By Stephen Spotswood
IOWA CITY, IA ― Veterans living in rural areas face a lot of challenges, the most common of which is having to travel long distances to access VA medical care. While community-based outpatient clinics (CBOCs) have helped bridge the gap between urban VAMCs and these veterans, they don’t entirely alleviate the difficulties.
For rural veterans needing regular specialty care, such as veterans diagnosed with HIV, those challenges are magnified. Now, with the help of telehealth technology, VA physicians are finding ways to bridge the distance between HIV specialists and the rural veterans that need them.
Michael Ohl, MD, MSPH, an infectious disease specialist at the Iowa City, IA, VAMC, has been working with HIV-positive veterans since his days as an internal medicine resident in San Francisco during the 1990s. “I trained in VAs in San Francisco and Seattle and worked in care in VA in every job I’ve had. It’s really part of my mission, working with that population,” he recounted.
Now in Iowa City, Ohl sees patients who sometimes drive hours to receive HIV specialty care. “I think there are challenges for people everywhere,” he said. “But there are some that are heightened in rural areas. Issues come up all the way along the continuum, from HIV testing to diagnosis to treatment.”
Rural veterans are less likely to have an HIV test, so when they are tested and found to be positive, they’re more likely to be tested with a more-advanced HIV infection. “Part of it is due to stigmas,” Ohl explained. “People don’t talk about it as much. And there are fewer people around with HIV, so people are less likely to think about it.”
Once a veteran knows he or she has HIV, the barriers are mostly geographic. State-of-the-art HIV care is generally delivered by specialists, and those tend to be located in urban centers. “If you need short-term care, that’s one thing. But if you need lifelong care, that can become burdensome.”