Rural human immunodeficiency virus health service provision. Indications of rural-urban travel for care.

We studied the travel of rural individuals positive for human immunodeficiency virus (HIV) to urban areas for HIV diagnosis and for ambulatory and inpatient HIV-related health services. We surveyed all (N = 84) identified HIV-positive adults (aged 18 years or older) residing in rural central and eastern Kentucky. Sixty-three individuals completed the survey, for a response of 75%. Although 60 respondents (95%) were living in a rural area at 18 years of age, 23 (37%) of the survey sample lived in urban areas at the time of their initial HIV diagnosis. Of the respondents, 13 (21%) traveled from rural areas to urban areas for their initial diagnosis of HIV. Forty-seven respondents (74%) traveled outside their county for HIV-related ambulatory care, with 40 respondents (64%) traveling to an urban area. The mean travel time required to obtain care for those who traveled to an urban area was almost 2 hours. Primary reasons for travel for ambulatory care include confidentiality concerns, belief that their physician was not knowledgeable enough about HIV, and referral to an outside physician. Increased training of rural primary care physicians regarding the psychosocial and biomedical aspects of HIV is suggested.