Outcasts in the Country

Two decades after AIDS was first diagnosed in the United States, health experts say the stigma attached to the disease has lessened in the urban communities that are home to 80 percent of US AIDS patients. But fear and ignorance linger in rural communities, even as these experience a growing incidence of HIV infections. About 7 percent of AIDS cases are in rural areas, up from 6 percent in 1994, according to the CDC. Yet in rural America, primary care physicians are often scarce, and support programs rarely exist -- and even when they do, accessing them can be difficult due to the travel required or fear of exposure. Health experts say the incidence of HIV in rural areas may be higher than is known because the residents there are less likely than city dwellers to seek testing -- even as they engage in high-risk behaviors because they believe their communities are invulnerable. "You have kids experimenting with unsafe sex, religious traditions that don't allow for condoms and schools that don't allow frank discussions [about] sex. All those are ingredients for disaster," said Dr. Martin W. Gallagher of Hagerstown, Md. Some rural pharmacists profess ignorance when handed a prescription for AIDS drugs. Some rural doctors claim the small number of HIV patients in their town does not justify their keeping up with the complex disease's developments. Others hesitate to treat HIV patients for fear of being branded as an "AIDS doctor."

Rhonda Norris, executive director of AIDS Response Effort in Virginia's Winchester County, Md., said her agency's name alone frightens prospective clients, prompting many to drive to Washington, D.C., or West Virginia, so they won't be recognized. "All those things that were stigmatized at the very onset of the disease are still very much present here," she said.

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