HIV/AIDS in Rural Communities

While higher rates of HIV cases continue to be centered in large metropolitan areas, rural communities in some areas of the country have high HIV prevalence rates.

In 2015, an outbreak of new HIV cases in a rural town in Indiana made national headlines. As of 2016, this small town of 4,000 people had nearly 200 new HIV diagnoses. Adding to the impact of the HIV outbreak, more than 80% of the cases were co-infected with the hepatitis C virus. The Indiana State Department of Health linked this outbreak to injection drug use of opioids, highlighting substance use as a significant problem in rural America. Overall this outbreak stressed the importance of implementing targeted programs in rural communities to prevent and treat HIV/AIDS.

In addition to the outbreak in rural Indiana, several rural communities in Southern states have seen notable increases in new infections since 2008. These Southern states have large rural regions and face unique challenges to HIV prevention and treatment. In recent years, nearly 50% of all new HIV infections have occurred in the Southern portion of the U.S., with close to 40% of new cases in nine Southern states. In these nine Southern states with the highest HIV incidence rates, a higher rate of new cases are concentrated in rural portions of the state compared to the U.S. overall.

More recently, a Centers for Disease Control and Prevention (CDC) analysis of HIV data in 2016-2017 had a substantial rural HIV burden, with 10% or more of new HIV diagnoses occurring in rural areas. Since then, the CDC has funded several priority jurisdictions to develop innovative HIV/AIDS program models that align with the key strategies of the Ending the HIV Epidemic: A Plan for America (EHE) initiative and address the unique local needs of each community. EHE plans developed by states with substantial rural HIV burden are listed below:

• Alabama
• Kentucky
• Mississippi
• Missouri
• Oklahoma
• South Carolina

For more information about HIV/AIDS program models that have been implemented together, please see Module 3: Program Clearinghouse. The increasing impact of HIV/AIDS in rural communities highlights the need for an increased focus on the use of evidence-based models and programs. However, rural residents also face unique barriers and challenges to accessing HIV/AIDS prevention and treatment services.

Resources to Learn More

Access to Critical Care: HIV/AIDS in Rural America
Website
A blog post highlighting the strategies and solutions for tackling HIV/AIDS in rural communities.
Organization(s): National Rural Health Association

Rural HIV Prevalence and Service Availability in the United States: A Chartbook
Document
Examines state- and county-level HIV prevalence in 2016, and the availability of HIV-related prevention, testing, and treatment services in 2019. Includes data breakdowns by rural/urban status.
Author(s): Ahrens, K., Burgess, A., Munk, L., & Ziller, E.
Organization(s): Maine Rural Health Research Center, Rural Health Research and Policy Centers
Date: 2/2021