The U.S. HIV epidemic among men who have sex with men (MSM) hits the South especially hard. This is according to the first analysis of HIV prevalence and diagnosis figures among MSM that was comprehensively broken down by states, counties and what are called metropolitan statistical areas (MSAs).

Researchers estimated that in 2012 about 4.45 million MSM were living in the United States and that 15 percent of them (669,000) were HIV positive. That year, 11.1 percent of the MSM population had been diagnosed with HIV, and in 2013, an additional 0.7 percent of that population was diagnosed.

“We need intensified prevention services, including barrier-free access to PrEP and [antiretrovirals] for treatment, for both urban and non-urban communities across the South,” says the study’s head, Eli Rosenberg, PhD, a researcher at the Emory University Rollins School of Public Health in Atlanta. Rosenberg previously estimated that 11 percent of young black MSM in Atlanta are infected with HIV annually.

Of the 25 MSAs with the highest rates of diagnosed HIV among MSM, all but four were in the South. The top six each had rates higher than 25 percent: Jackson, Mississippi (1,200 MSM, or 39 percent of the local MSM population); Columbia, South Carolina (1,620, or 30 percent); El Paso, Texas (1,130, or 29 percent); Augusta–Richmond County, spanning Georgia and South Carolina (690, or 27 percent); and Baton Rouge, Louisiana (1,090, or 25 percent).

Georgia is the only state to have a greater than 15 percent rate of diagnosed HIV as well as more than 15,000 cases (24,100, or 18.5 percent) among MSM.

In six states, all in the South, more than 1 percent of the HIV-negative MSM population is diagnosed with the virus each year, including Louisiana (2.2 percent), Mississippi (2.2 percent), Georgia (1.6 percent), South Carolina (1.6 percent), Alabama (1.3 percent) and Arkansas (1.2 percent).