Healthcare resource disparities for persons living with HIV and AIDS (PLWHA) in North Carolina and South Carolina

Background: Individuals in the Southern U.S. are disproportionately affected by HIV/AIDS. In 2009, SC and NC ranked in the top twelve states for AIDS case rates. In order to manage this chronic disease, we must determine if prevalence estimates are matched by an adequate availability of resources. Methods: We used a cross-sectional design to examine rural-urban differences in the prevalence of PLWHA and the presence of RW programs in NC and SC counties. The independent variable was rurality, measured at the county level (n=146). The dependent variable was presence of at least one Ryan White (RW) service program. Prevalence was estimated at the county level for 2008. Results: Of the counties studied 58% (n=85) were rural and 41% (n=61) were urban. In SC, the mean prevalence of PLWHA in rural counties (n=25) is 2.32/1,000, and 1.89/1,000 in urban counties (n=21). NC had a mean prevalence of PLWHA of 0.73/1000 in rural counties (n=60) and 0.94/1,000 in urban counties (n=40). There was no significant difference in prevalence of PLWHA in rural-urban counties of NC and SC. However, there was a significant rural-urban difference in availability of RW programs. Across states, 91% of rural counties lack a RW program (93% of NC counties and 84% of SC counties). Eighty-four percent of all counties do not offer RW programs. Conclusion: Findings underscore the importance of rural-urban resource disparities for PLWHA. Rural-urban counties have similar prevalence estimates, but significant resource variability. These results should be considered for rural-urban HIV/AIDS resource allocation.