Barriers to accessing HIV/AIDS care in North Carolina: Rural and urban differences

Abstract

Many HIV-positive individuals face multiple barriers to care and therefore frequently experience unmet medical and support services needs. Rural areas often lack the infrastructure to support the delivery of comprehensive HIV services; however, few studies have examined service barriers faced by rural residents with HIV/AIDS, particularly in the South where two-thirds of people living with HIV/AIDS in rural areas reside. We surveyed North Carolina HIV/AIDS case managers (N=111) employed at state-certified agencies regarding barriers to medical and support services that influence medication adherence for their rural and urban-living clients. For each of the seven barriers assessed (long travel for care, HIV-related stigma, and a lack of transportation; HIV-trained medical practitioners; housing; mental health services and substance abuse treatment), a substantial proportion of case managers (29–67%) reported it was a ‘major problem’. For five of the seven barriers, rural case managers were significantly more likely to identify the barrier as a ‘major problem’. Multivariate analysis revealed that rural case managers and case managers with more female clients reported a greater number of barriers. Because unmet medical and support service needs may result in poorer outcomes for HIV-positive individuals, barriers to these services must be identified and addressed, particularly in rural areas which may be highly underserved.

Acknowledgments

This research was funded by a 1999 developmental grant from the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR); an NIH funded program #9P30 AI50410. Additional funding was obtained from the North Carolina Rural Health Research Program at the Cecil G. Sheps Center, University of North Carolina at Chapel Hill. The authors would like to acknowledge the assistance of Steve Sherman and Donna White of the North Carolina HIV/STD Prevention and Care Branch. In addition, the authors are appreciative of the helpful comments of Drs Hsiao-Chuan Tien, T. R. Konrad and Thomas Ricketts.