first major health facility to offer routine testing to all ER patients
regardless of the reason for their visit.53
Additionally, the CDC allocated over 18 million dollars
to the Fulton County health department, colleges, and community organizations for HIV/AIDS
prevention and research.53
However, in order to address the issue of disproportionate health
burdens, both individual health behaviors and social determinants of health should be targeted.54
Previous public health strategies in this community described a period of two to three years to
see measurable behavior change.55
Possible Approaches to Address HIV/AIDS
From a behavioral standpoint, improved sexual education and awareness of HIV transmission
directly address common HIV risk behaviors. However the larger issues of poverty, lack of
widely available HIV screening and other health services, stigma, homophobia, and racial
discrimination are also important targets for decreasing HIV incidence among African
Americans in Metro Atlanta.54, 56
By using social cognitive theory, both personal factors and
environmental influences can be addressed to create measurable progress, particularly by
decreasing unprotected sex, increasing HIV screening, and increasing self-efficacy.
Conclusion
Given the subtle biological pathogenesis of HIV/AIDS, high prevalence rates within Metro
Atlanta compared to national statistics, and disproportionate health burden on the African
American MSM community, HIV/AIDS in Atlanta is best addressed by targeting both individual

8. 8
behaviors and institutionalized social determinants of health.
Landscape Scan of HIV/AIDS in Metro Atlanta, Fulton and DeKalb Counties, Georgia
Community Awareness of HIV/AIDS
The ongoing HIV epidemic in the Southeastern U.S., particularly in Atlanta, has attracted
monthly coverage from news outlets like The Washington Post and National Public Radio as
well as a responsive influx of organizations working to address HIV/AIDS related issues.57-59
In
Atlanta alone, approximately fifteen separate organizations are working to increase access to
HIV related resources and address barriers to health services. Most of these organizations, such
as AID Atlanta, MISTER (Men’s Information Services: Testing Empowerment Resources),
NAESM (National AIDS Education & Services for Minorities), and SisterLove, Inc., attempt to
provide basic HIV/AIDS and STI testing, primary care services, mental and emotional
counseling, and other instructional resources.60-63
Some programs directly target specific
populations such as gay and bisexual men, women of African descent, or underserved and
marginalized communities as a whole.61, 63-64
These organizations work not only to provide health
resources, but also ensure that infected individuals facilitate independent and productive lives by
providing occupational support like temporary housing, long-term housing placement, and job
placement. 65-67
Of the HIV/AIDS related non-profit enterprises in Metro Atlanta, about 25%
focus specifically on providing transitional and long-term housing services for those affected.62,
65-67
In addition to community-based HIV/AID efforts, social awareness activities and
government funded programs have also bolstered the movement. In 2014, the Fulton County
Board of Commissioners created a special task force that addressed individuals’ access to
treatment, transportation, housing, prevention, and other issues as they relate to HIV/AIDS.68
Atlanta also hosts an annual AIDS Walk and 5K Run as well as the CDC National HIV
Prevention Conference and other health awareness events.69-71
Stakeholders Addressing HIV/AIDS in Metro Atlanta
Current stakeholders addressing the HIV epidemic in Atlanta include community-based profit
and non-profit organizations, local government committees and programs, and financial support
from both the CDC and the federal government.
Stakeholder Profile 1: AID Atlanta is a non-profit, community based organization (CBO)

