Newly reported AIDS cases in rural areas of the US are increasing in the South, among young people, among African-Americans and Hispanics, and among people infected through heterosexual contact. In many rural areas, heterosexual contact accounts for the most HIV transmission. Drug use is closely linked to prostitution, especially among women and teens. These men may engage in unprotected sex in anonymous sexual encounters in public places like rest stops and adult book stores, or may travel to large cities where they encounter a large pool of HIV-infected men.
Rural communities can provide their members both strong support and strong condemnation at times.
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. Many rural residents do not have access to transportation, and for those who do, rugged topography, severe winters and long distances between towns can mean traveling several hours for medical care or social services. For many seasonal migrant farm workers, poverty, lack of access to health care services and isolation have hampered HIV prevention efforts.