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Owens C, Hurtado M, Moskowitz DA, Mustanski B, Macapagal K. Rural-Urban Differences in HIV Sexual Risk Behaviors and HIV Service Utilization Among Adolescent Sexual Minority Males in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2765-2775. [PMID: 38528296 DOI: 10.1007/s10508-024-02840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
In the United States, HIV prevalence is increasing in rural areas, specifically among rural adolescent sexual minority males (ASMM). However, it is unclear what HIV sexual risk behaviors rural ASMM engage in and what HIV preventative services they utilize. This study aimed to (1) document the lifetime HIV sexual risk behaviors and service utilization of rural ASMM and (2) compare rural-urban differences in the prevalence of HIV sexual risk behaviors and service utilization. We analyzed data collected from 1615 ASMM who participated in a baseline survey for an online HIV prevention program from April 2018 to June 2020. We compared the prevalence of lifetime HIV sexual risk behaviors and HIV healthcare utilization among rural and urban participants via descriptive statistics, chi-square tests, linear and logistic regressions, and zero-inflated Poisson regressions. These analyses indicated that rural ASMM were more likely than urban ASMM to engage in condomless sex when they had anal sex. Rural ASMM could benefit from offline and online evidence-based HIV prevention interventions, especially interventions that increase condom use.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Manuel Hurtado
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
| | - David A Moskowitz
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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2
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Owens C, Hubach RD. Rural-urban differences in monkeypox behaviors and attitudes among men who have sex with men in the United States. J Rural Health 2023; 39:508-515. [PMID: 36394371 DOI: 10.1111/jrh.12726] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE An outbreak of the monkeypox virus has been documented in the United States with most cases occurring among gay, bisexual, and other men who have sex with men (MSM). As monkeypox cases increase among relatively rural states, current public health messaging may not resonate with rural at-risk populations. Given this, there is a need to assess potential rural-urban differences in monkeypox behaviors and attitudes among MSM. METHODS A total of 582 eligible MSM completed an online cross-sectional survey between August 6 and 15, 2022. Participants answered questions about their demographics, sexual behaviors, monkeypox testing and vaccination behaviors, monkeypox media consumption and attitudes, and their intention and attitudes found in the Health Belief Model of getting the monkeypox vaccine. Rural-urban differences in behaviors and attitudes were assessed with a chi-square test of independence. Differences in intention to get vaccinated and Health Belief Model factors were assessed with a Mann-Whitney U test. FINDINGS Rural MSM, in comparison to their urban counterparts, were found to be less likely to report modifying their behaviors to decrease monkeypox exposure, being susceptible to monkeypox, or perceiving severe consequences acquiring monkeypox. Similarly, rural MSM had a lower intention to get vaccinated for monkeypox. CONCLUSIONS As vaccination uptake among rural populations for vaccine-preventable diseases remains suboptimal, results from this novel study can inform the development of monkeypox prevention, testing, and vaccination messaging campaigns geared toward rural MSM and other at-risk populations. It will be important to ensure that monkeypox prevention, testing, and vaccination interventions are available and accessible in rural areas.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
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3
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Hubach RD, O'Neil A, Stowe M, Giano Z, Curtis B, Fisher CB. Perceived Confidentiality Risks of Mobile Technology-Based Ecologic Momentary Assessment to Assess High-Risk Behaviors Among Rural Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1641-1650. [PMID: 32078710 PMCID: PMC7438245 DOI: 10.1007/s10508-019-01612-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 06/10/2023]
Abstract
Although men who have sex with men (MSM) within rural communities are disproportionately impacted by HIV, limited HIV research and programmatic resources are directed to these communities within the U.S. There is a need for improved behavioral data collection methods to obtain more detailed information on the relationship between rural environments, sexual behavior, and substance use. Utilization of mobile health (mHealth) technologies, such as ecologic momentary assessment (EMA), has been advocated for; however, limited research has evaluated its utility among rural MSM. Forty MSM residing in rural Oklahoma were recruited to complete in-depth interviews related to participating online/mobile-based HIV prevention research. Men described a willingness to participate in HIV and substance use studies that use EMA methodologies for data collection; however, they raised various research-related concerns. In particular, participants indicated potential privacy and confidentiality concerns related to the use of the mobile technology-based EMA in public and the storage of data by researchers. Given the varying degree of sexual orientation and substance use disclosure by participants, rural MSM were largely concerned with being inadvertently "outed" within their communities. Men described the various strategies they could employ to protect private information and methods to minimize research risk. Study findings suggest that EMA is an acceptable research methodology for use among rural MSM in the context of HIV and sexual health information, when privacy and confidentiality concerns are adequately addressed. Input from community members and stakeholders is necessary to identify potential areas of concerns for participants prior to data collection.