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that was established in 1982 in response to rapidly rising HIV incidence rates among gay
and bisexual men in the Metro Atlanta area.60
In the last three decades, its target population
has expanded to include all those living with the infection, at risk for developing an
infection, or unaware of their HIV status.60, 72
The organization offers these individuals
medical services such as primary care and testing for both HIV and other STI’s, medication
assistance, behavioral and clinical prevention options, and housing services.73
Stakeholder Profile 2: The Fulton County Health Department has been working to address
increased HIV prevalence since 2012 when the CDC provided additional funding for
HIV/AIDS prevention and research.53, 74
In conjunction with this increased financial
support, Fulton County’s Department of Health and Wellness paired up with the Fulton
Communicable Disease Prevention Branch and developed a High Impact HIV Prevention
Program (HIPP), which outlined four main directives: 1) HIV testing in both healthcare and
non-healthcare settings, 2) HIV prevention interventions, 3) condom distribution, and 4)
policy initiatives.74
in 2014, the newly created Fulton County Task Force on HIV/AIDS
submitted a Strategy to End AIDS in Fulton County. The objectives outlines in this
Strategy closely mirrored those of the HIPP and the 2020 National HIV/AIDS Strategy
(NHAS). 33
Stakeholder Profile 3: Someone Cares Inc. of Atlanta (S1C) is a 501(c)3 non-profit
organization addressing the multi-faceting nature of HIV/AIDs by taking a holistic
approach.64
S1C not only runs an Early Detection Intervention Clinic that provides
screening procedures and PrEP treatment, but also educates and empowers at risk
populations, spearheads an anti-stigma campaign among African American MSM,
implements behavioral intervention programs, offers mental health services, and represents
a strong network of HIV/AIDS related community support.75
State and Local Initiatives to Address HIV/AIDS
Along with community stakeholders, state and local initiatives have been created to address
HIV/AIDS and related issues. The Fulton County Health Department is targeting HIV screening
availability, condom distribution, and legislative policies that align with HIV prevention
efforts.74
CBOs are working to decrease stigma, increase social support, and provide access to
resources, especially within marginalized populations.60, 75

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Initiative 1: Fulton County’s HIPP has increased condom distribution among at risk
populations in Fulton and DeKalb counties by 10% annually since 2013.74
In order to
increase the number of clinical and non-clinical sites offering condom distributions, Fulton
County made free condoms available, actively recruited enterprises that serve HIV-positive
persons and high risk negative persons, and developed campaigns to promote regular and
correct condom use.74
Initiative 2: On a state level, the Georgia Campaign for Adolescent Power & Potential
(GCAPP) is Working to Institutionalize Sex Education, or WISE.76
Aside from advocacy,
the WISE initiative helps school districts select sexual health curriculum, train teachers,
educate parents, and provides technical assistance with implementation of comprehensive
sexual education in elementary, middle, and high schools.76
Barriers to Addressing HIV/AIDS
Addressing the HIV/AIDS epidemic in Atlanta involves overcoming both physical barriers like
lack of widespread screening as well as underlying, social determinants such as racism,
discrimination, stigma, health inequity, poverty, cultural values, and disparities in education and
access to resources.77-79
These structural inequalities make certain at risk populations more likely
to engage in behaviors that lead to HIV infection and then less likely to receive diagnosis and
treatment of the disease.80
Evidence of Stakeholder Involvement in Addressing the Barriers
In 2015, the Fulton County Task Force on HIV/AIDS published a progress report for their
Strategy to End AIDS in Fulton County.81
In order to assess disease burden in the community,
identify barriers to HIV/AIDS treatment and prevention, and characterize the culture and
population that are most directly affected by the disease, the Task Force collected a variety of
data including surveys from communities within Metro Atlanta and records from ongoing
disease surveillance.81
AID Atlanta also actively participates in community engagement by
promoting participation in focus groups and research studies, both clinical and behavioral.82
Conclusion
While awareness about the HIV epidemic in Atlanta is increased and a number of community-
supported and government-funded programs are addressing the issue, the many cultural,

