HIV/AIDS Access to Care for Rural Populations

Background: According to the United States Centers for Disease Control, in 2008, 9.8 percent of the newly diagnosed HIV cases were in non-metropolitan areas; 45,728 people from rural areas were living with HIV; and 28,537 were living with AIDS at the end of 2008⁽¹⁾. These numbers do not comprise the individuals who are oblivious to their HIV status and individuals who have relocated to rural areas after receiving an HIV/AIDS diagnosis in an urban setting. Individuals living with HIV/AIDS in rural areas encounter unique challenges. Among the many challenges are having to travel long distances for HIV/AIDS treatment services, inadequate local outlets for health services, and intimate social networks that make it unpopular to get tested for HIV. Moreover, urban epicenters tend to attract more attention, resources, and funding allocations have been honed to urban epicenters leaving the rural areas with little to no health care resources. The rural setting of the U.S. Southeast community represents unique constraints for providers, social workers, policy makers and HIV/AIDS advocates.

Program background: The U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health, HIV/AIDS Regional Resource Network Program has analyzed the state of HIV/AIDS access to care for rural populations; particularly those in the Southeast. Today, the region of the South as defined by the U.S. Census has the highest concentration of rural communities in the country as well as the highest HIV/AIDS prevalence rates. 

Evaluation Methods and Results: The evaluation method utilized was specifically, analyzing the outcomes from using a step-by-step approach to partnership development and overcoming barriers to collaboration to alleviate HIV/AIDS access to care concerns. This step-wise approach was garnered from the National HIV/AIDS Strategy overarching goal of “achieving a more coordinated response to the HIV/AIDS epidemic,” to emphasize the importance of forming effective partnerships in rural areas. A few southern states were identified as representative of the conditions faced by providers and officials in the Southeastern states.   

Conclusions: Effective partnership development and collaboration will eliminate/lessen the effect of disparities that exist for those facing HIV/AIDS access to care issues in the rural setting.  Additionally, increased coordination of efforts to align with the goals of the National HIV/AIDS Strategy will lead to effective allocation of resources, increased outreach/education that directly/indirectly affect stigma reduction.  

Implications for research and/or practice: New testing campaigns should be accompanied by studies outlining the increased care burden that will result from new case detection and how this burden will be assumed by Federal, State and Local partners. Further research is needed to explain the wide differences in adherence rates among seemingly similar rural settings. Additional programs or resources to reach patients lost to care should be considered for non-metropolitan areas. Social marketing campaigns to address HIV-related stigma are needed that include explanations of how stigma and access to care/treatment inhibits testing and treatment, thereby facilitating new infections. Lastly, strengthen partnerships between Federal, State, and Local. References:

1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Supplemental Report. 6(No. 2): 2000, 1-16.