Barriers to Care for Rural People Living With HIV: A Review of Domestic Research and Health Care Models

Abstract

Historically, the availability of heath care in rural areas has been sparse, and specialized care for people living with HIV (PLWH) has been especially problematic. Rural patients are faced with substantially greater barriers to care than their urban counterparts. A systematic review of empirical studies was conducted concerning barriers to care among patients infected with HIV in rural areas of the United States. This systematic review yielded 15 viable articles for analysis. Among the 27 barriers identified, the most commonly discussed were transportation needs, provider discrimination and stigma, confidentiality concerns, and affordability and lack of financial resources. Barriers to care must be addressed in conjunction with one another in order to alleviate their impacts. Key health care models addressing these concerns are highlighted and used to address the state of the field and provide suggestions for future research.

HIV Diagnoses, Prevalence and Outcomes in Nine Southern States

“…Challenges to HIV prevention and care in rural and suburban areas of the targeted states, such as lack of transportation, lack of qualified providers, and HIV-related stigma [23–27], may provide some explanation for the study findings regarding lower 5-year HIV and AIDS survival proportions in the targeted states in comparison to other US regions. In addition, the death rate among persons living with HIV (2010) was found to be higher in the targeted states compared to the overall United States; with rural and suburban areas having higher death rates among persons living with HIV than urban areas of the targeted states.…”

A Mixed-Methods Exploration of the Needs of People Living with HIV (PLWH) Enrolled in Access to Care, a National HIV Linkage, Retention and Re-Engagement in Medical Care Program

“…These competing needs pose barriers to optimal engagement at each stage of the HIV care continuum. Known barriers to HIV care can be grouped into three main categories—healthcare system factors (e.g., system navigation, scheduling appointments, facility waiting time, travel time to clinic, lack of culturally sensitive care, inconvenient visit hours, and care location), social factors (e.g., stigma, psychological or emotional barriers, and confidentiality concerns) and lastly, characteristics common among risk populations (e.g., financial constraints, homelessness, substance use, lack of health insurance, and mental illness) [2, 8]. Strategies used to moderate participant needs and barriers to care have included collaboration among community organizations, individualized case management plans, peer navigation systems, care team approaches, and coordinated health care services [2].…”

Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State

“…Geographic isolation limits access to health services that support sexual health for MSM residing in relatively rural areas (Williams, Bowen, & Horvath, 2005). Emergent research has documented barriers to sexual health care within these areas (Hubach et al, 2015;Pellowski, 2013;Reif, Golin, & Smith, 2005;Staton-Tindall, Webster, Oser, Havens, & Leukefeld, 2015), yet little is known about the scope of sexual health care available to them in relation to PrEP access and adoption. The nascent literature on MSM residing in relatively rural states, outside of the Deep South, have found that MSM have difficulty identifying prevention programs or local testing sites, do not believe that HIV and STIs are a local threat, and do not engage in HIV and STI risk reduction (Kelly, 1994;Williams et al, 2005).…”

“…Proximal and distal factors are coalescing to move the epidemic into rural locations (Schafer et al, 2017). MSM residing in rural areas have limited access to HIV preventive services compared to their urban counterparts (Bowen, Horvath, & Williams, 2007;Pellowski, 2013). Access to sexual health care is largely connected to the resources, or lack thereof, at their disposal (Bowen et al, 2007;Horvath, Rosser, & Remafedi, 2008;Rosenberger, Schick, Schnarrs, Novak, & Reece, 2014).…”