People living with HIV/AIDs in the Rural South

A recent article in the The Washington Post describes the difficulties faced by people living with HIV/AIDS (PLWHA) in the South. While nonprofit organizations, such as the Southern Aids Coalition, continue to advocate for increased awareness and funding, budget cuts threaten the availability of medical care and prescription drugs for PLWHA in the South.

The author, Teresa Wiltz, points to “social factors such as poverty, persistent anti-gay attitudes and a lack of transportation in rural areas” as leading factors that result in the higher rates of HIV in the South. A report released in 2013 by the SCRHRC on HIV/AIDS in Rural America found that in 2008, the South had the highest prevalence rate of PLWHA of the 28 states analyzed. 

Using 2010 data obtained by AIDSvu.org, we were able to map the rate of persons living with an HIV diagnosis by rurality (below). The dark shades of green (urban) and red (rural) indicate an above median rate of persons living with HIV. 

Map created by South Carolina Rural Health Research Center
Source: AIDSvu.org 2010 data

The map illustrates that Southern states are concentrated with high levels of HIV prevalence. As pointed out in the Washington Post article, an additional obstacle faced by Southern states is the decision to not implement Medicaid Expansion. This disproportionately impacts uninsured individuals, many of whom are minorities, as described in an infographic published by the Kaiser Family Foundation in JAMA. 

Access to care and the availability of discounted or free prescription drugs for PLWHA in the South continues to be of concern. Rural areas in the South are faced with the added barriers of lack of transportation, low awareness/education, and poverty.

Rural Medicare Advantage Enrollment--yet another disparity

Recently, Medpac released a statement debunking the thought that up to one-half of all new Medicare enrollees were choosing Advantage plans.  Their analysis indicates that this percentage is only 24%, with 28% of the overall Medicare population enrolled in Advantage plans.

This enrollment is much lower, however, among Rural populations  The RUPRI Center for Rural Health Policy Analysis estimate that less than 18% of rural beneficiaries are enrolled in Advantage plans, a majority of which are actually PPO plans.

Why is this lower percentage significant?  Advantage plans often offer additional benefits (such as dental or vision), care coordination, and lower out of pocket costs for their enrollees.  These benefits do come with a tradeoff in more restrictive networks and services, but it is one often beneficial to the individual.

Rural residents, much like everything else in health care, have a reduced access to Advantage plans.  An insurance industry analysis indicates that rural residents have fewer Advantage options, the premiums are higher, and have fewer benefits than those offered in urban areas.

While this may explain the lower enrollment proportion, it also indicates yet another area in which rural residents may be left behind.