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structural, and clinical barriers to HIV emphasize the need for both smaller local and state
initiatives as well as larger, collaborative interventions that specifically target those populations
at high risk for the infection.
Cultural Analysis of HIV/AIDS in Metro Atlanta, DeKalb and Fulton Counties, GA
Data Collection Process Used to Identify Cultural Issues in Metro Atlanta
Data collection began with a simple Internet search to identify common cultural themes in the
Atlanta area, including religious attitudes, political ideology, and racial composition. From there,
Fulton and DeKalb County Health Department Websites and literature databases were utilized to
identify more specific resources, collect reliable data, and find cited literature on cultural issues
both within Metro Atlanta as well as in the Southeastern U.S. as a whole. The Pew Research
Center, CDC website, U.S. Census Bureau publications, local area news articles, and HIV/AIDS
CBO websites provided the bulk of cultural knowledge.
General Cultural Issues in Metro Atlanta
Due to its metropolitan nature and ethnically diverse population, Atlanta is a cultural melting pot.
However, this city is geographically located within the Deep South, a region of the U.S. with
unique cultural constructs, including political conservatism, rural poverty, racial discrimination,
and devout religious faith.83-85
The Southern U.S. houses over half of all members of Evangelical
Protestant Churches in the U.S.83
Despite its diversity, 76% of Atlanta residents identify as
Christian and 33% of those individuals align themselves specifically with Evangelical
Protestantism.86
A trend of social conservatism accompanies this religious presence and recent
polling indicates that within the metropolitan area 33% of individuals believe homosexuality
should be discouraged and 44% strongly oppose gay marriage.87
Additionally, census
information reveals that while over half of the nation’s black population lived in the Southern
U.S. in 2010, racial discrimination on both a personal and an institutional level are more
prominent in the Southern states than anywhere else in the country. 88-90
Cultural Issues Tied to HIV/AIDS
A historic background of two prominent cultural issues will allow us to explore HIV in Atlanta
on a deeper level.

12. 12
Historic Background of Ethnic Wealth Disparity: Wealth inequality in the U.S. peaked
during the Great Depression of 1989.91
Despite a sharp subsequent decline, the ethnic
wealth gap has steadily risen again over the past two decades, with the median wealth of
white households reaching 13 times that of African American households and 10 times
that of Latino households in 2013.91, 92
Income inequity reflects a similar trend; household
income among families of color fell by 9% from 2010 to 2013 compared to a 1%
decrease in income for non-Hispanic, White households. 93
Historic Background of Religious Faith: Georgia was one of the original thirteen colonies
to rebel again British rule in the Revolutionary War and quickly became known as a
“melting pot” due to it’s religious diversity.94
By the 1900s, the largest religious groups in
Atlanta were the Baptists and the Methodists, and Evangelicalism began to dominate the
religious stage.95, 96
The spectrum of religious diversity is much wider in present day
Atlanta due to an ethnically diverse population and changing views around religion in the
last decade; however, Evangelical Christians still make up a large proportion of the
surrounding population of Georgia, including less urban areas surrounding the city.97, 98
Primary Barriers to Addressing the Cultural Issues
HIV-related stigma is one of the largest barriers to treatment among both HIV-infected
individuals and the community at large.99
Stigma often stems from prejudice about
homosexuality and other socially unaccepted behaviors, such as having multiple sexual partners
and injection drug use.100, 101
Homosexuality is often even more of an issue in communities of
color where being gay is a sign of weakness and opposes traditional gender roles in both African
American and Latino populations. 102, 103
Institutionalized racism and the undervaluing of
communities of color also leads to a cycle of poverty among these populations, ever widening
the gap of ethnic wealth inequality.104, 105
Specific Example of Community Program to Address Cultural Issues
Someone Cares Inc. of Atlanta supports an ongoing Anti-Stigma Social Marketing and Outreach
Campaign tailored specifically for the African American MSM community. 106
Aside from
HIV/AIDS specific initiatives, state and regional organizations such as Georgia Equality, the
Southern Poverty Law Center, and Georgia NAACP are working to address cultural issues such

