From the beginning of the U.S. epidemic, people have thought of AIDS as an urban disease. However, HIV and AIDS are more common in rural America than many people realize – and continuing to grow, particularly in the South. On a percentage-of-growth basis (not the absolute number, but the growth rate) many of the fastest-growing areas are predominantly rural or small-town.
The total number of AIDS cases in rural areas is still much smaller than in big cities; however, the resulting economic impact can be devastating. Many rural areas lack clinics or doctors that are adequately prepared to deal with the disease, and the cost of the new therapies can be prohibitive.
The face of AIDS is changing; increasingly heterosexual, minority, and female. However, some challenges remain the same, as infected people in rural areas still face the biases that confronted urban folks in the 1980s. Furthermore, AIDS prevention can be a difficult subject to address, especially when talk about sex is frequently taboo. Until small-town America is willing to discuss the issues openly and honestly, we will not make the beast go away.
This article appears in September 3 • 1999.