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Affiliation(s)
- Randolph D Hubach
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA.
| | - Andrew O'Neil
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Mollie Stowe
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Zachary Giano
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Brenda Curtis
- National Institute on Drug Abuse, Baltimore, MD, USA
| | - Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Bronx, NY, USA
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4
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Hu L, Luo Y, Zhong X, Lu R, Wang Y, Sharma M, Ye M. Condom Use and Related Factors among Rural and Urban Men Who Have Sex With Men in Western China: Based on Information-Motivation-Behavioral Skills Model. Am J Mens Health 2021; 14:1557988319899799. [PMID: 32028826 PMCID: PMC7008563 DOI: 10.1177/1557988319899799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This study aimed to determine the differences in condom use and related factors among rural–urban men who have sex with men (MSM) in Western China. A cross-sectional survey was conducted in Chongqing, Sichuan, and Guangxi, which recruited MSM by non-probability sampling. Data were collected through an anonymous, standardized, and self-reported questionnaire guided by an information–motivation–behavioral skills model. Structural equation model was applied to analyze the related factors. Out of the 1141 MSM included in this analysis, 856 (75%) and 285 (25%) were from urban and rural areas, respectively. The median age was 27 years for both groups. Self-reported consistent condom use for anal sex in the past 6 months was 57.58%. The rate of consistent condom use was lower in rural MSM than in urban MSM (50.88% vs. 59.81%, p = .008). Behavioral skills, HIV/AIDS intervention services, and response costs had direct positive and negative influences on condom use, respectively. By contrast, motivation and information exhibited indirect influence. All the factors were mediated by behavioral skills in rural and urban MSM, except for the information that had no effect among urban MSM but had an indirect effect among rural MSM. These findings suggest that service providers should pay attention to substantial rural–urban differences and design different AIDS prevention and intervention strategies targeting rural and urban MSM.
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Affiliation(s)
- Ling Hu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yetao Luo
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Xiaoni Zhong
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Rongrong Lu
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Yang Wang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS, USA.,School of Health Sciences, Walden University, Minneapolis, MN, USA
| | - Mengliang Ye
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
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5
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Scott D. Stigma in place: Black gay men's experiences of the rural South. Health Place 2021; 68:102515. [PMID: 33515909 DOI: 10.1016/j.healthplace.2021.102515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Black gay men (MSM) in the rural United States South are inequitably burdened by stigmatization and the HIV epidemic. Drawing from twelve oral history interviews with middle-aged and older Black gay narrators from rural North Carolina, this research explores the impact of sexual marginalization and the HIV epidemic on lived experiences of the rural South. Despite describing increasingly empowered views of HIV and sexual health, narrators expressed persistent difficulty managing social determinants of HIV vulnerability-sexual stigma and disconnection from LGBTQ collectivity. Narrators reported better managing sexual marginalization over their lifetimes in urban settings and places outside of the South such as New York (NY). This research suggests stressful structural and interpersonal experiences of stigma may define lived experiences of particular settings.
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Affiliation(s)
- Darius Scott
- Department of Geography, Dartmouth College Hanover, New Hampshire, 03755, USA.
