Wednesday, February 20, 2019

Stigma, limited privacy, lack of sex education, shortage of health insurance hamper rural efforts to fight HIV and AIDS

President Trump said in his State of the Union address that he wants to stop the spread of HIV in the U.S. within 10 years. "In addition to sending extra money to 48 mainly urban counties, Washington, D.C., and San Juan, Puerto Rico, Trump's plan targets seven states where rural transmission of HIV is especially high," Jackie Fortier reports for NPR. Health officials in those states (Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina) welcome the funding, but told Fortier that ending or slowing rural HIV transmission is a big challenge.

In rural areas,there is still a stigma attached to being gay and/or having HIV or AIDS, says Dr. Michelle Salvaggio, medical director of the Infectious Diseases Institute at the University of Oklahoma Health Sciences Center in Oklahoma City, a federally funded HIV clinic. It employed a case manager to serve a nearby rural area, but eliminated the position because no patients went to see her, Salvaggio told Fortier: "They didn't want to be seen walking into the HIV case manager's office in that tiny town — that can only mean one thing."

That lack of anonymity is not just a problem in small towns. When Native Americans, an at-risk population in Oklahoma, "go into an Indian Health Service clinic, it is possible that they will see their cousin behind the desk, and their cousin's brother-in-law working in medical records, and their niece's boyfriend working in the pharmacy," Salvaggio said.

An HIV-positive Cherokee, Ky Humble, told Fortier that rural Oklahomans with HIV and AIDS need more than medical funding; they also need more access to related services like food pantries, mental health therapy, and transportation assistance.

Another difficulty: Oklahoma, and many other states with large rural populations, don't require comprehensive sex education that could help teens learn about cheap, effective methods of preventing HIV, such as use of condoms. Lack of health insurance will also likely hamper efforts to get rural residents tested and treated, especially in states that did not expand Medicaid, Fortier reports.

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