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Cover: An HIV-positive client in rural Washington State.
Page 5: A road block in rural Mississippi.
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Substance Abuse

Rates of methamphetamine (known as “meth”), oxycodone (OxyContin, Percocet), and alcohol abuse are higher in rural America than in urban regions. Rural youth ages 18 to 25 are more likely than their urban counterparts to have used meth or oxycodone. Eighth graders in small towns are 104 percent more likely to use meth than are those in large urban areas.32

Substance use contributes to poor treatment adherence, missed appointments, and the inability to stay in treatment over time. Moreover, it severely inhibits the capacity to rebuild one’s health and may lead to risky behaviors, such as unprotected sex. Meth use, in particular, has been associated with increased HIV risk due to side effects such as increased sexual arousal and decreased inhibition and judgment.33

Services for substance abuse prevention and treatment are scarce in rural areas. “[Available resources] for treatment centers, law enforcement, and prevention programs are stretched thin over sparsely populated regions. Rural residents frequently must travel great distances and wait for months to be treated at the few, widely spaced and understaffed hospitals and health facilities available to them.”34 In fact, rural residents average between 13 and 30 miles to a substance abuse treatment facility (and longer distances in frontier areas), whereas 49 percent of urban residents live within 1 mile of a treatment facility.35

Difficulties in addressing substance abuse in rural areas, however, go beyond a lack of treatment. Rural residents are more likely to be referred to substance abuse treatment by the criminal justice system than by health care systems or through self-referral.36 Even where help is available, the stigma associated with drug abuse treatment can discourage people from seeking treatment in their home community.37

To help counter substance use, the East Arkansas Family Health Center provides educational outreach in addition to HIV testing. “We will do outreach at churches, community venues, and we’ll go to public housing,” explains Whitehead-Thompson, but “we really need more residential substance abuse treatment options. When someone is ready for help, we need to be able to put them in a place where they can be treated and get help. . . . It affects our success rate not having more residential substance abuse treatment in rural areas.”

One way of more effectively linking people with addiction issues to treatment services is through better screening. Whitehead-Thompson says, “When we encounter people at intake, we’ll ask them about substance use as part of our psychosocial screening. We offer available resources for substance abuse treatment, and if they’re willing to go, we’ll provide transportation or vouchers.” Similarly, SHRT’s Young notes, “We screen all HIV patients through our HIV Early Intervention (HEI) Substance Abuse Program. We have HEI case managers who specialize in substance abuse issues at our offices. They offer group and individual counseling.”

Provider partnerships with other area organizations serving PLWHA can also help increase success rates. The Healthy Relationship Intervention, for example, is a behavioral intervention program involving a partnership of the Jefferson Comprehensive Care System in rural Pine Bluff, Arkansas, with the Arkansas Department of Corrections, the Arkansas State Health Department, and addiction treatment and recovery centers. The organizations work together to identify and bring PLWHA engaging in high-risk sexual behaviors and drug use into treatment. Participants reported decreased risk activities and increased disclosure of HIV status.38

CONCLUSION

The challenges facing PLWHA in rural America are enormous. Like PLWHA everywhere, they need community and support, which are difficult to find where stigma is pervasive. PLWHA need opportunities for drug treatment and comprehensive health care, but these services may be elusive in rural settings. Rural providers face barriers, too, in expanding service area coverage or service offerings in an environment of “do more with less.”

Courageous PLWHA and extraordinarily committed organizations are wrestling with these and other challenges. Addressing HIV/AIDS requires health care interventions and social, cultural, and educational interventions. Where this approach is not in play, HIV incidence and AIDS morbidity are apt to increase. Where this approach is in place, infections are prevented, PLWHA become healthier, and they contribute to building healthier communities.

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REFERENCES
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