Rural counties experience funding and stigma problems in HIV prevention services
Research Activities, January 2011, No. 365
As local HIV prevention agencies fight growing rates of HIV infection, they have fewer and fewer resources, making it difficult for them to maintain existing programs and services, as well as launch new programs. Gaps in these services are often more acute in rural communities, according to a new study. Also, when such services exist, care coordination is often hampered by stigma barriers. As part of a larger interagency coordination study, researchers purposefully selected 10 North Carolina counties with characteristics likely associated with gaps in HIV prevention services. Syphilis rates were used to determine counties with high and low sexually transmitted disease (STD) rates. Counties were also categorized according to racial disparities in syphilis rates. In each of the 10 counties, face-to-face interviews were conducted with individuals deemed influential informants and representatives at prevention agencies.
Over 400 informants were asked about performance of county health services, HIV prevention activities, community attitudes, and community cooperation and collaboration. Agency representatives at 169 agencies were asked to evaluate how well their agency performed on HIV prevention-related services, such as accessibility and cost of services. The researchers found that informants in rural counties reported more gaps in prevention education, less commitment from the community, and less public-private cooperation compared with urban counties. Counties with high syphilis rates were found to have less than adequate relationships with the faith community. The majority of informants in rural counties, counties with high syphilis rates, and counties with high racial differences in syphilis rates reported that nonacceptance of people living with HIV was a major barrier to prevention services.
Service gaps most often mentioned included mental health, substance abuse, affordable health care, and the planning of a comprehensive system. While prevention agencies felt their networks were successful at offering services for a reasonable cost, they admitted there were areas for improvement in location, hours of operation, and other accessibility issues. Funding and stigma were most often cited as barriers to services. The study was supported in part by the Agency for Healthcare Research and Quality (HS10861).
See "Identifying gaps in HIV prevention services," by Elizabeth A. Torrone, M.S.P.H., Ph.D., Brooke A. Levandowski, M.P.A.c., James C. Thomas, M.P.H., Ph.D., and others in Social Work in Public Health 25, pp. 327-340, 2010.