“It’s difficult to fathom the fear people have of others finding out they have this disease if you haven’t lived in a rural area,” agrees Sister Betty Ann McDermott of Sacred Heart Southern Missions AIDS Ministry in Walls, MS.
In rural areas, stigma occurs in combination with low population density and long distances, resulting in immense feelings of isolation for PLWHA and the assumption that no one nearby is also suffering from the disease. That lack of support, coupled with resistance to disclosure, can push some patients to refrain from seeking care.
“The thing that I wish for is the day we move this from the moral arena to the medical arena,” says Hiers. “The fact is that there are many people in this world who have had unprotected sex, and that’s really all it takes to get HIV. If people want to be so judgmental about it, it really doesn’t help our cause.”
Limited access to high-quality education can perpetuate this vicious cycle of stigma, infection, and lack of care. Some States have strict laws discouraging discussion of sexual health in schools, making it more difficult for young people to obtain vital information about sexually transmitted diseases and condoms. “Kids aren’t being armed with the information they need to keep from making bad decisions,” says Hiers.
Even health care providers with years of education in the health sciences are not immune to stigma; a few have been known to deny care to patients with HIV/AIDS.27 “Our dentist drives from Dallas to provide services—it’s a three-hour drive—because no dentist in our area will touch anyone with HIV,” says Young of SHRT in East Texas. “They’re afraid. And these are educated people.”
Fighting stigma in rural areas is no easy task. Stigma is so high in some areas that clinics must be careful of how they brand their services to avoid unwanted attention.28 PLWHA often don’t want to be seen receiving care at the local HIV clinic, and noninfected people may be reluctant to go to a dentist or doctor who also sees HIV patients. For providers, it’s a cruel Catch-22: They are charged with offering life-saving services to hard-to-reach populations for a disease that leads to immense feelings of isolation, but they struggle to spread the word efficiently.
Some providers have learned to fight the impact of stigma one on one. SHRT reaches out to the wives of church leaders across East Texas. By connecting with and educating respected leaders in her community, Young says her organization can spread the word about her clinic’s services and engage more people in care.