The South has experienced the largest proportionate increase in persons with AIDS in recent years; however, there is little psychosocial and prevention research stemming from rural areas in the South where the stigma associated with HIV infection is widespread, resources are limited and community networks are tight. The proposed study seeks to fill the knowledge gap by collecting data on HIV infected individuals in six predominantly rural Southeastern states. The overall objective of the study is to learn more about psychosocial adaptation, utilization of physical, mental and non-traditional health services, attitudes about AIDS, and self-reported adherence to medical regimens of HIV infected individuals in the South. The rate of HIV infection among African-Americans is disproportionately high in the rural South relative to the size of the general population and the rate of HIV infection among women is high in the rural South relative to rates of HIV infection nationally. Therefore the analyses will compare men and women, those living in rural and urban areas, and African-American versus Caucasians on the variables listed above. We further wish to examine cross-sectionally and longitudinally the role of demographics and psychosocial adaptation (e.g., psychological symptoms, coping, social support, past trauma) on health status, quality of life, adherence to HIV treatment, and health care utilization. To address the above-mentioned aims, we propose to study 1000 HIV positive men and women living in rural and urban areas of the south. Patients will be recruited from selected Infectious Disease clinics in six southern states: Alabama, Georgia, Louisiana, Mississippi, North Carolina and South Carolina (11 clinics in all). Questionnaire and interview data will be collected at baseline and every 9 months for 3 years (5 data collection points in total). Baseline, 18 and 36-month data collection will be done in-person in either a private location at the clinic or in the home of the respondent. The 9and 27-month interviews will be done over the telephone. In addition, a yearly chart review will be performed during the 3-year study period to obtain information on disease status and utilization of health services from 1 year prior to study entry to 3 months after the final interview. We will also conduct a brief survey of clinicians who provide medical care for the patient respondents, requesting their demographics, training and experience, and attitudes toward poor individuals. A research survey company, Battelle, will be hired to perform all data collection, including recruiting and interviewing of subjects. The data analysis will result in a minimum of 12 peer reviewed journal articles.
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