Rural MSM living with HIV: Influences on sexual behavior and sexual health

Background. Studies have indicated that stigma, discrimination, and loneliness may be higher for men who have sex with men (MSM) in rural areas; however, few studies have addressed the potential connection to sexual behavior among those living with HIV. The overarching literature on HIV-positive MSM has analyzed sexual behavior within the context of risk, thus ignoring the social context for which sexual behaviors occur. Methods. In collaboration with community partners and consumers of HIV-related services, study protocols were developed. Using an internet-based questionnaire, we assessed HIV-related stigma, loneliness, safer sex attitudes, and event-level sexual behaviors in a sample of HIV positive MSM (n = 100) residing within a largely rural area in the Midwestern United States. Results. Negative attitudes towards safer sex was positively correlated with total HIV stigma (r = 0.255, p < 0.05), and HIV stigma was highly correlated with loneliness (r = 0.619, p < 0.01). Loneliness was negatively associated with condom usage with the most recent partner of unknown status (p < 0.05). Namely, a 1-unit increase in the UCLA loneliness score was met with a 10% decrease in odds of condom usage. Conclusions. Our study provides novel data on HIV-related stigma, loneliness, safer sex attitudes of HIV of HIV-positive MSM, and sexual behavior by illuminating possible pathways linking sexual beliefs and condom use among HIV-positive MSM. More refined data will inform clinical and social service practice, as they provide much-needed information on sexual health outcomes and experiences of an often underserved and under studied population.