13. 13
as racial discrimination, homophobia, human rights, and ethnic disparities in income level. 107-109
Ability of Specific Members of Metro Atlanta to Address the Cultural Issues
Specific members of the Atlanta community spend their time addressing these cultural issues.
Elected Leader: The leader of cultural change in Atlanta is Dr. Carlos Del Rio, a
professor at Emory University’s School of Medicine. 108
Dr. Carlos leads both clinical
and public health efforts to address the spread of HIV/AIDS and the cultural issues that
exacerbate it.108
Community Leader: Other than the elected leader, community-based leadership falls to
Clinton E. Dye, Chair of the Fulton County Department of Health and Wellness. 109
Dye
is not only a native of Metro Atlanta, he’s also been an advocate for social change within
the community and dedicated his career to public service in the fields of social work,
mental health, and the Atlanta area Urban League.109
Organization: PFLAG Atlanta advocates for community support and understanding of
LGBT individuals and offers resources for understanding homosexuality in the context of
religious faith.110
Consumer: 23-year-old LaMar Yarborough is an Atlanta resident living with HIV. He’s a
community organizer and has been very vocal about his experience with the diagnoses,
citing the segregation of communities, both by color and by income class, as one reason
HIV awareness and prevention efforts aren’t actively practiced within high risk
populations. 111, 112
Advocate: Advocates of cultural change within Atlanta include NAACP Board Chairman
Horace Bond and Founder of Someone Cares Inc. of Atlanta, Ronnie E. Bass. 113, 114
Ways to Prepare Metro Atlanta to Address Cultural Issues
In order for Atlanta to move forward with addressing cultural issues, collaborative leadership
must take place.115
The piece of collaborative leadership that is most important in addressing the
HIV epidemic in Metro Atlanta is sharing power and influence.115
Local CBOs and governmental
agencies are progressively working to fight HIV/AIDs; however, unifying this network of
people, organizations, and communities is key to managing the AIDS epidemic.115

14. 14
Conclusion
After a thorough investigation, research indicates that religious conviction, racial discrimination,
ethnic income inequity, and social conservatism are influential cultural themes within Metro
Atlanta, many of which also affect the spread and prevention of HIV/AIDS within this
community.
Prevention and Community Health Profile of HIV/AIDS in Metro Atlanta, Georgia
Interventions and Programs
Evidence-Based Interventions Recognized as Efficacious in Addressing Health Indicators
Two health indicators strongly correlated with HIV incidence are pre-existing STIs and income
level.21, 22
Examples of STI interventions include Focus on Youth, Healthy Love, and Project
START, which target behaviors like correct condom use, healthy sexual relationships, and
regular screening among various populations.116
Interventions addressing income disparity are
much more varied since there are so many factors linked to poverty. One example, however, is
Career Academics, which offers courses to low-income high school students in order improve
academic standing and teach career/technical skills.117
A variety of other programs also work to
increase access to preventative screenings and medical services for underserved populations.118,
119
Evidence-Based Interventions Recognized as Efficacious in Addressing HIV/AIDS
HIV/AIDs related interventions span a wide range of target populations and address the disease
in multiple ways.120
Some focus on specific behavior changes while others tackle ideological
elements of the disease.120
The CDC is aggressively fighting HIV/AIDS through their High
Impact Prevention (HIP) initiative, which provides resources, materials, and funding for many
existing evidence-based interventions.120
Metro Atlanta Programs Addressing HIV/AIDS
Several evidence-based HIV/AIDS interventions and community-based programs are currently
implemented in the Atlanta MSA.
Evidence-Based Intervention 1: The Healthy Love Workshop (HLW) is an innovative
group-level program that targets behaviors like number of sexual partners, condom use,
and HIV/AIDS testing among Black women.121
HLW is currently implemented by

15. 15
SisterLove, Inc., a CBO addressing women’s AIDS and reproductive justice.121
Evidence-Based Intervention 2: Healthy Relationships (HR) is evidence-based
intervention implemented by AID Atlanta that targets HIV positive men and women.122
The program utilizes small group workshops to strengthen self-efficacy, develop coping
skills for HIV/AIDS related issues, and provide guidance for building and maintaining
healthy relationships with family members, loved ones, and romantic partners.122
Observed Effects of the Intervention on Addressing the Health Indicators and HIV/AIDS
HLW addresses the challenges that Black women face regarding STD transmission and the
HIV/AIDS epidemic.121
Intervention workshops discuss the risk of individual behaviors as well
as risk posed by the communities in which these women live and provide guidance on
overcoming barriers.121
HR addresses the importance of supportive social networks and
relationships and reduces stigma by helping HIV positive individuals cope and communicate
with loved ones about their disease status.123
Barriers to Current Program
HLW was specifically developed for African American women and HR focuses on those
individuals already identified as HIV positive.121, 124
While the populations targeted by HLW and
HR struggle with unmet needs, African American MSM presents one of the most at-risk and
underserved communities in the fight against HIV/AIDS.30
Furthermore, given the large
proportion of individuals unaware of their HIV status, public health programs should prioritize
prevention and awareness.41
Cultural ideologies within Atlanta present another barrier to
HIV/AIDS health; evangelical religious beliefs and social conservatism both directly and
indirectly affect health outcomes.78, 87
Identification of Additional Evidence-Based Intervention
Many Men, Many Voices, or 3MV, is an evidence-based intervention that targets HIV and STD
risk reduction among African American MSM.125
The intervention uses small group support and
educational modules to increase HIV knowledge and discuss the social determinants of
HIV/AIDS, namely racial discrimination, homophobia, and disease related stigma.125
Justification of Evidence-Based Intervention for Target Population: 3MV was
specifically designed for the African American MSM community.126
3MV addresses and
incorporates culturally specific barriers and issues. Furthermore, two trained members of

