Alone in the United States: Loneliness and HIV risk behavior among rural MSM

Background. Loneliness is a subjective experience that is influenced by such variables as community connection, experiences, and situation. There has been little research examining the influence of negative psychological states as an antecedent for HIV risk behavior among rural men who have sex with men (MSM). As a stigmatized population, there is a need to understand the role community identity, connection, and psychological states play in the sexual behavior of rural MSM. Methods. MSM in a rural Midwest city (n = 228) were recruited to complete an online questionnaire to assess subjective feelings of general loneliness (R-ULS), self-esteem, sexual behavior, community identification and connection, and various psychosocial variables. Results. Rural MSM have higher loneliness scores (M = 47.14, SD = 9.67) compared to previous studies of non-MSM. In rural MSM there is a correlation between loneliness scores and age, r (228) = .24, p < .05. Higher levels of loneliness correlated with increased likelihood of engaging in HIV risk behaviors (e.g., unprotected anal intercourse), decreased likelihood of getting an HIV test, and decreased perceived risk for HIV acquisition. Rates of condom use, HIV/STI testing history, and psychosocial variables are also reported. Conclusions. Results suggest that loneliness and community connection in rural MSM plays a greater role in HIV risk behavior than previously understood. In contrast to previous studies, we found that loneliness scores increased with age. This may suggest increased stigma among older rural MSM. Loneliness, specifically the desire for connections with other MSM, may help explain HIV risk behaviors among rural MSM.