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6
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Sarno EL, Bettin E, Jozsa K, Newcomb ME. Sexual Health of Rural and Urban Young Male Couples in the United States: Differences in HIV Testing, Pre-exposure Prophylaxis Use, and Condom Use. AIDS Behav 2021; 25:191-202. [PMID: 32607917 DOI: 10.1007/s10461-020-02961-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Young men who have sex with men (YMSM) are disproportionally affected by HIV, and main partnerships account for a large proportion of new HIV infections. HIV prevention is largely focused on urban YMSM, and less is known about sexual health of rural male couples. The present study used data from a randomized controlled trial of a relationship education and HIV prevention program for male couples to test associations of rurality with HIV/STI testing, PrEP use, number of sexual partners, and condomless anal sex (CAS) acts. Participants were 430 YMSM in relationships. Rural YMSM were less likely to have been tested for HIV/STIs, and to have used PrEP, compared to urban YMSM. Although higher rurality was associated with fewer CAS acts, CAS was not infrequent among rural YMSM, highlighting the need for increased HIV prevention geared toward young male couples living in rural, less resourced areas.
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Affiliation(s)
- Elissa L Sarno
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Emily Bettin
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kyle Jozsa
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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7
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Giano Z, Kavanaugh KE, Durham AR, Currin JM, Wheeler DL, Croff JM, Hubach RD. Factors Associated with Condom Use among a Sample of Men Who Have Sex with Men (MSM) Residing in Rural Oklahoma. JOURNAL OF HOMOSEXUALITY 2020; 67:1881-1901. [PMID: 31125299 DOI: 10.1080/00918369.2019.1616430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Public health literature often neglects populations from rural communities, particularly with men who have sex with men (MSM). Although HIV/STI infections are decreasing slightly, there is an increase within rural MSM, thus opening the door for further research on condom use behavior in a rural context. In-depth interviews were conducted with 40 MSM in rural Oklahoma regarding their condom use and sexual behaviors. A qualitative analysis revealed five themes with respect to condom usage: physical discomfort of condoms, relationship trust, usage based on the type of sexual act, substance use, and knowledge of a partner's HIV/STI status. A sixth theme within the context of rural Oklahoma revealed participants' fear of physical/verbal abuse, hesitations seeking medical help due to confidentially issues, and general acknowledgment of the lack of education and resources available. Implications include increasing mobile testing locations and a push for marketing greater confidentially within health service providers.
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Affiliation(s)
- Zachary Giano
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Katherine E Kavanaugh
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - André R Durham
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Joseph M Currin
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - Denna L Wheeler
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Julie M Croff
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Randolph D Hubach
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
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8
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Maragh-Bass AC, Gamble T, El-Sadr WM, Hanscom B, Tolley EE. Exploring individual-level barriers to HIV medication adherence among men who have sex with men in the HIV Prevention Trials Network (HPTN 065) study. AIDS Care 2020; 33:1404-1413. [PMID: 33025791 DOI: 10.1080/09540121.2020.1828799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
African-American men who have sex with men (MSM) with HIV are more likely to have unsuppressed viral load than other racial/ethnic groups. HPTN 065 Study, completed in 2015, consisted of five interconnected study components conducted at clinics in Bronx, New York and Washington, D.C. Participants completed surveys with questions related to socio-demographic factors and individual-level HIV medication adherence barriers, such as forgetting doses or fear of taking medications in front of others. Descriptive analyses and ordinal logistic regression with robust standard errors were conducted. Fifty-seven per cent of participants (N = 359) were African-American (57.1%) and roughly 40% had no more than a high school education. Mean age was 48 years. Overall, MSM with viral load suppression identified fewer individual-level barriers to adherence (p < .01) and individuals with depressive symptoms identified a greater number of barriers to adherence (p < .01). Compared to African-Americans, white MSM had a lower likelihood of identifying barriers to adherence (p < .05). Findings suggest that individual-level barriers to HIV medication adherence are common among MSM, irrespective of time since diagnosis and viral suppression. Race-specific interventions which address intersectional stigma are needed to improve health outcomes among African-American MSM, who bear much of the burden of poor HIV outcomes in the United States.
