Rural human immunodeficiency virus health service provision. Indications of rural-urban travel for care
A. G. Mainous 3rd and S. C. Matheny
Department of Family Practice, University of Kentucky, Lexington, USA.
We studied the travel of rural individuals positive for human
immunodeficiency virus (HIV) to urban areas for HIV diagnosis and for
ambulatory and inpatient HIV-related health services. We surveyed all (N =
84) identified HIV-positive adults (aged 18 years or older) residing in
rural central and eastern Kentucky. Sixty-three individuals completed the
survey, for a response of 75%. Although 60 respondents (95%) were living in
a rural area at 18 years of age, 23 (37%) of the survey sample lived in
urban areas at the time of their initial HIV diagnosis. Of the respondents,
13 (21%) traveled from rural areas to urban areas for their initial
diagnosis of HIV. Forty-seven respondents (74%) traveled outside their
county for HIV-related ambulatory care, with 40 respondents (64%) traveling
to an urban area. The mean travel time required to obtain care for those
who traveled to an urban area was almost 2 hours. Primary reasons for
travel for ambulatory care include confidentiality concerns, belief that
their physician was not knowledgeable enough about HIV, and referral to an
outside physician. Increased training of rural primary care physicians
regarding the psychosocial and biomedical aspects of HIV is suggested.
