OREGON STATE UNIVERSITY

Adults with HIV in Rural Areas Experience Discrimination, Stigma

04/16/2009

CORVALLIS, Ore. – A new study by Oregon State University researchers shows that rural residents in Oregon who have HIV/AIDS experience stigma and discrimination in day-to-day living and when accessing health care services.

Ann Zukoski and Sheryl Thorburn, faculty members in OSU’s Department of Public Health, conducted the exploratory study interviewing 16 people living with HIV/AIDS. The results of their research are published in the April issue of the Journal of AIDS Patient Care and STDs.

The interview subjects lived in a four-county region in rural Oregon and were diverse in terms of their health and demographic characteristics.

“The majority of research on the impact of stigma and discrimination and HIV/AIDS has focused on urban populations,” Thorburn said. “In fact large numbers of people with HIV and AIDS live in rural areas. We wanted to better understand how people living with HIV in rural areas and small towns, where there generally are fewer resources and less anonymity, experience and respond to acts of stigmatization and discrimination.”

The types and depth of stigma and discrimination experienced by the interviewees was profound, the researchers said. Of the 16 participants, 11 reported feeling stigmatized or having one or more instances of being judged unfairly, treated with disrespect, or discriminated against when interacting with health care providers. Among the examples:

• One interview subject reported that a health care professional left the room to put on “thicker” gloves to take a blood pressure reading;
• One dentist refused to look inside the patient’s mouth, telling the patient she had to go to the city for treatment;
• Another participant described this experience with a dermatologist: “He wouldn’t treat me once I told him I was HIV-positive…”;
• One described this reaction from a nurse, who commented to the participant, “You sure look different than what I had pictured.”

As of 2005 more than 48,000 people in the United States diagnosed with AIDS were living in communities with 50,000 or fewer inhabitants. Another 83,372 are living in smaller cities of populations less than 500,000.

Zukoski said that the stigmatization and discrimination faced by those living with HIV may be intensified in a rural setting.

“There is less tolerance of people living with this disease in rural areas and this intolerance is intensified by peoples’ lack of access to transportation, limited access to health professionals, and a lack of social support services,” Zukoski said, adding that in some cases there is only one case manager who works two mornings a week for each county.

The researchers point out that very few studies have been done with people living with HIV/AIDS in rural areas. “While community interventions to address HIV-related stigma have occurred in urban settings, little work has been done in rural areas,” Zukoski said.

She said more research needs to be done to address the impact this discrimination might be having on health care access, as well as research on which specific rural-based interventions might be effective.