Rural human immunodeficiency virus health service provision. Indications of rural-urban travel for care

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Abstract
Studied the travel of rural individuals positive for human immunodeficiency virus (HIV) to urban areas for HIV diagnosis and for ambulatory and inpatient HIV-related health services. We surveyed all (N=84) identified HIV-positive adults (aged 18 years or older) residing in rural central and eastern Kentucky. Sixty- three individuals completed the survey, for a response of 75%. Although 60 respondents (95%) were living in a rural area at 18 years of age, 23 (37%) of the survey sample lived in urban areas at the time of their initial HIV diagnosis. Of the respondents, 13 (21%) traveled from rural areas to urban areas for their initial diagnosis of HIV. Forty-seven respondents (74%) traveled outside their county for HIV-related ambulatory care, with 40 respondents (64%) traveling to an urban area. The mean travel time required to obtain care for those who traveled to an urban area was almost 2 hours. Primary reasons for travel for ambulatory care include confidentiality concerns, belief that their physician was not knowledgeable enough about HIV, and referral to an outside physician. Increased training of rural primary care physicians regarding the psychosocial and biomedical as- pects of HIV is suggested. Arch Fam Med. 1996;5:469-473 As the acquired immunodeficiency syn¬ drome (AIDS) epidemic moves beyond the large cities in the United States to less populated areas,1"5 rural communi¬ ties are being challenged to meet the needs of a growing population with HIV infection. Between 1988 and 1990, the 25 counties with the highest rate of increase in AIDS cases were mostly rural counties, with an average county popula¬ tion of 73 000.6 This can be contrasted with the early stages of the epidemic between 1982 and 1984, when the 25 counties with the highest rate of increase of AIDS cases had an average population of 1.1 million. Human immunodefi¬ ciency virus (HiV) and AIDS surveillance data collected by the Centers for Disease Control and Prevention (Atlanta, Ga) show that during 1989 the rates among men who had sex with men were lowest in rural areas; the percentage increase to 1994 was 69%, highest among the met¬ ropolitan statistical area size categories.7 Successful provision of HIV-related health services is critical to the effective provision of adequate health care in rural areas and will become even more crucial in the future, given the current rates of in¬ crease in rural HIV infection. Although re¬ search has focused on the use of HIV test¬ ing in rural areas,8 information regarding the provision of health services for HIV- infected patients in rural areas is particu¬

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