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 North Carolina. Of 390 consecutive adult patients with HIV seen at one tertiary care medical center in the southeastern United States in the summer of 1990, 340 (87%) were approached, and 325 (83%) completed surveys. Thirty-seven percent of respondents thought they had been infected and 20% were told they were infected with HIV while living outside of 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 communities (population of < 50,000). Sixty percent of patients had moved to North Carolina since 1980; 61% of these were North Carolina natives. Injecting drug users were more likely than those with other modes of exposure to HIV to have been diagnosed with HIV infection out of state (34% vs 18%). Patients' reasons for moving to North Carolina included social support (88%), health reasons (54%), and better work/educational opportunities (52%). We found that most patients with HIV who seek health care services in North Carolina live in rural areas with their families, and a substantial proportion migrated in after they were diagnosed out of state. Characterizing these migration patterns is crucial for predicting the diffusion of HIV to rural areas; designing AIDS prevention strategies, education, and health service needs; and assessing federal HIV care funding policies.