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Affiliation(s)
| | | | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brett Hanscom
- HIV Prevention Trials Network Statistical Center for HIV AIDS Research and Prevention, University of Washington Seattle, Seattle, WA, USA
| | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
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9
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He L, Pan X, Yang J, Ma Q, Jiang J, Wang W, Qiu J, Zou Y, Wang P, Zhao D, Wang H, Jiang T. HIV risk behavior and HIV testing among rural and urban men who have sex with men in Zhejiang Province, China: A respondent-driven sampling study. PLoS One 2020; 15:e0231026. [PMID: 32240244 PMCID: PMC7117739 DOI: 10.1371/journal.pone.0231026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Currently, human immunodeficiency virus (HIV) sentinel surveillance among men who have sex with men (MSM) in China conducted in large and medium-sized cities, and no HIV sentinel surveillance conducted in rural areas. HIV testing and intervention is predominantly conducted in urban areas, there have been a limited number of studies in rural areas MSM, it is necessary to conduct the investigation of HIV risk sexual behavior, HIV testing among rural and urban MSM. METHOD Between December 2013 and August 2015, a cross-sectional study was conducted in rural and urban areas in Zhejiang Province using respondent-driven sampling (RDS). Participants completed face-to-face interviewer-administered questionnaire surveys and were tested for HIV. RESULTS A total of 710 MSM participants were recruited, of whom 36.1% were from rural areas. The overall HIV prevalence was 16.6%, and was considerably lower among MSM living in rural areas (3.9%) than those living in urban areas (24.2%). 61.1% participants had not condom use with male sexual behavior in the past 6 months (86.7% in rural areas and 46.7% in urban areas). The social demographic and behavioral characteristics had significance difference among rural and urban MSM. Multivariate logistic regression revealed that, compared to men living in urban areas, MSM living in rural areas MSM were more likely to use dating apps to find sexual partners, were more likely to engage in bisexual behavior, and had lower condom use. 43.0% participants had been tested for HIV in the past year (41.8% in rural areas and 43.6% in urban areas). Multivariate logistic regression also revealed that among participants living in rural areas, having rural health insurance and not accepting HIV intervention were associated with lower HIV testing rates, while a higher monthly income and through use of internet to find sexual partner were associated with higher rates of HIV testing. CONCLUSION High risk behavior was prevalent, and HIV testing rates were low among MSM living in rural areas compare to urban areas in Zhejiang Province, therefore, preventative intervention measures should be immediately among rural MSM urgently to reduce HIV transmission and to promote HIV testing.
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Affiliation(s)
- Lin He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- * E-mail: (XP); (QM)
| | - Jiezhe Yang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- * E-mail: (XP); (QM)
| | - Jun Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Wei Wang
- Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Jiaquan Qiu
- Kaihua county Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Yazhou Zou
- Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Ping Wang
- Jiangshan Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Dongshe Zhao
- Lucheng district Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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10
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Giano Z, Hubach RD. Adverse childhood experiences and mental health: Comparing the link in rural and urban men who have sex with men. J Affect Disord 2019; 259:362-369. [PMID: 31470179 DOI: 10.1016/j.jad.2019.08.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/04/2019] [Accepted: 08/17/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research shows individuals experiencing adverse childhood experiences (ACEs) as well as identifying as a man who has sex with other men (MSM) are at an increased risk for mental health issues. Less has been studied, however, on ACEs in MSM; with even fewer studies investigating non-urban (e.g., rural/small town/suburban) MSM, as most research features urban samples. This is problematic due to studies showing that rurality can influence the behavior of MSM. The current study comparatively investigates the impact of ACEs on the mental health of rural/small town/suburban and urban MSM. METHODS Participants included 156 MSM residing in Oklahoma. Linear regression was used to test the association between ACEs' and mental health (anxiety, depressive symptoms, and loneliness). Split-sample regressions were conducted on rural/small town/suburban and urban MSM. RESULTS ACEs were associated with all three mental health outcomes in the full sample. However, ACEs were significantly linked to anxiety and depressive symptoms only in urban MSM. LIMITATIONS Limitations include a smaller sample size with limited racial/ethnic variations. CONCLUSIONS Results suggest that living in an urban environment may amplify the risks of ACEs, rural/small town/suburban MSM may acquire outside, unique support networks which work to limit the effect of ACEs, or that rural/small town/suburban MSM may manifest the effects of ACEs differently (or a combination of the three). Trauma-informed programming has been shown to effectively reduce mental health issues, yet consideration is generally not given with regards to rurality. Future programming and research should consider rurality/urbanity as influential factor.
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Affiliation(s)
- Zachary Giano
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, OK, USA.
| | - Randolph D Hubach
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, OK, USA.
