HIV testing and HIV/AIDS treatment services in rural counties in 10 southern states: service provider perspectives.

CONTEXT: Forty percent of AIDS cases are reported in the southern United States, the region with the largest proportion of HIV/AIDS cases from rural areas. Data are limited regarding provider perspectives of the accessibility and availability of HIV testing and treatment services in southern rural counties. PURPOSE: We surveyed providers in the rural south to better understand: (1) the accessibility and availability, and (2) the facilitators and barriers of HIV testing and treatment services. METHODS: All county health departments (N = 326) serving populations of <50,000 persons, within 10 southern states, were mailed surveys. Responding health departments identified up to 3 HIV testing sites and up to 3 HIV treatment sites to which they refer clients. FINDINGS: Overall, 243 of 326 (75%) health departments, 133 of 250 (53%) HIV testing sites, and 73 of 152 (48%) HIV treatment sites responded to the surveys. The number of testing sites per county ranged from 0 to 20; the number of treatment sites ranged from 0 to 4. An average distance of 50 miles for clients to travel for HIV treatment was reported by health department respondents as a barrier. Facilitators of HIV testing were (1) integrating HIV testing into other health services; (2) using rapid HIV testing; and (3) establishing easily accessible HIV testing locations and free testing services. CONCLUSION: Providers perceive that distance from local health departments to HIV treatment sites presents a barrier to HIV care for their clients. Future studies should ascertain clients' perspectives to ensure appropriate service provisions.

Predictors of HIV risk among Hispanic farm workers in South Florida: women are at higher risk than men.

This study examined factors associated with being at risk of sexually acquiring HIV among a community sample of 244 Hispanic migrant and seasonal farm workers. Bilingual staff interviewed respondents anonymously at worksites, camps, and other public venues in South Florida during the 2002 winter/spring growing season. The following variables were positively associated with being at risk of sexually acquiring HIV in multivariable analyses: being female; being married; having "some" or "a lot" of knowledge about HIV transmission, having ever used marijuana, having two or more sex partners in the last 12 months, and having had a sexually transmitted infection. The findings heighten the importance of recognizing women's elevated risk of HIV infection and conducting further studies to examine the factors associated with this increased risk. The study is an important first step toward developing tailored HIV prevention interventions for this at-risk, understudied population.