DID YOU KNOW?

Only 10 percent of physicians practice in rural America even though 22 percent of Americans live there.2

Rural people living with HIV/AIDS are less likely than their urban counter­parts to be receiving highly active antiretroviral therapy, or HAART. Approxi­mately 66 percent of rural residents on HAART travel to an urban area to receive care.3

Rural Americans are more likely to live below the Federal Poverty Level and receive food stamps than are non-rural Americans.4

U.S. Department of Health and Human Services
Health Resources and Services Administration

NEW STRATEGIES for RURAL CARE

For people in urban America, rural life can be hard to imagine. What is a quick walk around the block for milk in New York City can be a 15-mile drive in many parts of the country. A short ride to the doctor’s office in Los Angeles can be a round trip that takes an entire day for people in small towns, assuming that they have a car—and a doctor.

A W.K. Kellogg Foundation study revealed that misconceptions and contradictory views about rural America are widespread:

[R]ural life represents traditional American values but is behind the times; rural life is more relaxed and slower than city life, but harder and more grueling; rural life is friendly, but intolerant of outsiders and differences; and rural life is richer in community life, but epitomized by individuals struggling independently to make ends meet.1

Beyond the clichés is a rural America that is unique, diverse, complex—and too often fraught with health disparities. Of 41 million uninsured Americans, about 20 percent are rural residents. Nearly one-half of rural residents suffer from a major chronic illness, yet rural residents average fewer medical appointments than people in urban areas.5,6 Health care provider shortages in rural areas extend to most medical disciplines, including dentistry.7,8,9 Even when services are available, people face distance- and time-related barriers to accessing care.

These structural issues have a detrimental impact on the health of rural Americans. People living with HIV/AIDS (PLWHA) in rural areas report crippling levels of stigma. And comorbidity rates for HIV and addiction and mental illnesses are high. These circumstances, among others, foster the spread of HIV infection and make treating HIV/AIDS more difficult.

SURVEILLANCE DATA

About 1 in 5 Americans—or 65 million people—live in rural areas, classified as “nonmetropolitan regions of the U.S. with <50,000 people” by the U.S. Office of Management and Budget (OMB).10,11

AIDS Prevalence. In rural areas, more than 51,000 cumulative AIDS cases had been reported among adults and adolescents by December 31, 2006.12

AIDS Rate. In 2006, the AIDS rate per 100,000 adults and adolescents was 6.4 in nonmetropolitan America compared with 19.3 in metropolitan statistical areas (MSAs)* with more than 500,000 people.13 The AIDS rate in the rural South at 9.8 per 100,000 is the highest in rural America, followed by the rural Northeast (7.1), the West (3.4), and the Midwest (2.8).14

Race/Ethnicity.African-Americans represent only 8.5 percent of the rural population in the United States but account for 50 percent of all rural AIDS cases.15,16 In the Northeast, African-Americans and Latinos each represent 1 percent of the rural population but 25 percent and 20 percent of AIDS cases, respectively.17

Region. The South now accounts for 67 percent of all AIDS cases among rural populations.18 This large share is attributable to the disproportionate impact of HIV on racial and ethnic minorities and to the fact that 90 percent of rural African-Americans live in the South.19,20

Age and Gender. The age at diagnosis and gender of PLWHA does not vary significantly among urban, suburban, and rural areas.21

 

REPORTED AIDS CASES and RATES, ADULTS and ADOLESCENTS, through 2006
MSA Population Number Rate/100,000 Population Cumulative Cases Through 2006
>500,000 30,607 19.3 807,912
50,000–500,000 4,239 9.2 88,041
<50,000 (nonmetropolitan) 2,696 6.4 51,146
Source: Centers for Disease Control and Prevention. HIV/AIDS in urban and nonurban areas. n.d.

