HIV Risk Behaviors and Utilization of Prevention Services, Urban and Rural Men Who Have Sex with Men in the United States: Results from a National Online Survey

Abstract

Rural men who have sex with men (MSM) are heavily affected by HIV, and many lack culturally competent HIV prevention resources. Rural MSM may find sexual partners on the internet, which may also be a way to deliver prevention services to them. To understand the differences between rural and urban MSM with respect to HIV risk factors and behaviors and the utilization of online HIV prevention services, we used data from the 2012 Web-Based HIV Behavioral Survey (WHBS). Using WHBS data collected between June and August 2012, we compared the characteristics of MSM with positive or unknown HIV infection status who had sex with a male in the past 12 months, from rural vs urban areas using Chi square tests and median tests. We used logistic regression and calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to compare self-reported HIV risk behaviors, HIV/STI testing behaviors, use of prevention services, and perceived discrimination. Of the 8166 MSM included in our analysis, 3583 (44%) were from rural areas, and 4583 (56%) were from urban areas. Compared to urban MSM, rural MSM were less likely to ever test for HIV (aPR = 0.94, CI 0.92-0.95), to be tested for HIV in the last year (aPR = 0.83, CI 0.79-0.87), or to receive free condoms (aPR = 0.83, CI 0.79-0.86) or individual prevention counseling in the past year (aPR = 0.86, CI 0.78-0.95). Rural MSM were less likely to have been tested in the last year for syphilis, gonorrhea, or chlamydia (aPR = 0.70, CI 0.62-0.78; aPR = 0.72, CI 0.64-0.81; aPR = 0.75, CI 0.67-0.85, respectively). Rural MSM also reported perceiving less tolerance of gays and bisexuals within their community (aPR = 0.80, CI 0.77-0.84). HIV prevalence is lower among MSM in rural areas compared to MSM in urban areas, but rural MSM report that they are more likely to face intolerance and are less likely to use basic HIV prevention services compared to urban MSM. Therefore, this hard-to-reach population could benefit from prevention services offered through the internet.

Prevalence and correlates of lifetime and recent HIV testing among men who have sex with men (MSM) who use mobile geo-social networking applications in Greater Tokyo

“…Socio-demographic factors significantly associated with lifetime testing (age, education, residence) were similar to previous findings among both gay mobile app using and non-using MSM in Japan and abroad. Higher education was associated with higher lifetime testing among respondents similar to previous findings among venue-attending MSM in Japan [9], and abroad [38,40,41], and rural residency was significantly associated with lower lifetime HIV testing among MSM, possibly due to lower HIV information access and lower tolerance for sexual minorities [42], and lower HIV knowledge [43]. Lifetime HIV testing was significantly lower among MSM youth, and only half (52.2%) of respondents aged 18–25 had been tested for HIV, and one-quarter (24.7%) in the past 6-months.…”

National trends in HIV pre‐exposure prophylaxis awareness, willingness and use among United States men who have sex with men recruited online, 2013 through 2017

“…During a 5‐year period from 2013 to 2017 in the United States, there were substantial, ongoing increases in three key pillars of the PrEP continuum – awareness, willingness and use. These data represent the largest published sample ever used to evaluate the PrEP continuum among MSM in the United States and include data from MSM in rural areas and smaller cities (critical because the use of many prevention services is lower among rural MSM ), and men recruited through non‐sex‐seeking online venues. Our data extend the findings of the NHBS , and previous online studies recruited exclusively from online sex‐seeking websites or in specific US cities .…”

Exploring the Pre-exposure Prophylaxis (PrEP) Health Care Experiences Among Men Who Have Sex With Men (MSM) Who Live in Rural Areas of the Midwest

“…Rural MSM have previously reported PrEP care continuum services (e.g., PrEP-providing clinics, HIV testing sites) are not available in their communities, and they would have to travel to specialists if they wanted to adopt PrEP (Hubach et al, 2017;Maloney et al, 2017;Sun et al, 2019). Although this lack of PrEP infrastructure and driving time is not exclusively unique to rural areas, rural areas are less likely to have PrEP-providing clinics, infectious disease, and LGBTQ+ health specialists (McKenney et al, 2018;Pellowski, 2013;Schafer et al, 2017). MSM who live in metropolitan cities may have around a 15-minute travel time to their PrEP provider, compared to MSM who live in rural areas where that time is between 30 and 60 minutes or more (Siegler et al, 2019).…”