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11
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Hubach RD, Currin JM, Giano Z, Meyers HJ, DeBoy KR, Wheeler DL, Croff JM. Experiences of Stigma by Gay and Bisexual Men in Rural Oklahoma. Health Equity 2019; 3:231-237. [PMID: 31289783 PMCID: PMC6608693 DOI: 10.1089/heq.2018.0095] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: The unique experiences of men who have sex with men (MSM) residing in culturally conservative rural areas are not well represented in the scientific literature. The human immunodeficiency virus (HIV) epidemic in the United States has shifted toward rural areas where populations are dispersed and health care resources are limited. Methods: We recruited 40 sexual minority men, ages 22-66, residing in rural Oklahoma for in-depth, qualitative sexual health interviews that sought to understand how cultural and social environments impacted health behaviors. Findings: Participants described a stigmatizing social environment and less access to quality, sexual minority medical care within rural communities and perceived these as substantial barriers to enhancing health. Structural issues, including lack of sexual minority-affirming policies, institutional practices, and hostile cultural norms, were noted. Conclusions: Results indicate the need to develop greater awareness of stigma as an etiologic factor that contributes to the health of rural sexual minority populations, specifically when it relates to provision of culturally appropriate care.
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Affiliation(s)
- Randolph D. Hubach
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | | | - Zachary Giano
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Hunter J. Meyers
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Kyle R. DeBoy
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Denna L. Wheeler
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Julie M. Croff
- Center for Wellness and Recovery, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
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12
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Lauckner C, Truszczynski N, Lambert D, Kottamasu V, Meherally S, Schipani-McLaughlin AM, Taylor E, Hansen N. “Catfishing,” cyberbullying, and coercion: An exploration of the risks associated with dating app use among rural sexual minority males. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2019. [DOI: 10.1080/19359705.2019.1587729] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Carolyn Lauckner
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | | | - Danielle Lambert
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | - Varsha Kottamasu
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | - Saher Meherally
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | | | - Erica Taylor
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | - Nathan Hansen
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
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13
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Giano Z, Hubach RD, Deboy K, Meyers H, Currin JM, Wheeler DL. A comparative analysis of rural and urban MSM depressive symptomology: the mediating effects of loneliness. PSYCHOLOGY & SEXUALITY 2019. [DOI: 10.1080/19419899.2019.1593885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Zachary Giano
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Randolph D. Hubach
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Kyle Deboy
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Hunter Meyers
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Joseph M. Currin
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Denna L. Wheeler
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
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14
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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. AIDS Behav 2018; 22:2127-2136. [PMID: 28986669 DOI: 10.1007/s10461-017-1912-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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.
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Bowen DJ, Hyams T, Goodman M, West KM, Harris‐Wai J, Yu J. Systematic Review of Quantitative Measures of Stakeholder Engagement. Clin Transl Sci 2017; 10:314-336. [PMID: 28556620 PMCID: PMC5593160 DOI: 10.1111/cts.12474] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/17/2017] [Indexed: 01/23/2023] Open
Affiliation(s)
- DJ Bowen
- University of WashingtonSeattleWashingtonUSA
| | - T Hyams
- University of WashingtonSeattleWashingtonUSA
| | - M Goodman
- College of Global Public HealthNew York UniversityNew YorkNew YorkUSA
| | - KM West
- University of WashingtonSeattleWashingtonUSA
| | - J Harris‐Wai
- University of CaliforniaSan FranciscoCaliforniaUSA
| | - J‐H Yu
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
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Cain DN, Mirzayi C, Rendina HJ, Ventuneac A, Grov C, Parsons JT. Mediating Effects of Social Support and Internalized Homonegativity on the Association Between Population Density and Mental Health Among Gay and Bisexual Men. LGBT Health 2017; 4:352-359. [PMID: 28792886 DOI: 10.1089/lgbt.2017.0002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Depression negatively impacts the health and well-being of gay and bisexual men (GBM). However, little is known about the contexts in which rural GBM live relative to those living in urban areas and their overall mental health. The aim of this study was to examine associations between population density and depressive symptoms and the role of internalized homonegativity and social support as potential mediators. METHODS A nationally representative sample of 1071 GBM (mean age = 40.24) was enrolled. Participants provided their zip codes, which were categorized according to population density and rank-normalized. RESULTS In a path analysis model adjusted for race/ethnicity, college education, age, and relationship status, higher population density was significantly associated with increased social support (B = 0.11, P = 0.002) and decreased internalized homonegativity (B = -0.06, P < 0.001). In turn, lower social support (B = -2.93, P < 0.001) and greater internalized homonegativity (B = 4.93, P < 0.001) were significantly associated with greater depressive symptoms. The indirect effects of population density on depression through social support (B = -0.33, P < 0.001) and internalized homonegativity (B = -0.31, P < 0.001) were statistically significant, suggesting evidence for mediation of the effects. CONCLUSIONS These results indicate that living in less inhabited areas acts on depressive symptoms through mechanisms of lower social support and higher internalized homonegativity. These findings suggest that social contexts in which GBM live can affect mental health outcomes and indicate the need for further support and inclusion of GBM, especially in less inhabited areas.
