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Background:  The HIV epidemic has moved into rural America, especially the southeastern states. Risk reduction counseling by primary care providers for persons living with HIV is considered a key element in prevention of HIV transmission, but little is known about risk reduction counseling by rural providers. We report the results of a survey of HIV care providers that assesses risk reduction counseling by rural and urban practitioners in 2 southeastern states.

Methods:  Physicians, nurse practitioners, and physician assistants who care for HIV-infected adults in Florida and South Carolina were mailed a self-administered survey that included questions about training, practice characteristics, perceptions of various aspects of care, and risk-reduction counseling.

Results:  Surveys from 162 physicians (71%) were received and form the basis of this report. These included 83 BE/BC ID specialists, 71 BE/BC internists, 35 BE/BC family practice doctors, 13 general practitioners, and 16 with other training. ID specialists accounted for 59% of the 105 urban practitioners, but only 21% of the 72 rural practitioners. For newly diagnosed HIV-positive (HIV⁺⁾ patients, urban providers were less likely than their rural counterparts to provide risk counseling (odds ratio (OR) 0.35, 95%, confidence interval (CI) 0.14 to 0.87; p =0 02) Also, male providers were less likely than female providers to provide risk counseling (OR 0.26, 95%, CI 0.088 to 0.778; p = 0.016). Shifting the focus to established HIV⁺ patients, urban providers were less likely than rural providers to provide counseling (OR 0.45, 95%, CI 0.215 to 0.951; p = 0.037) adjusting for race/ethnicity, gender, provider’s training, and numbers of HIV⁺ patients the provider currently served. Interestingly, non-ID trained providers were more likely to provide risk-reduction counseling than ID specialists (OR 2.42, 95%, CI 1.09, 5.33; p = 03)

Conclusions:  We found that rural practitioners in Florida and South Carolina provide more prevention counseling than do their urban counterparts to all HIV⁺ patients, and ID specialists do less than do non-ID specialists when providing care to established HIV⁺ patients. It is imperative to continue prevention counseling to all HIV⁺ patients throughout the course of their disease. Our study confirms a need for greater emphasis and training on the delivery of prevention counseling, especially for urban providers and ID specialists caring for persons living with HIV.

Keywords: HIV/AIDS; Rural; Medical Providers