Access to Critical Care: HIV/AIDS in Rural America

By: Jessica Seigel | 2/28/19

---

In President Donald Trump’s recent State of the Union Address, he announced plans to eradicate HIV/AIDS by 2030. Until recently, HIV/AIDS was thought of as a predominantly urban issue, but the 2015 HIV outbreak in Scott County, Indiana brought a new light and a new lens to the disease’s prevalence in rural America. As Congress works with the Administration to develop strategies to prevent future cases of HIV/AIDS, they must acknowledge the challenges and needs of rural Americans living with the condition and struggling to access necessary care.

A Growing Population: HIV/AIDS in Rural America
While higher rates of HIV/AIDS cases remain focused in urban areas, research published by the American Psychological Association has shown that rural communities in some areas of the country have HIV/AIDS prevalence rates that are nearing rates of more populated urban centers.

Recently, nearly 50% of all new HIV/AIDS cases have occurred in the South, with close to 40% of new cases in 9 Southern states - Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas. A Journal of Community Health article focusing on those states found that they have a higher rate of new cases concentrated in rural portions of the state compared to the rest of the country. These are also the states with the most rural hospital closures in the country, the states that are losing access to even the most basic kinds of care.

Those living with HIV/AIDS face four common factors that particularly affect rural residents:

1. Increasing prevalence of other chronic diseases;
2. A high prevalence of chronic pain;
3. Mental health and substance abuse disorders;
4. And oral health needs. 

These are the same rural health disparities that we speak about when we discuss broader challenges in health outcomes and access to care in rural America. Yet for rural individual living with HIV/AIDS, these challenges are even greater, and necessary care may be even more difficult to find. In a New England Journal of Medicine study discussing the outbreak in Scott County, researchers wrote, “Resources related to the prevention and treatment of HIV did not exist in this community before the outbreak, and, as in many rural communities, access to basic health care, substance-abuse treatment, and HIV prevention services was limited.”

We need to examine effective strategies and policies for keeping care in rural communities, and for ensuring that rural individuals at risk for or living with HIV/AIDS have access to the resources they need.

Addressing HIV/AIDS in Rural America: Strategies and Solutions
Because the majority of HIV/AIDS cases were located in urban centers, the bulk of prevention efforts have been in these areas. It is imperative to expand the focus to rural America and to increase prevention, detection, and treatment to stop its continued growth.

1. Prevention

• Identify the needs and available resources of each rural community to plan an effective strategy for the community since solutions that address HIV in rural areas are not one-size-fits-all.
• Distribute educational materials to key locations in communities to help raise HIV/AIDS awareness in rural communities.

2. Detection

• Enhance efforts to screen for HIV, especially in the rural South, by establishing and maintaining screening facilities to encourage individuals who would be otherwise reluctant to or would not be able to travel to urban sites for HIV screening.
• Target high risk populations by employing outreach workers/ community health workers who can encourage residents in rural communities to get screened. Increased support for community health works is essential in outreach.

3. Treatment

• Strengthen efforts to increase the relationship between health care services to improve the continuum of care in rural areas.
• Seek new resources to provide transportation infrastructure to enable those living with HIV/AIDS in rural areas to access regularly necessary care.
• Train rural health care workforce including physicians on HIV specific issues and their management as well as cultural competency.
• Increase the number of Ryan White medical providers in rural counties or offer incentives for HIV specialists who deliver their services to rural communities.
• Employ innovative service delivery strategies to offer patient-centered comprehensive medical care through telemedicine for consultation with urban HIV specialists as well as supportive or ancillary services.
• Support rural hospitals that are struggling through bipartisan, commonsense policy that allows them to keep their doors open. Rural hospitals and other providers are the direct health care providers in their community, but they are closing rapidly and communities are losing care.

To read NRHA’s 2014 Policy Brief on HIV/AIDS in rural areas, visit our website here.