The association between substance use, HIV, and other sexually transmitted diseases is well established in the literature (CSAT, TIPs 17 and 20, 1995). While much of our focus has been traditionally on the metropolitan areas and "hot spots" due to their dense population base and high prevalence for substance abuse and infectious disease, there is a growing awareness of the need for Cross-Training in rural communities. Statistics have shown that:

• Persons using substances may be at a greater disadvantage because of individual resistance to access services if they fear disclosure and consequences for their substance use-related behaviors (CSAT, TIP 20, 1995).
  
  
• The decrease over the years in screening resources in the United States may further complicate the burden of STDs on rural populations because of barriers to health care (CSAT, TIP 20, 1995).
  
  
• Denial of vulnerability to HIV infection is common among rural residents, and may mean they are less likely to change risky sexual behavior than urban and suburban residents (Rural Center for AIDS/STD Prevention, 1998).
  
  
• The South has reported more cases of AIDS than any other region of the U.S. since the mid-1980's, and the number of rural AIDS cases in the South is significantly higher than in other regions (Rural Center for AIDS/STD Prevention, 2002).
  
  
• Health care access is worse for rural minority populations than their urban counterparts. In addition, these communities are not typically involved in the development and implementation of community-based health care initiatives, and are underrepresented in the health professions workforce (National Rural Health Association, 2001).