90 Minute Workshop & Poster presentation

Category: Care & Services

Presentation Date & Time: 03/25/98 15:45:00

Background: HIV is increasing in rural areas at a faster rate than more urban areas. Little is known about the epidemiology of HIV in these rural areas. Vermont is one of the most rural states in the nation. The Comprehensive Care Clinics (CCC) are four HIV specialty clinics that provide care to the majority of patients with HIV in Vermont. Methods: Since 1994, an 11-page evaluation questionnaire has been used to collect demographic, transmission risk, and health status information on patients with HIV upon entering the clinics. Results: Between 1994 and 1997, there has been a 19% increase in patients with HIV seen in the CCC program (189 to 225 patients). The annual number of follow-up visits has doubled from 843 to greater than 1600. At the same time, the rate of newly diagnosed AIDS cases in Vermont has decreased by 32%. A total of 299 patients have been cared for by the CCC program over the last three years. Eighty-four percent of patients are men and 85% Caucasian. The mean age is 38.9 years with a range of 17-73. Transmission risk is: men having sex with men - 49%, men having sex with men and intravenous drug users - 5%, intravenous drug users only - 17%, heterosexual contact - 20% and blood products - 1%. Only 19% of patients feel that they were infected in Vermont, while 64% feel they were infected in a state other than Vermont. The majority of patients have advanced disease upon entering into the CCC program: 62% have CD4 counts <500, and 43% meet the criteria for AIDS. Eighty percent of patients have a high school or less education. Sixty-one percent are either disabled or unemployed. Thirty-four percent have Medicaid, 17% no insurance, 16% Medicare, 13% private insurance, 8% BC/BS and 12% self pay or another combination. Financial support, if patients are not working, is predominantly from disability (59%) and welfare (15%). Only 60% of patients live in their own home or apartment. Conclusions: Vermont is seeing an increasing incidence of HIV infection, although less patients are progressing to AIDS. Most of the patients were infected outside of the state. The majority present for care with advance HIV infection. The patient population is relatively poor with limited education and inadequate health insurance. Although rural states, such as Vermont, may have lesser numbers of patients with AIDS, they require more patient visits. Patients appear to be waiting longer to receive health care and may need more outreach and case management services.