What about Us? Economic and Policy Changes Affecting Rural HIV/AIDS Services and Care

Abstract

Health care budgets and policies are chief drivers in the delivery and access to health services. Place is also a factor that affects patient and provider experiences within the health care system. We examine the impact of policy changes and subsequent budget cuts on rural HIV/AIDS care, support services, and prevention. We interviewed 11 social workers, case managers, and outreach workers who serve rural people living with HIV/AIDS. We conducted telephone interviews inquiring about the effect of economics and policies on direct practice with rural clients. We analyzed data using a content analysis approach. We found several themes from the data. Ryan White funding and policy changes shifted direct practice to a medical case management model. Changes in federal and state poverty levels affected client eligibility for the AIDS Drugs Assistance Program. Policy banning financial support for syringe service programs hindered prevention efforts to reduce HIV/AIDS transmission. Ancillary services were reduced, such as housing assistance, transportation, and emergency financial assistance. In conclusion, we highlight the importance of place-based policies to improve access to healthcare and services. We also provide recommendations for greater inclusion in HIV/AIDS-related policy development, care, and service planning for rural workers.

Assessing Differences in CDC-Funded HIV Testing by Urbanicity, United States, 2016

“…This is consistent with previous work that found persons residing in rural areas were more likely to be tested in a healthcare setting than a non-healthcare setting [5]. Some reasons for this finding may be a lack of community-based organizations in rural areas or, where available, limited testing resources [12]. It is also possible that fear of stigma may play a role in higher testing in healthcare settings—persons may feel greater anonymity seeking testing in a healthcare setting.…”

“…Transmitting HIV can occur if an HIV-negative person injects with the same equipment used prior by a person living with HIV [24]. Given that rural residents may already have barriers that include higher local stigma about HIV infection, limited availability of providers specializing in HIV and substance abuse, hospital closures, and significant travel burdens to obtain care [4, 12–16, 25], public health officials should be alert to instances where HIV prevention and care resources may be needed in rural areas.…”

“…Often, rural residents at risk for or living with HIV experience barriers that include higher local stigma about HIV infection, limited availability of providers specializing in HIV, and significant travel burdens to obtain care [4, 12–16]. Recent reports of HIV outbreaks associated with injection drug use in rural areas further highlight the unique challenges [17, 18].…”

“…Rural residents at risk for or living with HIV face unique challenges [4], One national survey found the likelihoods of having ever been tested for HIV and tested in the past year decreased as residence became more rural [5], People living with HIV in rural areas are more likely to receive a late-stage diagnosis or have advanced disease at medical care entry [6–9] and have lower levels of retention in care and viral suppression [10, 11] than their urban counterparts. Often, rural residents at risk for or living with HIV experience barriers that include higher local stigma about HIV infection, limited availability of providers specializing in HIV, and significant travel burdens to obtain care [4, 12–16]. Recent reports of HIV outbreaks associated with injection drug use in rural areas further highlight the unique challenges [17, 18].…”

The Effect of Routine Management Combined with Case Management Model on Social Support, Self-Efficacy, Self-Management Ability, and Psychological Flexibility of AIDS Patients

“…Xinjiang is a multiethnic area, and there are some differences in population distribution, customs, and language environments among different ethnic groups [ 15 ]. Compared with the conventional hospital management model, the case management model can combine the essentials of AIDS prevention and control work to provide patients with more personalized management services and professional support, which has the characteristics of strong individualization and strong pertinence [ 16 ]. In addition, this model plays a very important role in promoting effective self-health management of patients, improving patient compliance and quality of life, strengthening the cooperation of medical-related teams, and improving their work efficiency [ 17 ].…”