Variations in Rural AIDS Epidemiology and Service Delivery Models in the United States

Abstract

This article reviews AIDS surveillance data and the rural health literature to summarize what is known about the rural AIDS epidemic, characteristics of rural environments that affect HIV service delivery, and approaches that rural areas are using to address the health and support service needs of HIV-positive residents. During 1999, nonmetropolitan (non-MSA) adult/adolescent AIDS rates were highest in the South (11 per 100,000) and Northeast (9 per 100,000). The South had the highest non-MSA proportion of adult/adolescent AIDS cases (12%), followed by the North Central region (9%), the West (4%), and the Northeast (3%). Variations in rural HIV/AIDS epidemiologic patterns and the demographic, socio-economic, and cultural characteristics of rural environments are likely to require different levels of resource investment and different methods of organizing and delivering HIV services. Currently, many HIV-positive rural residents are traveling to metropolitan areas for medical care because of concerns about confidentiality or a lack of confidence in the HIV management capabilities of local physicians. Rural communities are attempting to address these problems by developing the HIV care capacity of existing clinics, building local networks of physicians with HIV management experience, and cultivating "shared care" arrangements with urban-based specialists.

Delayed access to HIV diagnosis and care: Special concerns for the Southern United States

“…This number more than doubled to 45,643 by the year 2000 (McKinney, 2002). The South accounted for more than two-thirds of non-MSA AIDS cases in 2001, with non-MSA Southerners accounting for 21% of the regions incident HIV-diagnoses (CDC, unpublished data).…”

“…At the UAB 1917 Clinic, 25.8% of patients were from Alabama non-MSA, and 43.3% of these patients already had CDC-defined AIDS at first presentation (Krawczyk et al, 2006). A higher proportion of HIV-infected rural residents are uninsured (19.6%) or publicly insured (13.4%) when compared to urban residents (14.3% and 11.1%, respectively) (McKinney 2002). The adverse impact of uninsured status among rural HIV-infected Southerners is clear; in a survey of non-urban HIV-infected Alabamians, 39% had no form of insurance and 16% had lost their insurance since becoming HIV-infected (Beltrami et al, 1999).…”

“…Providers and facilities offering HIV medical care are also limited in rural regions. In 2001, the median number of physicians per 100,000 population was 85.6 (range: 57.3-125.1) in Northeastern non-MSAs compared to 55 (range: 42.2-70.5) in Southern non-MSAs (McKinney, 2002). One HIV clinic in Albany, Georgia covers 14 different counties with some patients traveling three hours to receive care (AIDS Alert, 2003).…”

Experiences of Stigma and Discrimination among Adults Living with HIV in a Low HIV-Prevalence Context: A Qualitative Analysis

“…20 In addition, rural regions in particular are affected by inadequate health infrastructure, underfunded rural health and social services programs, higher poverty, geographic challenges and a higher proportion of people who lack health insurance. 13,[21][22][23] The handful of HIV-related stigma and discrimination studies conducted in rural areas suggests that social context matters. In a study comparing urban and rural people living with HIV=AIDS, Heckman et al 24 found that rural people living with HIV, compared to their urban counterparts, reported significantly lower satisfaction with life, lower perceptions of social support from family members and friends, reduced access to medical and mental health care, elevated levels of loneliness, more community stigma, and heightened personal fear.…”

HIV Provider Perspectives: The Impact of Stigma on Substance Abusers Living with HIV in a Rural Area of the United States

“…8 Other research indicates that people living with HIV in rural areas travel to metropolitan areas for medical care due to concerns about confidentiality, or lack of confidence in the ability of rural physicians to assist in the medical management of HIV infection. 9 Researchers have also reported that rural residents living with HIV are challenged by a lack of adequately trained medical and mental health providers. 8 It has been recognized for quite some time that certain illnesses or conditions are associated with an increased level of stigma, 10 including: lung cancer, 11 sexually transmitted infections, 12 and HIV/AIDS.…”