Written by Ashlee Folsom, Prevention & Outreach Specialist for Southwest Iowa

In April 2018, I started a project funded by the Iowa Department of Public Health, to increase HIV testing in rural Southwest Iowa.  Since the project began, I have had a lot of success building relationships with community service providers and clients, providing HIV testing, and connecting clients to needed services.  However, I have also encountered an important roadblock: stigma. 

I have taken time to build relationships to overcome stigma.  When I started the project, I reached out through existing agency partners to connect with community service providers in Southwest Iowa.  Although many providers were excited about the project and saw the need their clients had for HIV testing and other related services, several community service providers commented that they did not provide HIV testing or other related services to their clients, due to a lack of HIV in the area.  I have worked to overcome this stigma among community service providers in several ways.  First, I have relied heavily on the IDPH Rural Outreach Liaisons.  The information they share with medical and other community service providers has been wonderful to dispel myths about HIV in rural Iowa.  Next, I have been so grateful for print and media information from IDPH, on current Iowa HIV statistics.  Furthermore, I have continued to build relationships by attending community collaboration meetings and networking in person with community service providers.  Building trust among community service providers is a key step to the success of my project. 

As I have continued my project and worked directly with clients, I have also heard many myths that are contributing to stigma.  Many clients have said they feel that HIV doesn’t happen in their town, that they would definitely know if they had a HIV due to symptoms, that they can tell by looking at a person if the person has HIV, that they definitely don’t have HIV because they are in a long term relationship, or that they have been tested for all HIV due to having blood drawn at some point.  To overcome this stigma, I have found it best to provide HIV 101 education to groups of clients, right before offering testing.  I am able to build rapport and dispel myths, so that clients feel comfortable, and see the importance of HIV testing.  Providing education first, and testing after is also a key step to the success of my project.  I also find that encouraging clients to test by offering other services, such as Hepatitis testing, or conducting testing at an agency where other services are happening at the same time (vaccinations, a free health clinic, or health fair) works great.  Clients are more likely to get tested for HIV if they can also receive these other services.  Furthermore, I find that offering a prize for testing gives clients an “excuse” if they really want to get tested — but they can tell their friends they just want the free T-shirt.     

In conclusion, I have had to work to overcome stigma related to HIV in rural Iowa.  The steps I have used to overcome stigma have helped the success of my program.  Most importantly, connecting with community service providers, providing education to clients, and offering HIV testing along with other services has helped me overcome stigma and increase HIV testing in rural Southwest Iowa.