From 1988 to 1990, the 25 counties in the US with the highest rates of increase in AIDS cases were mostly rural counties with an average population of 73,000. In rural eastern North Carolina, people with HIV are more likely to be female, heterosexual, non-white, and younger. In many rural areas, heterosexual contact accounts for the most HIV transmission. Monroe also has one of the highest syphilis rates in the nation. Drug use is closely linked to prostitution, especially among women and teens.
Rural communities can provide their members both strong support and strong condemnation at times.
In rural areas, traditional moral values, conformity to community norms and intolerance of diversity can be strong. In some cases, homophobia, racism, sexism, and stigmatization of people with AIDS, homosexuals, minorities and drug users makes effective HIV prevention nearly impossible. Health care providers are the primary source for health education and prevention counseling in many rural areas. However, rural clinicians may believe that HIV is not a problem in their area and may not conduct proper risk assessments of patients and may not properly diagnose cases. In addition to addressing prevention issues in their own areas, rural service providers must also address issues surrounding residents who travel to urban areas and may engage in high risk sexual or drug using behavior while there.