Evidence of an increasing AIDS burden in rural America.

As the AIDS epidemic has matured in the United States, the characteristics of affected populations have shifted from a predominantly white homosexual/bisexual population to one now including increasingly more minorities, injecting drug users and women. Concomitant with the changing nature of persons diagnosed with AIDS there has been an increasing proportion of AIDS cases diagnosed in non-metropolitan areas. Both AIDS incidence and mortality data suggest a possible shift in AIDS from urban to rural areas, and from coastal to interior parts of the country. Migration of persons with AIDS may be contributing to this shift. National strategies for prevention and treatment of AIDS should consider taking into account the geographic behavior of this epidemic. The analysis addresses this issue by summarizing current knowledge regarding the spread of AIDS in rural areas, describing the urban-rural migration patterns from a major U.S. urban epicenter and presenting new NYC data on migration of people with AIDS and previously unpublished AIDS mortality data by state.