 

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REFERENCES
  1. W.K. Kellogg Foundation. Perceptions of rural America. Exit Disclaimer n.d. Accessed November 18, 2008. p. 1.
  2. National Rural Health Association (NRHA). What’s different about rural health? Exit Disclaimer n.d. Accessed November 18, 2008.
  3. RAND Corporation. Research brief: disparities in care for HIV patients: results of the HCSUS study. Exit Disclaimer 2006. Accessed November 18, 2008.
  4. NRHA, n.d.
  5. Kaiser Family Foundation (KFF). Health insurance coverage in rural America chartbook. Exit Disclaimer 2003. Accessed November 18, 2008.
  6. U.S. Department of Health and Human Services (HHS). Fact sheet: HHS programs to protect and enhance rural health. Exit Disclaimer 2006. Accessed November 18, 2008.
  7. National Conference of State Legislatures. States address problems plaguing health care delivery in rural areas. Exit Disclaimer Washington, DC: Author; n.d. Accessed November 18, 2008.
  8. Wilhide SD. Testimony: Rural health disparities and access to care. Exit Disclaimer March 20, 2002. Accessed November 19, 2008.
  9. Casey M, Davidson G, Moscovice I, Born D. Access to dental care for rural low income and minority populations. Exit Disclaimer Working Paper 54. Minneapolis: University of Minnesota Rural Health Researcvh Center; 2004. p. 2. Accessed November 2008.
  10. KFF, 2003.
  11. Centers for Disease Control and Prevention (CDC). HIV/AIDS in urban and nonurban areas. n.d.
  12. CDC, n.d.
  13. CDC, n.d.
  14. CDC, n.d.
  15. George L, Pinder J, Singleton T. Race, place, and housing: housing conditions in rural minority counties. Exit Disclaimer Washington, DC: Housing Assistance Council; 2004. Accessed November 2008.
  16. Bowen A, Gambrell A, DeCarlo P. What are rural HIV prevention needs? Exit Disclaimer San Francisco: University of California; 2006. Accessed November 14, 2008.
  17. Bowen et al, 2006.
  18. CDC, n.d.
  19. CDC, n.d.
  20. Pinder et al, 2004.
  21. CDC, n.d.
  22. Ham B. Rural Black teens have riskier sex than urban counterparts. Exit Disclaimer Press release. Washington, DC: Center for Advancement of Health; July 28, 2003. Accessed November 19, 2008.
  23. Sallar AM, Ba NS, LaSage D, Scribner R. Differences in behavioral risk factors between rural and urban residents in Louisiana Exit Disclaimer [abstract]. Presentation at the National HIV Prevention Conference, Atlanta, GA, 2003. Accessed November 19, 2008.
  24. Bowen et al, 2006.
  25. Bowen et al, 2006.
  26. HHS National Advisory Committee on Rural Health and Human Services. 2007 report to the Secretary: rural health and human service issues. 2007. Accessed November 14, 2008.
  27. Bowen et al, 2006.
  28. Helseth C. Partnerships pay off in rural transportation. Exit Disclaimer Rural Monitor, Fall 2006; pp. 1-2, 8-9. Accessed November 19, 2008.
  29. Gingrich N, Boxer R, Brooks B. Telephone medical consults answer the call for accessible, affordable and convenient healthcare. Exit Disclaimer Washington, DC: Center for Health Transformation; 2008. Accessed November 19, 2008.
  30. Mississippi State Department of Health, STD/HIV Division. STD/HIV trends and results. Exit Disclaimer Accessed November 2008.
  31. Bowen et al, 2006.
  32. HHS, 2007.
  33. National Institute on Drug Abuse. Research report series: methamphetamine abuse and addiction. NIH Pub. No. 06-4210. Revised September 2006. Accessed November 18, 2008.
  34. Van Gundy K. Substance abuse in rural and small town America. Carsey Institute Reports on Rural America 1(2). Durham: University of New Hampshire; 2006. p. 26.
  35. HHS National Advisory Committee, 2007.
  36. HHS National Advisory Committee, 2007.
  37. HHS National Advisory Committee, 2007.
  38. Smith AJ, Gaynor H. Advancing HIV prevention in rural Arkansas. Presentation at the National HIV Prevention Conference, Atlanta, GA; 2005.
  • *MSAs are geographic entities defined by OMB for use by Federal statistical agencies in collecting, tabulating, and publishing data.
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