Background: This study examines disparities in HIV-related healthcare access, support, and treatment adherence between rural and urban Black/African American populations in Georgia, USA, emphasizing structural, socioeconomic, and stigma-related barriers affecting health outcomes. Methods: A cross-sectional quantitative study was conducted using structured surveys administered via RedCap from August to December 2023. Participants (n = 55) were recruited through community-based HIV organizations, healthcare providers, and advocacy networks. The survey assessed demographic factors, healthcare access, adherence to treatment, support systems, and experiences with stigma. Data were analyzed using IBM SPSS Statistics, version 28.0 (IBM Corp., Armonk, NY, USA), with chi-square tests examining associations between geographic location and HIV-related outcomes. Results: Findings indicate significant disparities in HIV care access and support. Urban participants were more likely to receive family and friend support (p < 0.01), financial assistance through the Ryan White Program (p = 0.01), and timely linkage to care within one week of diagnosis (p < 0.05). Rural participants reported lower educational attainment, income levels, and limited healthcare access, contributing to poorer health outcomes. No significant differences were observed in PrEP or condom use. Conclusions: The study underscores the need for targeted interventions. Expanding telehealth, enhancing community outreach, and reducing stigma through policy reforms are critical to improving HIV-related health outcomes in rural Georgia.