Despite that diversity of experiences, rural Americans face some common challenges. Issues such as health disparities, poverty, workforce shortages, and lack of transportation all interact, causing additional complexity. In rural areas, these challenges are severe and can often seem insurmountable.
For example, nearly one-half of rural residents suffer from a major chronic illness, yet rural residents average fewer medical appointments than their urban counterparts.6 Rural residents are also less likely than urban residents to be tested for HIV and thus, often present later for care and treatment.7,8 This may, in part, have to do with the fact that rural Americans are more likely than urban Americans to live below the Federal Poverty Line (FPL),9 which can lead to inadequate health insurance coverage.
Shortages of available doctors make health care, notably specialty care, even more difficult to obtain. In Alaska, access to emergency care often requires a plane ride. In some parts of rural North Carolina, patients must board Medicaid buses at 5 a.m. for an all-day excursion to one of the State’s large research hospitals—assuming, of course, that they can get the day off of work to do so.
What’s more, a dearth of public transportation can be a struggle for people without access to cars.10 Bridget Ware, a regional liaison in HRSA’s Office of Rural Health Policy, recalls a story of a man riding his tractor to go to the clinic and pick up his medications because he lacked other transportation.
In an effort to improve access to care in remote areas, some Ryan White providers distribute gas cards to patients to assist with their medical-related travel expenses.
Long travel distances and low population density also can make community support seem out of reach—especially where it pertains to stigmatized issues such as sexually transmitted infections (STIs), depression, or alcoholism. Factor in a lack of programs addressing substance abuse and mental health, and it’s clear that problems that could be readily addressed in an urban setting can become a massive challenge in rural America.
HRSA’s Early Response
On March 20, 1987, the U.S. Food and Drug Administration (FDA) approved zidovudine (AZT), the most effective drug to date for the treatment of AIDS, and the first anti-HIV drug approved for use in the United States.11 Working hard to ensure that this medication got into the hands of patients in need, HRSA quickly launched its AZT Drug Reimbursement Program. This program brought life-prolonging treatment to people who lacked insurance coverage or the financial resources to acquire AZT on their own. The funding was available to all 50 States, and though most of the funds went to more urbanized States, the program did represent another step forward in fighting HIV/AIDS in rural areas.12