HIV Prevention Strategies in Rural Communities

Segment Description: Gregory Felzien, MD, AAHIVS, medical advisor in the Division of Health Protection at the Georgia Department of Public Health, discusses barriers to HIV care, particularly in neglected rural areas.

Interview transcript: (modified slightly for readability)

There's not a single barrier that we can really identify for individuals accessing either direct HIV care or prevention. Really, it's a multifactorial process and a lot of intersectionality. So we might get a simple answer of, ‘I have issues with transportation.’ But in reality, when you start peeling back the layers, there might be issues at home where an individual is being emotionally abused, physically abused, there's a single car family, which another individual is using to get to and from work. There's really limitations [in] being able to get to the clinics and see the providers.

We really have to think about it from that standpoint, but we also have to think about making sure that we're not sending mixed messages to communities and making sure that there is really consistent messaging. Because when we think about communities, it's not just the health care system, faith based organizations, It's the political arena.

And we might have individuals that feel that HIV is more of an urban issue, and it's not affecting their community. But the CDC sent out a report that stated that in 2017, that 23% of new diagnoses in the South, where I practice, are occurring in suburban and rural areas. We really have to make sure that we're sending the correct messages and that providers understand that there are individuals living with and affected by HIV in their community. I think that's really important. You can imagine if you're an individual that lives in that community and what you're hearing from the media, and the community itself, that this isn't an issue, then that starts to propagate more stigma and discrimination.

What happens a lot of times is those individuals don't feel like they can be seen in their own community. They're driving to another city, another county, another district for care. So that gets into really health care equity. They really don't have that equal access to be able to be seen in their local clinics. The other things that we really have to consider is [in] a lot of these clinics we have a lot of burnout, we have individuals going in and out of the system. You might have clinics that have high staff turnover. And that's not just the clinic itself. It's the pharmacy. It's other health care institutions. And you can imagine that you feel like this is your medical home, and suddenly the staff has changed over, you have to reestablish that trust. There are a lot of issues that you have to take into consideration when you talk about barriers. We also have to consider especially the care in the programs that we see today.

An institution might be training individuals specifically for HIV care. But a lot of times they themselves are overwhelmed. So we have telehealth network set in place. And they'll say, well, how can I take care of my own population and take on other populations and other communities in caring for those individuals? They themselves are overwhelmed, and then trying to get individuals who have been trained out into rural communities is a huge challenge. We have a lot of folks that are finishing their training. They're going to administrative positions, research positions, they're staying in the university, they're staying in the urban center. But like I said, if we're having nearly a quarter of the new diagnoses outside of a metropolitan urban area, how do we reach those, those individuals? And that can be challenging.