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Affiliation(s)
- Demetria N Cain
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,2 Community Health Sciences Doctoral Program, Community Health Sciences, University of Illinois at Chicago School of Public Health , Chicago, Illinois
| | - Chloe Mirzayi
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,3 Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy , New York, New York
| | - H Jonathon Rendina
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,4 Department of Psychology, Hunter College of the City University of New York (CUNY) , New York, New York.,5 Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY) , New York, New York
| | - Ana Ventuneac
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,6 Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Christian Grov
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,3 Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy , New York, New York
| | - Jeffrey T Parsons
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,4 Department of Psychology, Hunter College of the City University of New York (CUNY) , New York, New York.,5 Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY) , New York, New York
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Hubach RD, Currin JM, Sanders CA, Durham AR, Kavanaugh KE, Wheeler DL, Croff JM. Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:315-329. [PMID: 28825858 DOI: 10.1521/aeap.2017.29.4.315] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Biomedical intervention approaches, including antiretroviral pre-exposure prophylaxis (PrEP), have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. However, there is limited understanding of PrEP access and uptake among men who have sex with men (MSM) residing in relatively rural states. Twenty semistructured interviews were conducted (August-November 2016) to assess opinions of and perceived barriers to accessing and adopting PrEP among MSM residing in Oklahoma. Participants perceived substantial barriers to accessing PrEP including a stigmatizing environment and less access to quality, LGBT-sensitive medical care. Overall, geographic isolation limits access to health providers and resources that support sexual health for Oklahoma MSM. Addressing stigma situated across ecological levels in an effort to increase adoption of PrEP by MSM residing in rural states remains necessary. Without this, social determinants may continue to negatively influence PrEP adoption and sexual health outcomes.
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Affiliation(s)
- Randolph D Hubach
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Joseph M Currin
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Carissa A Sanders
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - André R Durham
- School of Educational Foundations, Leadership, and Aviation, Oklahoma State University
| | - Katherine E Kavanaugh
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Denna L Wheeler
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
| | - Julie M Croff
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
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White Hughto JM, Pachankis JE, Eldahan AI, Keene DE. "You Can't Just Walk Down the Street and Meet Someone": The Intersection of Social-Sexual Networking Technology, Stigma, and Health Among Gay and Bisexual Men in the Small City. Am J Mens Health 2016; 11:726-736. [PMID: 27885147 PMCID: PMC5393935 DOI: 10.1177/1557988316679563] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Social-sexual networking technologies have been reported to yield both psychosocial benefits and sexual risks for gay and bisexual men, yet little research has explored how technology interacts with the social-geographical environment to shape the health of gay and bisexual men in the relatively understudied environment of small cities. This article draws on 29 semistructured interviews examining the use of social-sexual networking technologies among racially diverse gay and bisexual men in two small cities. Questions probed participants' use of technology to meet sexual partners, engagement in the gay community, and the role of virtual and nonvirtual spaces in relation to health. Findings suggest that social networking technologies can help men navigate the challenges of small cities, including small and insular gay communities, lack of dedicated gay spaces, and sexual minority stigma. However, participants also describe declines in gay community visibility and cohesion, which they attribute to technology use. The article concludes by discussing the intersections of virtual and physical space in small cities as sites for the production of health and illness.
