The emerging epidemiology of rural AIDS.

The incidence of AIDS in rural areas is increasing rapidly. However, historically it has been overshadowed by AIDS in the epicenters. From 1991-1992 the increased percentage of cases was higher in nonmetropolitan areas than in any other areas of residence. The rate per 100,000 also increased at almost the same rate in rural areas as in the largest metropolitan areas, defined by the Centers for Disease Control (CDC) as having a population of more than 500,000, and in other metropolitan areas of 50,000 to 500,000 population, as designated by CDC. To date, the epidemiology of AIDS in rural areas has not been defined. This information is necessary to developing effective policies and programs. The research presented here reviews the literature on AIDS in specific areas and populations at risk as a basis for generating hypotheses for further study. The first wave of the epidemic, primarily affecting homosexual or bisexual men, is strongly evident in many rural locations. The second wave of the epidemic is strongly evident in the South and can be seen among high-risk groups such as black women, adolescents, migrant and seasonal farm workers, people who abuse alcohol, intravenous drug users, and users of crack cocaine, including those who trade sex for drugs. Poverty is a common characteristic of the second-wave population. Proximity to interstate highways as well as metropolitan areas may also be associated. A national study of the epidemiology of AIDS in rural America is imperative.