THE GEOGRAPHY OF AIDS - PATTERNS OF URBAN AND RURAL MIGRATION

We sought to describe the migration patterns of patients infected with the human immunodeficiency virus (HIV) who seek health services in No rth Carolina. Of 390 consecutive adult patients with HIV seen at one t ertiary care medical center in the southeastern United States in the s ummer of 1990, 340 (87%) were approached, and 325 (83%) completed surv eys. Thirty-seven percent of respondents thought they had been infecte d and 20% were told they were infected with HIV while living outside o f North Carolina. One in five patients thought they had been infected while living in a rural county and more than half now live in rural co mmunities (population of <50,000). Sixty percent of patients had moved to North Carolina since 1980; 61% of these were North Carolina native s. Injecting drug users were more likely than those with other modes o f exposure to HIV to have been diagnosed with HIV infection out of sta te (34% vs 18%). Patients' reasons for moving to North Carolina includ ed social support (88%), health reasons (54%), and better work/educati onal opportunities (52%). We found that most patients with HIV who see k health care services in North Carolina live in rural areas with thei r families, and a substantial proportion migrated in after they were d iagnosed out of state. Characterizing these migration patterns is cruc ial for predicting the diffusion of HIV to rural areas; designing AIDS prevention strategies, education, and health service needs; and asses sing federal HIV care funding policies.