Living with HIV/AIDS in rural NC – An exploration of the physical and socio-cultural environmental barriers

Minorities in southeast rural communities are disproportionately affected by HIV/AIDS. Life with HIV/AIDS is shaped by the local community's socio-cultural and physical environment. Understanding disease experiences allows us to meet the needs of people living with HIV/AIDS (PLWHA). We present physical and socio-cultural barriers to service access and influences on living and coping with HIV/AIDS.

We conducted 35 individual interviews with PLWHA (30 English, 5 Spanish), 11 focus groups with community leaders and HIV/AIDS service providers (10 English, 1 Spanish), and supplemented these data with 5 Community Advisory Board (CAB) meetings. The CAB is comprised of leaders in these specified groups. Audio-taped and transcribed sessions were analyzed in a back/forth approach between discovery and verification of findings, and triangulated between sets of respondents.

Each set of respondents noted physical and socio-cultural factors that present barriers to service access and create difficulty in living with HIV/AIDS. Physical environmental aspects included distance to HIV/AIDS service sites (including clinical trials) and lack of available services and resources (e.g., counseling, clinical, housing). Socio-cultural environmental aspects included prevalent community-wide stigma, discrimination, confidentiality concerns, religious influences, alienation, and misperceptions of HIV transmission.

Understanding the context within which PLWHA live illuminates the barriers to service access, trial participation, and social functioning that impede quality of life. Creating forums for communities to reconstruct context in their own words, and using a CAB to clarify and inform findings, allows researchers and providers to address the multidimensional challenges to successfully living with and providing adequate services for PLWHA.