16. 16
the community lead group sessions.126
Organization Best Suited to Implement the New Intervention: Due to convenient
physical placement in the target community and extensive previous work with HIV/AIDS
related issues, AID Atlanta is the organization best suited to implement this
intervention.127
Previous successes include not only other evidence-based intervention
activities but also ongoing access to primary care resources and social support services.124
Budgeting and Program Plan
Proposed Intervention
The proposed intervention is a group level prevention program called Many Men, Many Voices
(3MV). 127
3MVaddresses both individual risk behaviors and social determinants that influence
health outcomes in the target population, namely cultural and religious norms, the relationship
between HIV and other STIs and STDs, racism and homophobia, and dynamics within sexual
and romantic relationships.127
Organizational Plan for 3MV
The executive director role for 3MV will be the existing executive director of AID Atlanta,
Nicole Roebuck. Roebuck will devote a small portion of her time to oversight of 3MV budgeting
operations, ensuring that all line items are accounted for and distributed according to the terms of
funding. The 3MV program manager will communicate with the executive director about all
financial decisions as well as coordinate with AID Atlanta staff, hire the two other program
employees, prepare intervention materials, maintain data collection, and oversee implementation.
The program coordinator and recruiter will play a dual role as group facilitators and will report to
the program manager.
Identification of SMART Goals and Objectives for 3MV
Objectives of 3MV include increased participant knowledge of HIV risk behaviors and
interaction between HIV and other STDs, enhanced self-efficacy in decreasing HIV risk
behaviors, and development of alternative behavioral options for sexually risky activities.126
Work Plan: Before the program begins, group facilitators will attend a 4-day, CDC
supported HIP training session.128, 129
After the training session, staff will begin recruiting
for the first intervention cycle by promoting the intervention to those utilizing AID

17. 17
Atlanta services as well as traveling off-site to at-risk neighborhoods in order to
physically distribute promotional information in highly trafficked areas. The first
intervention cycle will begin a week after recruitment with Session 1 led by the two
group facilitators. Each of the seven sessions will be held twice weekly (one at each AID
Atlanta location) during the intervention cycle. After the seventh session, there will be a
recruitment week for cycle two. This pattern will continue for a total of 6 cycles over 12
months.
Health Outcomes for the Target Population
Participation in 3MV is proven to reduce HIV/STD risk behaviors and improve protective health
activities in the target population.130, 131
Health Outcome 1: Participation in 3MV will result in reduced HIV transmission between
sexual partners.130
This outcome is achieved by decreasing the overall number of sexual
partners and reducing episodes of unprotected anal intercourse with casual male partners,
both of which are behavior changes achieved by men who completed 3MV compared to a
control group of men who were wait-listed for the intervention but never participated.130
Health Outcome 2: 3MV will increase awareness of HIV status and decrease late HIV
diagnoses.130
Men who participate in the intervention had 81% greater odds of screening
for HIV six months after completion than those who did not partake in the study.130
Process Outcomes for the 3MV
Intervention staff in partnership with AID Atlanta will meet program implementation goals in
order to facilitate achievement of the proposed health outcomes.
Process Outcome 1: Program staff will actively recruit 3MV participants from at-risk
neighborhoods by publishing print advertisement in two local media sources, networking
with other CBOs and businesses within the target neighborhoods to garner support, and
verbally advocating enrollment for individuals visiting AID Atlanta.132
Process Outcome 2: Program staff in conjunction with AID Atlanta will implement the 7-
week program six times over 12 months, providing one week of full-time recruitment in
between each intervention cycle.132

