Connecting PLWHA in Rural Virginia to Health and Mental Health Care-Perspectives from the Life Worlds of Frontline Health Workers and PLWHA

Abstract

Many areas in the rural south have historically been impoverished and medically underserved.1-4 Virginia encompasses two geographically underserved regions: Appalachia and the Southeast. According to the Virginia HIV Epidemiology Profile (2011), at the end of 2009, approximately 18% of residents resided in rural locations. Virginia’s Rural Health Plan (2008) utilizes the Isserman rural definition which combines all counties and county equivalents that are classified as rural or mixed rural as “rural” (see “defining rural” http://www.va-srhp.org/ docs/plan/11-appendix-d.pdf). Among this population, nearly 53% had progressed to AIDS. Seventy-five percent of rural Persons Living with HIV/AIDS (PLWHA) were male, and 60% were African American. The majority of rural PLWHA without evidence of care were male (79%) and African American (47%). Forty-nine percent of rural PLWHA with unmet need reported a risk of MSM followed by high-risk heterosexual contact (19%). Cene and colleagues (2011) and the research teams of Akers et al.5 and Sutton et al.6 found that rural African American PLWHA are concentrated in areas lacking crucial resources necessary for self-sufficiency which may lead to engagement in high-risk behaviors as an escape mechanism. Other researchers concluded that there is a great need to assess the conditions of rural PLWHA regarding their susceptibility to new infections of HIV and to uncover the barriers to affective delivery of HIV testing, care, and treatment. Further, they contend that such efforts can serve a dual role by identifying unmet needs for a wide range of services (i.e. mental health, substance abuse, STI screening) for PLWHA in the rural south.7,8