Rural HIV/AIDS in Southeast Ohio

Rural HIV/AIDS in Southeast Ohio

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Rural HIV/AIDS in Southeast Ohio

History

Of all the known cases of HIV / AIDS in the United States "…5.5 percent were reported from nonmetropolitan statistical areas (non-MSAs). The Office of Management and Budget defines a metropolitan statistical area (MSA) as a county or group of counties that includes a city of 50,000 residents or an urbanized area with at least 50,000. Nonmetropolitan counties are all remaining counties (Gwinn & Wortley, 1996). "…6 percent of the female AIDS cases reported to the Center for Disease Control (CDC) during 1994 were residing in non-MSAs at the time of AIDS diagnosis (CDC, 1996). This is the case in Southeast Ohio where the nearest metropolitan area is Columbus an hour and a half away from Athens.

Rural HIV/AIDS patients tend to be diagnosed in later stages of the disease because their physicians do not consider them to be at risk for HIV (Calonge, Petersen, Miller, & Marshall, 1993; Miller, et al., 1995). Many of the clients that apply for services at the Athens AIDS Task Force do so only after a referral from a medical professional after they have been hospitalized with a serious illness. Most already have Center for Disease Control (CDC) diagnosis for AIDS (T-Cell count below 200, normal count is 800 – 1500).

Even as the spread of AIDS into small towns escalates, HIV-infected patients who live outside urban areas continue to confront significant obstacles to effective care. Nearly all doctors who specialize in the treatment of HIV are located in cities. Quality of life for HIV-infected rural residents is potentially worse, often for reasons that involve a lack of person-to-person contact both at the medical level and at the personal support level. Researchers have noted that rural HIV/AIDS patients often travel two or more hours to obtain medical care because they lack confidence in their local physicians, are unable to find a local physician who will see them, and are concerned about confidentiality. (Mainous & Matheny, 1996; Rounds, 1988; Rumley, et al., 1991). This is certainly the case in Rural Ohio, many clients travel to Columbus, Akron, Pittsburgh, Pennsylvania and Parkersburg, West Virginia for medical treatment. Many fear that they will run into acquaintances or relatives if they should visit physicians closer to home. People living in rural areas are still generally afraid of casual contact with anyone with the AIDS virus. We also see less intervention and prevention efforts directed toward rural areas, in part because they tend to be more conservative and not as open to sexuality education and safer sex education.

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Many people still avoid testing and treatment for HIV because they are terrified that a breach of confidentiality could lead to discrimination or rejection by loved ones. Once a rural person is infected they might be much more hesitant to seek services because it's going to be harder to keep the disease private. In a small town there can be a lot more ostracism, and nearly always there are a lot fewer support groups. The sense of isolation is very high.

FUNDING OF HIV/AIDS CARE

Rural HIV/AIDS patients also are less likely than urban patients to have public or private health insurance (Weslowski, Andrulis, & Martin, 1992). As a result, they may delay seeking care until they are in advanced stages of the disease and have significantly shorter survival times than their urban counterparts (Whyte, & Carr, 1992). Added to this long distances between homes and medical facilities and shortages of doctors, nurses, psychologists, counselors and social workers in rural areas, the lack of formal and informal support systems, and discriminatory attitudes on the parts of those few places that do provide these services.

The Ryan White CARE Act was passed in fiscal year (FY) 1991. This major funding source through the government was established in the name of the juvenile hemophiliac from Indiana that received national attention in the 1980’s when he was expelled from a public school when it was found out he was infected with HIV. In Ohio these funds come in the form of grants from the Department of Health. Newer drug "cocktails" and other treatment interventions are steadily prolonging the lives of persons with HIV in US cities. However, social stigmatization and limited access to health care systems can reduce the benefits of aggressive approaches to AIDS for people in rural areas.

Through the Ryan White Fund, Case Managers are able to assist those infected receive the proper medical treatment, medications that control the virus (costs for a month supply easily top $1500.00) and emergency assistance with housing, transportation and food. With the ever increased belt tightening on the budget through Columbus, clients must first access all other options before Ryan White. This includes County Departments of Jobs and Family Services and food pantry’s. To qualify one must be able to provide written documentation of HIV infection and be at or below 300% of the poverty level.

Another program was developed in 1992 and is another grant program that is channeled through the Ohio Department of Development from the Housing and Urban Development (HUD) at the federal level. This program has less stringent requirements in regards to income and in addition to assistance with mortgage and rent can also assist with utility bills when patients are faced with paying emergency expenses.

The other major source of funding for medical care for HIV/AIDS is Medicaid, to qualify for Medicaid the recipient must have a monthly income at or below $550.00.

In Athens and surrounding counties assistance is available through the Athens AIDS Task Force (AATF). Founded in 1986 AATF provides case management services to 7 counties in Southeast Ohio down from the previous 21 counties served in 1999. This is due to the ever increasing case load and the Ohio Department of Health breaking up the region into 3 different areas to be better served by more case managers closer to where clients are located. In addition to providing linkage to the above services also provides support groups to those infected and affected by those with the HIV Virus. AATF can be reached by calling 592-4397 in Athens or 1-800-667-2323 out of town.

Works Cited

http://www.nrharural.org/dc/issuepapers/ipaper10.html
May 11, 2004

http://www.hud.gov/offices/cpd/aidshousing/programs/index.cfm
May 17, 2004

http://healthlink.mcw.edu/article/1031002314.html
May 11, 2004

http://www.cbsnews.com/stories/2003/11/14/health/main583739.shtml
May 11, 2004
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