18. 18
Budget
This intervention will operate on a total budget of $100,000 to fund 12 months of 3MV
implementation within AID Atlanta. See Appendix A for a detailed layout of 3MV expenses.
Budget Justification
Narrative justification of each item within the 3MV budget plan is described in Appendix B.
Funding Currently Available in Metro Atlanta
The Community Foundation for Greater Atlanta collaborates with the United Way of Greater
Atlanta and Fashion Cares to support an Atlanta AIDS Fund for program implementation and
prevention research.133
Other funding sources include the Elton John AIDS Foundation and the
Ryan White HIV/AIDS Treatment Extension Act.134, 135
Possible Funding Sources for the New Intervention: 3MV is supported by the CDC’s
HIP initiative.125
Since it’s induction, the CDC has helped fund implementation of the
program in various communities.125
The Community Foundation for Greater Atlanta as
well as Emory University also support HIV research and often accept grant proposals for
HIV/AIDS related program support.133, 136
Conclusion
Metro Atlanta is a mix of Southern culture, specifically conservative ideology and religious
adherence, as well as racial diversity, urban density, and LGBT activism. The split personality of
this city creates a complexity that influences health on both individual and community levels.
HIV/AIDS is a looming public health issue within the Atlanta MSA, and local statistics double
or even triple state and national averages. The cultural atmosphere within Atlanta coupled with
socioeconomic disparities, racial discrimination, and other HIV-related stigma contribute to the
multi-faceted nature of the HIV/AIDS epidemic. Disease incidence along with two closely
related health indicators, namely pre-existing STI’s and income level, are measurable targets
whose data has painted a picture of the disease burden within Metro Atlanta. While on a national
level HIV/AIDS incidence has slowly declined since 2005, the number of new diagnoses in
Atlanta has continued to rise with the largest burden affecting African American MSM.
Currently about two-dozen CBOs and government agencies are working to fight HIV/AIDS in

19. 19
the Atlanta area through evidence-based interventions, awareness campaigns, and community
organized programs. Given the large number of physical and social barriers to HIV prevention,
however, public health needs still exist in the community, especially for those individuals at high
risk of infection. Many Men, Many Voices (3MV) is a group-level HIV/AIDS prevention
intervention specifically designed for African American MSM. 3MV in partnership with AID
Atlanta, an existing partner within the community, can help meet urgent community health
needs.
APPENDIX A: Budget Template

20. 20
Executive Director: Nicole Roebuck
Type of Budget: 3MV Budget
Sponsor: AID Atlanta
Budget Dates: January 1, 2017 - December 31, 2017
$100,000
BASE
% BASE PROJECT PROJECT FRINGE PROJECT
PERSONNEL TITLE EFFORT SALARY SALARY SALARY BENEFITS TOTAL
Salaried Nicole Roebuck Executive Director 5.0% 75,000 $75,500 $3,775 $895 $4,670
Mary Akel Program Manager 20.0% 60,000 $60,400 $12,080 $2,863 $14,943
Frank Ocean Project Coordinator/Group Facilitator40.0% 32,000 $32,853 $13,141 $3,114 $16,255
James Stinson Recruitor/Group Gacilitator 40.0% 32,000 $32,853 $13,141 $3,114 $16,255
#DIV/0! $0 $0 $0
#DIV/0! $0 $0 $0
#DIV/0! $0 $0 $0
#DIV/0! $0 $0 $0
Total FTE (12 months) 1.05
Wages
$0 $0 $0
$0 $0 $0
$0 $0 $0
Total Salaries/Wages/Fringe Benefits: 42,137 9,986 $52,123
OTHER COSTS
Rent, Bldg. Space *** $17,690
Supplies (Furniture, props, and promotional materials) $3,700
Printing and Postage $2,000
Consultant Fees $0
Subcontracts $0
AID Atlanta
Domestic Travel $983
Local Travel $1,026
Meeting / Conf. Expenses $800
Long Distance Telephone $0
Computer Equipment & Software $0
Equipment Maintenance $3,600
Website & Data System $0
Total Other Costs: $29,799
Total Direct Project Costs $81,922
MODIFIED TOTAL DIRECT COSTS $64,232
Sponsor Reimbursed Indirect Costs @ 26% $16,700
TOTAL FUNDING REQUESTED $98,623
APPENDIX B: Narrative Budget Justification

