Sarnquist Clea C, Soni Shila, Hwang Helen, Topol Barbara B, Mutima Salima, Maldonado Yvonne A
Pediatric Infectious Diseases, Stanford University School of Medicine, CA, USA.
AIDS Care. 2011 Jul;23(7):792-6. doi: 10.1080/09540121.2010.516345.
HIV-infected women living in rural areas often have considerably less access to care than their urban and suburban counterparts. In much of the USA, little is known about HIV care among rural populations. This study elucidated barriers to care for rural women in California. Methods included retrospective structured interviews conducted with 64 women living in rural areas and receiving HIV care at 11 California healthcare facilities. Facilities were randomly sampled and all HIV-infected female patients seeking care at those facilities during a specified time period were eligible. The most commonly cited barriers to accessing care included physical health problems that prevented travel to care (32.8%), lack of transportation (31.2%), and lack of ability to navigate the healthcare system (25.0%). Being divorced/separated/widowed (compared to being either married or single) was associated with reporting physical health as a barrier to care (p=0.03); being unemployed (p=0.003) or having to travel 31-90 minutes (p=0.007, compared to less than 31 or greater than 90) were both associated with transportation as a barrier; and speaking English rather than Spanish was associated with reporting "difficulty navigating the system" (p=0.04). Twenty-nine women (45.3%) reported difficulty in traveling to appointments. Overall, 24 (37.5%) women missed an HIV medical appointment in the previous 12-month period, primarily due to their physical health and transportation limitations. Physical health and transportation problems were both the major barriers to accessing health services and the primary reasons for missing HIV care appointments among this population of HIV-infected women living in rural areas. Providing transportation programs and/or mobile clinics, as well as providing support for patients with physical limitations, may be essential to improving access to HIV care in rural areas.
生活在农村地区的感染艾滋病毒的妇女获得护理的机会往往比城市和郊区的妇女少得多。在美国大部分地区，农村人口的艾滋病毒护理情况鲜为人知。本研究阐明了加利福尼亚州农村妇女获得护理的障碍。方法包括对64名居住在农村地区并在加利福尼亚州11家医疗机构接受艾滋病毒护理的妇女进行回顾性结构化访谈。医疗机构是随机抽样的，在特定时间段内在这些机构寻求护理的所有感染艾滋病毒的女性患者均符合条件。获得护理最常被提及的障碍包括妨碍前往就医的身体健康问题（32.8%）、缺乏交通工具（31.2%）以及缺乏应对医疗系统的能力（25.0%）。离婚/分居/丧偶（与已婚或单身相比）与将身体健康报告为护理障碍相关（p=0.03）；失业（p=0.003）或必须出行31 - 90分钟（与少于31分钟或多于90分钟相比，p=0.007）均与将交通作为障碍相关；说英语而非西班牙语与报告“应对系统困难”相关（p=0.04）。29名妇女（45.3%）报告前往就诊有困难。总体而言，24名（37.5%）妇女在过去12个月内错过艾滋病毒医疗预约，主要原因是她们的身体健康和交通限制。身体健康和交通问题既是获得医疗服务的主要障碍，也是这一农村地区感染艾滋病毒妇女群体错过艾滋病毒护理预约的主要原因。提供交通项目和/或流动诊所，以及为身体有局限的患者提供支持，对于改善农村地区艾滋病毒护理的可及性可能至关重要。
