Rural HIV Prevalence and Service Availability in the United States: A Chartbook


This chartbook examines 2016 HIV prevalence and the availability of HIV prevention, testing, and treatment services across the rural-urban continuum and by U.S. census region. Publicly available county-level HIV prevalence data from the Centers for Disease Control and Prevention and state-produced HIV surveillance reports were used to estimate HIV prevalence across the rural-urban continuum. HIV prevalence data include all diagnoses of HIV infection, with or without a stage 3 (AIDS) diagnosis. Geocoded data on organizations that provide prevention, testing, and treatment services related to HIV were obtained from the National Prevention Information Network.

HIV prevalence is higher in urban counties than rural counties (399 per 100,000 compared with 149 per 100,000, respectively), with prevalence decreasing with increasing level of rurality. HIV prevalence in urban counties is higher than HIV prevalence in rural counties in all but two states (South Carolina and Hawaii). The Northeast has the highest HIV prevalence (485 per 100,000) followed by the South (429 per 100,000), West (302 per 100,000), and Midwest (205 per 100,000).

Analyses of the availability of HIV-related services show that compared with urban counties, a smaller proportion of rural counties have organizations that provided HIV prevention, testing, and treatment services. The findings of this study may help inform policies that augment rural HIV prevention, diagnosis, treatment, and outbreak response efforts.

Maine Rural Health Research Center
Katherine Ahrens, Amanda Burgess, Louisa Munk, Erika Ziller