21. 21
AID Atlanta
Many Men, Many Voices (3MV)
CDC/Community Foundation for Greater Atlanta
January 1, 2017 – December 31, 2017
PERSONNEL:
Nicole Roebuck, Executive Director ($75,000). 137
Nicole Roebuck, the current Executive Director of
AID Atlanta will serve as Executive Director of 3MV. Her role will include oversight of 3MV expense
reports, attendance at quarterly intervention staff meetings, and coordination with other staff members
as needed.
Salary Calculation: $75,000/12 x .05 FTE x 12 months = $3,775
Fringe Calculation: $3,775 x .237 = $895
Total: $4,670
Mary Akel, Program Manager ($60,000). 138
The 3MV program manager will lead staff meetings,
plan program curriculum, make purchases for the intervention, provide guidance other staff during
implementation, and help create recruitment strategies.
Salary Calculation: $60,000/12 x .2 FTE x 12 months = $12,080
Fringe Calculation: $12,080 x .237 = $2,863
Total: $14,943
Frank Ocean, Project Coordinator/Group Facilitator ($32,000). 139
The project coordinator will
play a dual role as one of the two group facilitators. He will assign 25% of his effort to guiding two to
three hour group sessions twice weekly for seven weeks during each of six intervention cycles. The
other 15% effort will be spent maintaining a network with partner organizations and enterprises within
target communities, ensuring intervention resources are available before each group session, and
carrying out program retention efforts.
Salary Calculation: $32,000/12 x .4 FTE x 12 months = $13,141
Fringe Calculation: $13,141 x .237 = $3,114
Total: $16,255

22. 22
James Stinson, Recruiter/Group Facilitator ($32,000). 140
The 3MV recruiter will also serve as the
second group facilitator and 25% of his time will again be spent guiding group sessions. During
recruitment weeks in between each cycle, this staff member will work full-time promoting the
intervention both at both AID Atlanta locations and within target communities.
Salary Calculation: $32,000/12 x .4 FTE x 12 months = $13,141
Fringe Calculation: $13,141 x .237 = $3,114
Total: $16,255
Total Personnel $ 42,137
FRINGE BENEFITS: Fringe benefits at AID Atlanta are estimated based on the agreement
negotiated with DHHS. The fringe benefit rate for salaried employees is 23.7%, so each staff member’s
fringe benefit has been calculated using this rate and their projected salary for the 2017 calendar year.
Fringe Benefit Cost $ 9,986
TRAVEL
Domestic Travel - Training: Domestic travel costs were calculated based on transportation and
lodging expenses for two Group Facilitators to attend a CDC-supported High Impact Prevention
Training for 3MV. The training will happen once annually before the first cycle of program
implementation. Each individual is budgeted $400 dollars for three nights of hotel stay and is eligible
for transportation reimbursement equal to 57 cents per mile for up to 40 miles per day of training.
($400 lodging per individual per training = $800) + ([40 miles x $0.57/mile] x 4 days of training x 2
individuals = $182.40) = 982.40
Total Long Distance Travel Cost $ 983
Local Travel - Staff: Local travel costs are calculated based on a reimbursement of 57 cents per mile
to cover both gas and maintenance for the program recruiter’s personal vehicle. The individual is
eligible for this travel reimbursement during full-time recruitment weeks that occur between each
intervention cycle. Since some promotional assignments will require him to travel between each AID
Atlanta location and to many neighborhoods surrounding the Atlanta MSA, 3MV will cover up to 60
miles per day of full-time recruitment work. (6 weeks of full-time recruitment x 5 days per week x [60
miles x $0.57/mile] = $1,026)

