Rural HIV: Barriers
At the height of the HIV epidemic resources were allocated heavily to urban areas. This was the site of the most cases and the center of most research institutions and policymakers that allocated resources to finding a cure for HIV.
HIV care access in the American South and rural areas
As the years have gone by, we haven’t seen this infrastructure spread to rural areas and adapt to the needs of populations different from the average urban dweller. In my last article, HIV in the South: Part I, we talked about this problem a bit. Here I wanted to go a bit deeper and hone in on some barriers to access for people living in the South.
HIV stigma and privacy concerns
Rural environments provide some unique social barriers with stigma and lack of privacy being two them.
Self-stigma can make one not want to even get tested knowingly for the virus. And it may also be because the local doctor knows everyone in town. And although the doctor's office is suppose to be private, it might get out to people outside of your interaction.
These fears are real for individuals and can be quite frightening deterrents to getting tested or care.
Limited access to Ryan White providers
This combined with an overall lack of services creates a public health problem that needs solutions. It was particularly heartbreaking to see that people living below the poverty line have very little access to the safety net systems like the Health Resources and Services Administration Ryan White Program.
This program was meant to help low-income individuals receive free or low-cost HIV services. A 2013 study by the South Carolina Research Institute found that 74.8 percent of people living with HIV (PLWHIV) live in a rural county without access to a Ryan White provider, compared with urban PLWHIV (11 percent).1
Broken down by geographic area, rural patients in a county with a Ryan White provider was: 97.4 percent in the Midwest, 80.6 percent in the Northeast, 68.4 percent in the South and 66.1 percent in the west.1
Possible solutions to improved rural healthcare access
So those are the statistics, but the solutions aren’t so simple. We also have to consider that the number of cases in rural areas will be less because population densities are less. So coming up with economically feasible methods are key.
Increase internet and telehealth access
Thinking about addressing the stigma around HIV, I think technology could play a positive role in helping people get the resources they need. Telemedicine is increasingly being used. Patients are seeing doctors on their computer screens and phones.
Ease physical barriers to care and treatment
HIV test kits and medications can be directly sent to one’s address. Even considering reimbursing travel expenses to the doctor’s office would incentivize those who have to travel far to receive care.
Understanding rural healthcare needs
As advocates and PLWHIV, it is time that health professionals realize we all live unique lifestyles and healthcare must adapt to us. Could you share your experience with rural healthcare? I live in an urban environment so I would love to hear different perspectives to add to this story. Thanks for checking out my blog and comment below.
How often does someone offer you unsolicited advice on your health?