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Li MJ, Hubach RD, Dodge B. Social Milieu and Mediators of Loneliness Among Gay and Bisexual Men in Rural Indiana. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2015. [DOI: 10.1080/19359705.2015.1033798] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Hubach RD, Dodge B, Schick V, Ramos WD, Herbenick D, Li MJ, Cola T, Reece M. Experiences of HIV-positive gay, bisexual and other men who have sex with men residing in relatively rural areas. CULTURE, HEALTH & SEXUALITY 2015; 17:795-809. [PMID: 25608847 DOI: 10.1080/13691058.2014.994231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Most previous studies of the sexual behaviour of gay, bisexual and other men who have sex with men living with HIV are based on samples of men recruited within relatively urban and suburban areas of the USA. The aim of the present study was to explore the potential challenges associated with HIV-related stigma and residing in a relatively rural area. We conducted a qualitative study based in south-central Indiana, a relatively rural area of the USA. Twenty-three HIV-positive gay, bisexual and other men who have sex with men, aged 21-48 years, were interviewed on topics regarding community engagement, perceived HIV-related stigma, relationship formation, sexual behaviour and HIV status disclosure. Findings indicate HIV-related stigma is commonly reported at the interpersonal and community levels. Because of this, men face complex situations on how and when to disclose their HIV status to members of their social and sexual networks. Although many participants reported many challenges associated with relationship formation, all expressed a desire for romantic and/or sexual connections with other men and/or women. Results suggest that new programmatic approaches are necessary to inform the work of social service and medical providers on mechanisms to intervene and combat stigma and discrimination inherent in communities, programmes and policies.
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Affiliation(s)
- Randolph D Hubach
- a School of Applied Health and Educational Psychology, Oklahoma State University , Stillwater , USA
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Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2:e47. [PMID: 25355249 PMCID: PMC4259926 DOI: 10.2196/mhealth.3745] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 11/17/2022] Open
Abstract
Background The Centers for Disease Control and Prevention recommends that sexually active men who have sex with men (MSM) in the United States test for human immunodeficiency virus (HIV) at least three times per year, but actual testing frequency is much less frequent. Though mHealth is a popular vehicle for delivering HIV interventions, there are currently no mobile phone apps that target MSM with the specific aim of building an HIV testing plan, and none that focuses on developing a comprehensive prevention plan and link MSM to additional HIV prevention and treatment resources. Previous research has suggested a need for more iterative feedback from the target population to ensure use of these interventions. Objective The purpose of this study is to understand MSM’s preferences for functionality, format, and design of a mobile phone-based HIV prevention app and to examine MSM’s willingness to use an app for HIV prevention. Methods We conducted focus group discussions with 38 gay and bisexual men, with two in-person groups in Atlanta, two in Seattle, and one online focus group discussion with gay and bisexual men in rural US regions. These discussions addressed MSM’s general preferences for apps, HIV testing barriers and facilitators for MSM, and ways that an HIV prevention app could address these barriers and facilitators to increase the frequency of HIV testing and prevention among MSM. During focus group discussions, participants were shown screenshots and provided feedback on potential app functions. Results Participants provided preferences on functionality of the app, including the type and delivery of educational content, the value of interactive engagement, and the importance of social networking as an app component. Participants also discussed preferences on how the language should be framed for the delivery of information, identifying that an app needs to be simultaneously fun and professional. Privacy and altruistic motivation were considered to be important factors in men’s willingness to use a mobile HIV prevention app. Finally, men described the potential impact that a mobile HIV prevention app could have, identifying individual, interpersonal, and community-based benefits. Conclusions In summary, participants described a comprehensive app that should incorporate innovative ideas to educate and engage men so that they would be motivated to use the app. In order for an app to be useful, it needs to feel safe and trustworthy, which is essential when considering the app’s language and privacy. Participants provided a range of preferences for using an HIV prevention app, including what they felt MSM need with regards to HIV prevention and what they want in order to engage with an app. Making an HIV prevention app enjoyable and usable for MSM is a difficult challenge. However, the usability of the app is vital because no matter how great the intervention, if MSM do not use the app, then it will not be useful.
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Affiliation(s)
- Tamar Goldenberg
- Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, United States.
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