Keywords: HIV diagnosis, rural healthcare, social stigma, healthcare access, UK.

Background:

Late HIV diagnosis remains a significant public health challenge in rural and coastal areas of the UK, where limited healthcare access, social stigma, and low awareness exacerbate delays in testing. Early diagnosis is crucial in preventing progression to AIDS, saving lives, and reducing healthcare burdens. Understanding the barriers to timely HIV testing is essential to improving public health outcomes in underserved communities.

Aim of the study:

This review aimed to identify barriers to HIV testing and diagnosis in rural, remote, and coastal communities, exploring contributing factors such as geographical isolation, healthcare infrastructure, and social stigma. Key research questions were: What are the barriers to timely HIV testing in rural and coastal areas, and how can they be addressed to improve early detection and healthcare outcomes?

Methodology:

The systematic review included studies published between 2014 and 2024. Overall, 6465 studies were screened; 116 met the eligibility criteria, and 8 were included in the final review. Qualitative and quantitative research was included, and key criteria included adults or adolescents aged 15 or over from rural and coastal areas of the UK and studies reporting on late diagnosis and testing of HIV infections.

Results:

The review found that primary barriers included:
• Geographic isolation: long travel distances to healthcare facilities for treatment and testing.
• Limited healthcare resources: a shortage of HIV testing services in rural areas.
• Social stigma: cultural factors discouraging HIV testing.
• Lack of targeted education: Insufficient HIV awareness campaigns in rural settings.

Conclusions:

Overcoming these barriers requires targeted public health initiatives that are culturally appropriate and tailored to the place-based needs of rural communities. Comprehensive education and training for health and social care professionals in geographically isolated and peripheral populations could significantly improve early HIV diagnosis, treatment, and care.