title: What about Us? Economic and Policy Changes Affecting Rural HIV/AIDS Services and Care.
abstract: Health care budgets and policies are chief drivers in the delivery and access to health services. Place is also a factor that affects patient and provider experiences within the health care system. We examine the impact of policy changes and subsequent budget cuts on rural HIV/AIDS care, support services, and prevention. We interviewed 11 social workers, case managers, and outreach workers who serve rural people living with HIV/AIDS. We conducted telephone interviews inquiring about the effect of economics and policies on direct practice with rural clients. We analyzed data using a content analysis approach. We found several themes from the data. Ryan White funding and policy changes shifted direct practice to a medical case management model. Changes in federal and state poverty levels affected client eligibility for the AIDS Drugs Assistance Program. Policy banning financial support for syringe service programs hindered prevention efforts to reduce HIV/AIDS transmission. Ancillary services were reduced, such as housing assistance, transportation, and emergency financial assistance. In conclusion, we highlight the importance of place-based policies to improve access to healthcare and services. We also provide recommendations for greater inclusion in HIV/AIDS-related policy development, care, and service planning for rural workers.
authors.affiliation: a Department of Community Health and Social Medicine, CUNY School of Medicine, City College of New York , New York , New York , USA.
authors.forename: Tashuna
authors.initials: T
authors.lastname: Albritton
authors.affiliation: b Department of Social and Behavioral Sciences , Harvard University , Cambridge , Massachusetts , USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Martinez
authors.affiliation: c Wisconsin Department of Health Services , Madison , Wisconsin , USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Gibson
authors.affiliation: d Epidemiology, Emory University , Atlanta , Georgia , USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Angley
authors.affiliation: e Yale University , New Haven , Connecticut , USA.
authors.forename: Valen R
authors.initials: VR
authors.lastname: Grandelski
mesh_terms: D015658:HIV Infections; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence*; D006801:Humans; D007407:Interviews as Topic; D011050:Policy Making; D036301:Qualitative Research; D012423:Rural Health; D012947:Social Work; D014481:United States
keywords: HIV/AIDS; health policy; place-based policy; rural health; social work