Abstract

Background. Too little is understood about the spread of the acquired immunodeficiency syndrome (AIDS) in rural America. This study focuses on changes over 5 years in two low prevalence and two high prevalence human immunodeficiency virus (HIV) rural service areas.

Methods. An initial study conducted in 1993 provided a base line for the study. Each site was revisited in the summer of 1998. Data were analyzed by degree of rurality of the site, prevalence levels, and risk categories.

Results. Changes in the number of AIDS cases ranged from slow steady growth to increases of an epidemic magnitude. Some settings were characterized primarily by white homosexual men, and others had a more diverse population living in poverty.

Conclusions. Populations receiving priority for national AIDS funding should be expanded to include rural America as a target group, and funding should provide the latitude for communities to match their local needs.