23. 23
Total Local Travel Cost $ 1,026
Total Travel Cost $2,008
SUPPLIES: Supplies for 3MV include promotional materials such as advertisement space used for
recruitment as well as props and furniture needed for intervention group sessions. The 3MV budget has
allowed for the purchase of 25 chairs, 12 chairs at each location plus one extra. These chairs will be
used primarily during intervention group sessions and each one will cost no more than $20 according to
the proposed budget allotment (25 chairs x $20/chair = $500). 3MV will also purchase ongoing
advertisement in Atlanta Daily World, a local newspaper, and David Atlanta, an LGBT magazine. The
allotted budget for a small column ad in both based on the average cost of newspaper ads in the area
will be $250 a month ($250/month x 12 months = $3,000). 141, 142
The budget will also allow for an
extra $200 for props and other materials used for role-play and interactive activities during group
sessions.
Total Supply Cost $ 3,700
CONTRACTUAL: No Contractors will be needed
Total Contractual Cost $ 0.00
OTHER COSTS
Consultant: No consultants will be needed
Total Consultant Cost $ 0.00
Rent: Rent calculations are based on cumulative FTE of intervention staff and average monthly rental
costs for the 2017 calendar year. Monthly rent for this time frame is on average about $1490 and staff
use of rental space is about 1.05 FTE.
Total Rent Cost $ 17,690
Website Costs: The only online presence of 3MV will be on the AID Atlanta Program Page where it
will be listed with a brief description, regularly updated meeting times and locations, and contact
information for the intervention Recruiter. Since AID Atlanta already pays for this online space in order
to advertise it’s other ongoing programs, not additional payment is necessary for 3MV.

24. 24
Total Website Cost $ 0.00
Meeting Expenses/Conference Registration Fees: There will be a quarterly meeting for all
intervention-related staff. During this time, the Executive Director of AID Atlanta will be updated on
intervention progress and any unforeseen program issues will be discussed. These meetings will take
place during a normal workday and lunch will be provided. $200 has been allotted for each meeting to
cover the costs of food, drink, conference room space, and print or technological materials.
Total Meeting/Conference Expense $ 800.00
Long Distance Telephone: There will be no long distance telephone costs.
Total Long Distance Telephone Cost $ 0.00
Printing and Postage: Postage will be used for distribution of promotional materials, retention efforts,
and post-intervention outreach. Postage expenses will come to approximately $50 per month for 12
months ($50/month x 12 months = $600). Printing costs will cover materials necessary for the
intervention group sessions, recruitment and advertisement resources, and retention purposes. Colored
prints cost 30 cents per page on average. Participants will be allotted two handouts during each of the 7
group sessions as well as an attendance reminder sent to their home or work address each week during
the intervention cycle ([25 participants x 2 handouts/session x 7 sessions x $0.30/handout = $105/cycle
x 6 cycles = $630] + [25 participants x 1 attendance reminder/session x 7 sessions x $0.30/reminder =
$52.50/cycle x 6 cycles = $315] = $945). The remaining amount will be used during recruitment weeks
to print promotional materials ($455).
Total Printing and Postage Cost $ 2,000
Equipment Maintenance: Equipment maintenance includes the costs of computers, software, and
networking technology as well as maintenance for these resources. The program manager, coordinator,
and recruiter will all have access to one intervention-related computer as well as partial access to other
technologies currently within the AID Atlanta headquarters. 3MV will cover partial costs of wireless
internet services and maintenance for the technology used. This budget is allotted $300 per month for a
total of 12 months.
Total Equipment Maintenance $ 3,600

25. 25
Total Other Cost $ 29,799
INDIRECT COST (IDC): The IDC is calculated at the organization-negotiated rate of 26% for all
activities and personnel. The modified total direct cost calculation, in this case $64,232, is used to
determine the base to which the applicable percentage is applied.
Total Indirect Cost $ 16,700

26. Akel, Mary 26
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