Rural AIDS Cases Rising Three Times Faster Than Urban Cases

BUFFALO, N.Y. -- AIDS cases in rural areas appear to be increasing at a rate three times faster than in metropolitan areas, where health-care facilities are better equipped to deal with the problem.

Rural AIDS cases increased 9.4 percent from 1991-92 -- the last period for which comparison statistics are available -- compared with 3.1 percent in major metropolitan areas, according to a review of scientific literature focusing on rural HIV/AIDS conducted by the New York Rural Health Research Center at the University at Buffalo.

The review also found that unlike the typical urban AIDS patient, who is likely to be male and homosexual, rural AIDS patients are more likely to be female and heterosexual.

The review, commissioned by the Agency for Health Care Policy and Research, included 70 articles and reviews.

³In terms of both total cases and research, rural AIDS remains dwarfed by the urban epidemic,² said Robin Graham, Ph.D., senior research scientist at the center and lead author on the study. ³But our literature review indicates that AIDS is a serious rural problem, with growing numbers of patients requiring services from ill-equipped local health-care systems.

³Most of the vast literature on HIV and AIDS has focused on metropolitan centers. Yet even in the early years, when it was viewed as a big-city phenomenon, there was never a scientific foundation for believing the epidemic would bypass rural America.²

A small number of researchers realized this, Graham said, and their findings have been accumulating since the late Œ80s. The studies reveal several distinct characteristics of the rural epidemic:

€ The rate of increase of AIDS cases in proportion to the population is much greater in rural areas.

€ Rural AIDS is distributed unevenly, with 30 percent of cases concentrated in the South Atlantic states.

€ Rates are particularly high among black women (some research indicates infection rates up to 35 times those of white women), adolescents, Native Americans and migrant workers.

€ A substantial portion of rural HIV patients have migrated from metropolitan areas, returning home to family exhibiting advanced cases of the disease.

€ Intravenous drug use and heterosexual contact are becoming important modes of transmission of rural HIV.

€ Rural homosexual/bisexual men appear to be slower to adopt the changes in sexual behavior credited with slowing HIV transmission in large U.S. cities.

€ Rural health services, already inadequate in many areas, lack the resources to care for rural AIDS patients.

Graham said that in many cases, the limited amount of research that has been done on rural HIV/AIDS raises more questions than it answers.

³There has been no large-scale investigation of HIV/AIDS incidence and prevalence in the general rural population, although the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 required one,² she said. ³Such an effort should focus on variations among risk groups, as well as among different types of rural communities and regions of the nation.

³HIV/AIDS is a serious public-health problem for rural areas, and it is worsening,² she stated. ³More comprehensive, rigorous research of the epidemiology of the disease and the availability of health services to deal with it is needed if the nation is to address this problem.²

Co-authors of the study are Maureen L. Forrester, Jere A. Wysong, Ph.D., Thomas Rosenthal, M.D., and Paul James, M.D., all of the New York Rural Health Research Center and the UB Department of Family Medicine.