Rural HIV Service Needs, Barriers, and Social Determinants of Health across 51 Counties In East Texas: Findings from a 2025 Comprehensive Needs Assessment

Background and Purpose: Rural people living with HIV (PLWH) experience persistent disparities in prevention, care engagement, mental health access, and supportive services due to geographic isolation, transportation constraints, provider shortages, stigma, and socioeconomic disadvantage (Quinn et al., 2022; Carbajal, 2023; Carbajal & Cordova, 2024; Carbajal & Cooper, 2026). East Texas comprises five HIV Service Delivery Areas (HSDAs)—Texarkana, Tyler, Lufkin, Beaumont, and Galveston—spanning 51 counties with heterogeneous service capacity. Using primary data from the 2025 East Texas HIV/AIDS Administrative Service Area (HASA) needs assessment, this study aimed to (1) describe access to and unmet need for HIV-related medical and supportive services; (2) identify barriers to service utilization; and (3) characterize co-occurring mental health and social determinants of health (SDOH) needs relevant to retention in care and well-being.

Methods: A cross-sectional mixed-methods needs assessment survey was administered through community sites via focus groups and one-on-one sessions. After data cleaning, the analytic sample included 358 PLWH from all five HSDAs: Texarkana 17% (n=61), Tyler 27% (n=98), Lufkin 15% (n=54), Beaumont 28% (n=99), and Galveston 13% (n=46). The survey included demographic items; measures of HIV care engagement and health perceptions; and items assessing access, unmet needs, and barriers across 15 Ryan White–funded service categories. Descriptive analyses summarized frequencies and percentages overall and by HSDA.

Results: Across HSDAs, most respondents reported relatively easy access to core HIV medical services (doctor visits: 76–86%; HIV medication: 73–82%; case management: 65–87%). Substantial gaps persisted for supportive services, with common barriers including transportation challenges, financial strain, limited awareness of available services, application complexity/administrative burden, provider availability, and scheduling constraints—especially affecting oral health care, emergency financial assistance, housing programs, and mental health counseling. The mental health burden was high; respondents frequently reported anxiety, sadness, loneliness, difficulty concentrating, and insomnia. Diagnosed conditions were common (depression: 25–43%; anxiety/panic disorders: 16–28%; bipolar disorder: 13–22%; PTSD: 6–20%; schizophrenia/psychosis: 7–8%). HIV-related stigma remained significant (9–19% reported differential treatment, harassment, or threats due to HIV status). Structural vulnerabilities were prominent: 18–33% reported difficulty obtaining or maintaining stable housing, and up to 41% reported difficulty accessing healthy food. Prevention knowledge was mixed; although many had heard of U=U, PrEP, and PEP, meaningful knowledge and access gaps persisted.

Conclusions and Implications: Findings indicate that while core components of the HIV care continuum are functioning for many rural PLWH in East Texas, supportive service gaps and SDOH constraints continue to undermine equitable outcomes. Practice implications include trauma-informed, culturally responsive mental health supports; transportation coordination; housing stabilization; and client navigation strategies that reduce administrative burden. Policy implications include targeted investments to strengthen rural supportive-service infrastructure and anti-stigma strategies. Future research should test rural-specific, multi-sector interventions integrating HIV care, mental health, housing, and transportation to improve retention, quality of life, and equity across rural service regions.