Addressing the mental, physical, and sexual health of individuals living with HIV in rural areas

Within the current literature addressing the sexual behaviors of men who have sex with men (MSM) living with HIV, there is a propensity to recruit samples within more urban and suburban areas of the United States (U.S.), thus ignoring the potentially unique experiences of those men residing within more rural areas. The purpose of this dissertation study was to gain a deeper understanding of the sexual lives and experiences of HIV-positive men residing in a relatively rural area of the U.S. In collaboration with a local HIV community-based organization serving south central Indiana, a multi-phase study was completed utilizing two methods of inquiry. Utilizing a grounded theory approach, 23 HIV-positive MSM residing in south central Indiana completed in-depth sexual life history narratives. Additionally, 100 HIV-positive MSM, residing in relatively rural areas, were recruited to complete an Internet questionnaire. Measures included recent/lifetime sexual behavior history, condom use, psychological characteristics, and HIV/STI transmission and vulnerability beliefs. Data presented in this dissertation reflect two manuscripts that address: (a) the influence of HIV-related stigma on sexual partner seeking, status disclosure and sexual behavior; and (b) the influence of loneliness on sexual behavior and condom utilization. Data provide a number of implications for future research and programs targeting HIV-positive MSM residing in relative rural areas. Results suggest new programs are necessary to inform the work of providers on mechanisms to intervene, and combat HIV-related stigma, discrimination, and loneliness impacting MSM living with HIV.