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Of the estimated 231,000 adults who received care for HIV infection during the first 2 months of 1996, only 4 percent lived outside of a metropolitan area. Yet nearly three-fourths of these rural residents received HIV/AIDS health care in urban areas. The majority of these patients (85 percent) said that their urban care was not conveniently located, they had twice the mean travel times of patients with rural providers, and over 25 percent had put off obtaining care in the past 6 months because of travel considerations.
Seeking urban care clearly places a huge burden on this group and suggests some inadequacy in rural HIV care, conclude Martin F. Shapiro, M.D., Ph.D., of RAND and the University of California, Los Angeles, and Samuel A. Bozzette, Ph.D., of RAND and the University of California, San Diego. They are co-principal investigators of the HIV Cost and Services Utilization Study (HCSUS), a nationally representative sample of HIV-infected adults receiving care in the United States that is supported in part by the Agency for Healthcare Research and Quality (HS08578).
The study reported here was limited to people who made at least one visit for HIV/AIDS care during a 2-month period in early 1996. The number of providers available and the providers' level of HIV experience seemed to drive decisions to seek urban or rural care. For example, 84 percent of those rural residents who traveled to an urban usual source of care (USOC) characterized their provider as one who primarily cared for people with HIV/AIDS compared with half of those using a rural USOC. Also, the mean number of physicians per 1,000 population was almost twice as high in the counties where people receiving care at a rural USOC resided compared with those counties where people with an urban USOC resided.
Surprisingly, use of HIV medications was similar across these urban and rural settings (68 percent at urban USOCs vs. 63 percent at rural USOCs). The researchers caution that they were not able to account for the location of the closest HIV clinic, the prevailing attitude toward HIV in a given community, or other factors that may have affected the chosen site of care.
See "Where to seek care: An examination of people in rural areas with HIV/AIDS," by Claudia L. Schur, Ph.D., Marc L. Berk, Ph.D., Jennifer R. Dunbar, M.H.S., and others, in the Spring 2002 Journal of Rural Health 18(2), pp. 337-347.
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