John F. Yannessa, MS¹, Michael Reece, PhD, MPH¹, and Larry Jimison². (1) Department of Applied Health Science, Indiana University, HPER Building 116, 1025 East 7th Street, Bloomington, IN 47405-7109, (812) 855-6797, jyanness@indiana.edu, (2) Indiana State Department of Health, 2 N. Meridian Street, 6-C, Indianapolis, IN 46204

Background: HIV continues to be an increasingly important issue for rural America. Recent literature has documented growing concerns over dual diagnoses among individuals living with HIV in these areas. Previous research has investigated these issues from a client perspective, but limited research has investigated provider perspectives of rural issues surrounding HIV and substance abuse. The purpose of this research was to examine issues that impact the ability of care providers to create sustainable linkages to care sources for rural duel diagnosis clients. Method: To better understand the multiple ways that stigma manifests itself in rural communities, semi-structured, in-depth interviews were conducted with 39 HIV service providers at 11 agencies in rural communities throughout the state of Indiana. Results: Stigma emerged as the leading factor that presents challenges to service providers in rural areas and limits their ability to provide effective services for duel diagnosis clients. Stigma manifests itself in rural communities on three primary levels, including: client stigma, provider stigma, and stigma related to public health infrastructure. Among the identified impacts of stigma were poor treatment of duel diagnosis clients by referred medical staff, refusal of primary medical staff to provide clients with specialty referral, and refusal of free medications to rural HIV clients when available. Conclusion: Stigma continues to be a major factor in the ability of rural America to deal with the growing HIV epidemic. Through strategic efforts to address stigma on all levels, rural providers may build their capacity to better provide services and strengthen HIV-related infrastructures.

Learning Objectives:

• Goals
• 1. Participants will recognize the many ways stigma manifested itself in rural communities.
• 2. Participants will be able to describe specific ways that care providers can work together to overcome the barriers to care created by stigma.

Keywords: HIV/AIDS, Rural Populations

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.