Global Health Institute

Since June 1981, the HIV/AIDS epidemic has claimed hundreds of thousands of lives. Today, over 1.1 million people live with HIV throughout the United States. Studies have indicated that the epidemic has differentially impacted individuals living in urban and rural areas. According to CDC surveillance of HIV in urban and nonurban areas through 2016, of adults and adolescents diagnosed with HIV, there is a substantially larger percentage who have progressed to AIDS. Between 1985 and 2015, HIV-positive individuals who have progressed to AIDS in larger urban areas have progressively decreased while those of smaller cities (populations of 50,000 to 499,000) and metropolitan areas have increased. A secondary analysis of 2005 and 2009 Behavioral Risk Factor Surveillance System data found that individuals living in rural areas are less likely than their urban counterparts to report prior HIV testing, which may contribute to later HIV diagnosis in rural areas. Limited HIV testing is simply a symptom of a larger problem: disparities in healthcare access. 20 percent of Americans live in rural areas, yet only 9 percent of physicians practice there. A strong health infrastructure that provides essential prevention and care, therefore, is integral to reducing the impact of HIV/AIDS.

After looking down at my watch which showed four minutes past the hour, I hurriedly scampered through the streets of Georgetown towards the Berkley Center. My final clinic patient, whom I had just left, had arrived late and presented an issue which required more than the standard 20 minutes allotted per appointment. I had patiently listened to her concerns, conducted a physical, and presented an assessment and plan to the attending physician. As soon as the appointment ended, I excused myself and stuffed my white coat and stethoscope into my backpack, which I later shoved under my chair, the last available seat in a room filled with students waiting to hear a Conversations in Global Health lecture. As I settled myself, I heard our speaker introduced: Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health. As my heart rate relaxed, I wondered, “How in the world do I get from here to there?”