National Rural Health Association

2016 Policy Institute

Rural HIV/AIDS Resource Center

About Rural HIV/AIDS

Impact hardest on poor, south, minority populations

Over the years in the U.S., rural areas have comprised 5 to 8 percent of all US HIV cases. 1 Certain rural areas and ethnic groups are disproportionately affected, the South and African Americans in particular. To illustrate:

  • Southern states comprise 68% of all AIDS cases among rural populations. 2 In certain Southern rural spots, HIV/AIDS diagnosis rates are almost as high as those in urban areas. 3
  • African Americans represent 50% of rural AIDS cases, whites 37%, Latinos 9% and American Indian/Alaska Natives 2%. 2 African Americans and Latinos are disproportionately affected by HIV in rural areas.
  • While most rural AIDS cases (75%) are among men2, rates among rural women are increasing, particularly among African American women. Heterosexual transmission accounts for most cases among rural women, whereas injection drug use is the most common transmission category for urban women. 2
  • Among rural men, men who have sex with men (MSM) comprise approximately 60% of rural AIDS cases and injecting drug users (IDUs) about 20%.2 In 2000, in the rural South, 28.5% of men were infected through heterosexual contact. 3

Above adapted from What are rural HIV prevention needs? CAPS Fact Sheet, 5/06, prepared by UCSF Center for AIDS Prevention Studies.
For more, see the NRHA Issue Paper: HIV/AIDS in Rural America Disproportionate Impact on Minority and Multicultural Populations, 2004.

1 Steinberg S, Fleming P. The geographic distribution of AIDS in the United States: is there a rural epidemic? Journal of Rural Health. 2000;16:11-19.

2 Centers for Disease Control and Prevention. HIV/AIDS surveillance in urban and nonurban areas.

3 Hall HI, Li J, McKenna MT. HIV in predominantly rural areas of the United States. Journal of Rural Health. 2005;21:245-253.


In many ways, delivery of HIV/AIDS care in rural areas is the same as for any locale. But notable challenges, from great distances to limited capacity, require special efforts on the part of rural areas. Among the most common barriers:

  • Spatial. Distance and small populations pose very real challenges in getting services to people with HIV/AIDS. Rural areas, by definition, have low population density and great distances, making it harder to get services to clients. Rural areas also generally have smaller numbers of HIV/AIDS cases, which means that few specialized services are likely to be available.
  • Health system gaps. Rural areas tend to have limited health care infrastructures with few providers and facilities. This includes providers who are not involved in HIV care and, additionally, providers who are not trained or otherwise prepared to deliver quality HIV services. Reimbursement for HIV/AIDS care can also be limited as infected individuals are more likely to be from underserved and under-/un-insured populations.
  • Stigma and confidentiality. People with HIV disease are reportedly reluctant to access HIV services in their area given the stigma of having HIV and how it might result in rejection by the community, family, friends and co-workers. Clients are also reportedly often fearful that health care workers will not maintain their confidentiality.

Resources for Providers

Rural HIV/AIDS Care: Resources for Providers presents web-based resources on delivery of HIV care and is intended to minimize the "digging" for online help. Included are resources specific to rural settings (e.g., provider training venues, ways to co-manage a client with an HIV expert). Also provided are general HIV care resources that are relevant no matter what the location of the provider, such as treatment guidelines.

Best practices in Rural HIV/AIDS care 

Best Practices: Travel and Transportation- A brief overview of several successful HIV transportation programs around the country including voucher use, shared rides and others.

Provider Training Techniques - Illustrates best practice models being used around the country to encourage rural physicians to obtain basic training skills in the treatment of HIV.

Fighting Stigma and Denial - Review of such topics as the role of leadership, clinic adjustments, peer support, legal protections and other techniques to combat HIV stigma and discrimination. 

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