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Study: Urban-Rural Divide in HIV Prevention for Gay and Bi Men

The HIV epidemic in the U.S. began as an urban phenomenon in cities like New York and San Francisco. Since then, patterns of HIV infection have shifted to include an alarming number of gay and bisexual men in rural areas across the country. Compared to those in urban settings, gay and bisexual men in rural areas are less likely to utilize HIV prevention services, according to a study released earlier this month.

Rural gay and bisexual men were 17% less likely to have received HIV testing in the past year, the study, by researchers at Emory University, found. The disparity between STI testing in rural and urban areas was even greater. Compared to urban men, those in rural areas were 30% less likely to have been tested for syphilis, gonorrhea, or chlamydia in the past year.

Among the 8,166 gay and bisexual men included in the national survey, there were no significant differences in HIV risk behaviors, such as condomless anal sex or meeting on the Internet, between urban and rural men. Despite being exposed to similar risk for HIV and other STIs, rural men receive less prevention services than those in urban areas.

Rural men also reported 20% less tolerance towards gay and bisexual people in their communities. Their perception of intolerance may hinder them from utilizing HIV testing and other prevention services offered by local healthcare providers. After all, previous research has found that almost 40% of gay and bisexual men purposefully do not disclose their sexual identity to healthcare providers, mostly due to stigma.

Jennie McKenney, a postdoctoral fellow at Emory University and first author of the study, noted that rural areas face challenges in providing culturally competent HIV prevention to gay and bisexual men. For instance, the fact that gay and bisexual men tend to live in cities rather than in rural areas means that HIV prevention services tailored for LGBTQ individuals are mostly concentrated in cities. McKenney highlighted the potential for technology to address the lack of services in rural areas.

“One solution to this dearth of HIV prevention services is the Internet,” said McKenney. “With the increasing availability of smartphones, providing prevention services through mobile apps is feasible, cost-effective, and acceptable.”

Extending HIV prevention services through the Internet and smartphones would be especially beneficial to men in remote rural areas where in-person services may not be offered. These areas have seen an increase in smartphone use in recent years.

Although technology-enabled HIV prevention does address the HIV and STI testing disparity between urban and rural areas, it does not resolve the perceived intolerance towards gay and bisexual men in these communities. Given the well-established interrelation between discrimination, psychosocial health, and HIV risk, HIV prevention services for rural gay and bisexual men could also add to their feelings of being discriminated against.

As the landscape of HIV infection in the U.S. continues to evolve, studies like this underscore the need to deliver HIV prevention services outside of the cities where they have traditionally been available. These services must acknowledge the unique psychosocial needs of gay and bisexual men in rural communities.