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Barriers to HIV/AIDS Care in Rural Communities

Many social, environmental, and economic factors converge to cause barriers and challenges that complicate HIV/AIDS treatment and prevention in rural areas. Some overarching factors include poverty in many rural areas, limited resources, and structural barriers that pose challenges to accessing services.

This section describes barriers to treating and preventing HIV/AIDS in rural communities. Often, many of these factors intersect, amplifying the barriers to treatment and prevention.

Unique Social Aspects of Rural Communities

  • Stigma: Stigma in rural communities can have a widespread impact on both HIV/AIDS treatment and prevention, including making individuals less willing to be tested and/or treated for HIV. Stigma can present barriers to care for populations that have a high prevalence of HIV, including sexual orientation and gender identity minorities, as well as intravenous drug users.
  • Privacy and lack of anonymity: Because rural communities are small and tend to have close-knit social networks, it can be difficult for individuals to privately seek HIV/AIDS services. Community members may see individuals accessing these services, or may work at an organization where HIV testing or treatment services are provided. Combined with social stigma, the inability to privately access services may deter people from getting tested for HIV or seeking care for HIV/AIDS.
  • Lack of awareness: There is a lack of awareness of the prevalence of HIV in rural communities. Because, historically, the HIV epidemic has been most intense in urban areas, there may be a lack of awareness that HIV/AIDS is a problem in rural communities. In addition, prevalence of HIV/AIDS in rural areas may be underestimated, as individuals who are tested in urban areas may move back to rural areas for family support after a diagnosis, or individuals from rural areas may provide testing facilities a false address out of fear that others will learn about their HIV status.

Physical Isolation, Low Population Density, and Persistent Poverty

  • Lack of services: Rural communities may not be able to sustain important services, such as public transportation and homeless shelters, due to sparse populations. Lack of basic transportation services can make it difficult for individuals in rural areas to access HIV/AIDS services. In addition, a lack of services can make it challenging for HIV-positive individuals with low resources, such as people who are homeless, to engage in regular HIV care or adhere to an HIV treatment regimen.
  • Lack of specialized service providers: Rural communities may lack healthcare providers who specialize in providing care to patients with HIV/AIDS. Rural residents may need to travel long distances to find a provider, which impacts retention in HIV treatment.
  • Lack of Ryan White providers: Because of the high rates of persistent poverty in rural areas, people in rural communities often require financial assistance to subsidize their treatment, especially if they are uninsured and unable to qualify for Medicaid. Though the Health Resources and Services Administration Ryan White Program provides subsidized or free treatment to HIV-positive individuals, a South Carolina Rural Health Research Center article shows that only five percent of rural counties in the U.S. actually have a Ryan White provider, making the high cost of treatment a significant barrier in rural communities that lack this key resource.
  • Low population density & HIV prevalence: Because of the low population density in rural areas, and consequently the low density of HIV-positive individuals, rural HIV programs have a high per person operating cost compared to programs that serve people in urban areas.
  • Cost of treatment: Cost of HIV treatment can be unaffordable for people who live on low incomes, especially if they are uninsured and unable to qualify for Medicaid.

The interaction between community stigma, consequences of isolation, lack of financial resources, and other barriers demonstrate that these factors must all be addressed together, in order to reduce their collective impact and improve HIV/AIDS prevention and treatment in rural areas.

For rural stakeholders who are interested in implementing an HIV/AIDS prevention or treatment program, various cross-cutting program implementation considerations are discussed in Module 4: Implementation Considerations.

Resources to Learn More

Barriers to Care for Rural People Living with HIV: A Review of Domestic Research and Health Care Models
Systematic literature review examining the barriers faced by rural people living with HIV. Barriers identified relate to transportation, provider discrimination and stigma, confidentiality, and cost.
Author(s): Pellowski, J.
Citation: Journal of the Association of Nurses in AIDS Care, 24(5), 422-437
Date: 2013