The care of HIV-infected adults in rural areas of the United States

Objective: This study describes the population of HIV-infected adults receiving care in rural areas of the United States and compares HIV care received in rural and urban areas. Methods: Interviews were conducted with a nationally representative sample of 367 HIV-infected adults receiving health care in rural areas and 2806 HIV-infected adults receiving health care in urban areas of the contiguous United States. Results: We estimate that 4800 HIV-infected persons received medical care in rural areas during the first half of 1996. Patients in rural HIV care were more likely than patients in urban HIV care to receive care from providers seeing few (<10) HIV-infected patients (38% vs. 3%; p < .001). Rural care patients were less likely than urban care patients to have taken highly active antiretroviral agents (57% vs. 73%; p < .001) or Pneumocystis carinii pneumonia prophylactic medication when indicated (60% vs. 75%; p = .006). Conclusions: Few American adults received HIV care in rural areas of the United States. Our findings suggest ongoing disparities between urban and rural areas in access to high-quality HIV care.