The Influence of Stigma on the Sexual Risk Behavior of Rural Men Who Have Sex with Men
Abstract
Research investigating predictors of risky sexual behavior of rural MSM is sparse, even though the prevalence of HIV in rural areas has increased. This study explored two sets of predictors of 93 rural MSM's levels of risky sexual behavior: mental health variables and stigma emanating from men's family members, health care professionals, and people in the rural communities in which they live. Over 47% of the men were found to be at modified high to high risk. Logistic regression using a continuation logit model was used to test the relationship of the predictor variables and the four levels of risk. Findings indicate that self-esteem was predictive of the highest sexual risk behavior but not lower levels of risk. Stigma was predictive of modified high sexual risk when compared to low and no risk categories. No variables differentiated men at low risk from men at no risk.
References
Adib , S. M., Joseph, J. G., Ostrow, D. G., & James, S. A. (1991). Predictors of relapse in sexual practices among homosexual men. AIDS Education and Prevention, 3, 293–304. Medline, Google ScholarAlonzo , A. A., & Reynolds, N. R. (1995). Stigma, HIV and AIDS: An exploration and elaboration of a stigma trajectory. Social Science and Medicine, 41, 303–315. Crossref Medline, Google ScholarBeltran , E. D., Ostrow, D. G., & Joseph, J. G. (1993). Predictors of sexual behavior change among men requesting their HIV-1 antibody status: The Chicago MACS/CCS cohort of homosexual/bisexual men, 1985–1986. AIDS Education and Prevention, 5, 185–195. Medline, Google ScholarBennett , M. E., Weyant, R. J., & Simon, M. (1993). Predictors of dental students' belief in the right to refuse treatment to HIV-positive patients. Journal of Dental Education, 57, 673–679. Medline, Google ScholarBerry , D. E. (2000). Rural acquired immunodeficiency syndrome in low and high prevalence areas. Southern Medical Journal, 93, 36–43. Crossref Medline, Google ScholarBinson , D., Woods, W. J., Pollack, L., Paul, J., Stall, R., & Catania, J. A. (2001). Differential HIV risk in bathhouses and public cruising areas. American Journal of Public Health, 91, 1482–1486. Crossref Medline, Google ScholarCarballo-Dieguez , A., Remien, R. H., Dolezal, C., & Wagner, G. (1997). Unsafe sex in the primary relationships of Puerto Rican men who have sex with men. AIDS and Behavior, 1, 9–17. Crossref, Google Scholar- Center for Rural Pennsylvania. (2000). Pennsylvania data base. Harrisburg, PA: Author. Google Scholar
- Centers for Disease Control and Prevention. (1995). Update: Trends in AIDS among men who have sex with men—United States, 1989–1994. Weekly Morbidity and Mortality Reports, 44, 401–404. Medline, Google Scholar
- Centers for Disease Control and Prevention. (1999a). HIV incidence among men who have sex with men—seven US cities, 1994–2000. Morbidity and Mortality Weekly Report, 50, 440–444. Google Scholar
- Centers for Disease Control and Prevention. (1999b). Increases in unsafe sex and rectal gonorrhea among men who have sex with men—San Francisco, California, 1994–1997. Morbidity and Mortality Weekly Report, 48, 45–48. Medline, Google Scholar
- Centers for Disease Control and Prevention. (2001). HIV/AIDS Surveillance 13, Atlanta: Author. Google Scholar
Clarke , A. E. (1993). Barriers to general practitioners caring for patients with HIV/AIDS. Family Practice, 10, 8–13. Crossref Medline, Google ScholarCohn , S. E. (1997). AIDS in rural America. Journal of Rural Health, 13, 237–239. Crossref Medline, Google Scholar- Derogotis, L. R. (1993). The Brief Symptom Inventory: Administration, scoring, and procedures manual. Minneapolis, MN: National Computer Systems. Google Scholar
Dolezal , C., Meyer-Bahlburg, H. F., Remien, R. H., & Petkova, E. (1997). Substance use during sex and sensation seeking as predictors of sexual risk behavior among HIV+ and HIV− gay men. AIDS and Behavior, 1, 19–28. Crossref, Google ScholarEckstrand , M. L., Stall, R. D., Paul, J. P., Osmond, D. H., & Coates, T. J. (1999). Gay men report higher rates of unprotected anal sex with partners of unknown or discordant HIV status. AIDS, 13, 1525–1533. Crossref Medline, Google Scholar- Finberg, S. (1980). The analysis of cross-classified categorical data (2nd ed.). Cambridge, MA: MIT Press. Google Scholar
- Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall. Google Scholar
Halkitis , P. N., Parsons, J. T., & Stirratt, M. J. (2001). A double epidemic: Crystal methamphetamine drug use in relation to HIV transmission among gay men. Journal of Homosexuality, 41, 17–35. Crossref Medline, Google ScholarHerek , G. M., & Capitanio, J. P. (1999). AIDS stigma and sexual prejudice. American Behavioral Scientist, 42, 1130–1147. Crossref, Google ScholarHerek , G. M., Capitanio, J. P., & Widaman, K. F. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92, 371–377. Crossref Medline, Google ScholarHospers , H. J., & Kok, G. (1995). Determinants of safe and risk-taking sexual behavior among gay men: A review. AIDS Education and Prevention, 7, 74–96. Medline, Google ScholarKalichman , S. C., Nachimson, D., Cherry, C., & Williams, E. (1998). AIDS treatment advances and behavioral prevention setbacks: Preliminary assessment of reduced perceived threat of HIV/AIDS. Health Psychology, 17, 546–550. Crossref Medline, Google ScholarKalichman , S. C., & Rompa, D. (1995). Sexual Sensation Seeking and Sexual Compulsivity Scales: Reliability, validity, and predicting HIV risk behavior. Journal of Personality Assessment, 65, 586–601. Crossref Medline, Google ScholarKelly , J. A., & Kalichman, S. C. (1998). Reinforcement value of unsafe sex as a predictor of condom use and continued HIV/AIDS risk behavior among gay and bisexual men. Health Psychology, 17, 328–335. Crossref Medline, Google ScholarKelly , J. A., Murphy, D. A., Sikkema, K. J., & Kalichman, S. C. (1993). Psychological interventions to prevent HIV infection are urgently needed: New priorities for behavioral research in the second decade of AIDS. American Psychologist, 48, 1023–1034. Crossref Medline, Google ScholarKoblin , B. A., Chesney, M. A., Husnik, M. J., Bozeman, S., Celum, C. L., Buchbinder, S., et al. (2003). High risk behaviors among men who have sex with men in 6 US cities: Baseline data from the EXPLORE study. American Journal of Public Health, 93, 926–932. Crossref Medline, Google ScholarKoblin , B. A., Torian, L. V., Ren, L., MacKellar, D. A., & Valleroy, L. A. (2000). High prevalence of HIV infection among young men who have sex with men in New York City. AIDS, 14, 1793–1800. Crossref Medline, Google Scholar- Lindhorst, T. (1997). Lesbians and gay men in the country: Implications for rural social workers. In J. D. Smith & R. J. Mancoske (Eds.), Rural gays and lesbians: Building on the strengths of communities (pp. 1–11). New York: Haworth Press. Google Scholar
Mansergh , G., Colfax, G. N., Marks, G., Rader, M., Guzman, R., & Buchbinder, S. (2001). The Circuit Party Man's Health Survey: Findings and implications for gay and bisexual men. American Journal of Public Health, 91, 953–958. Crossref Medline, Google ScholarMattison , A. M., Ross, M. W., Wolfson, T., Franklin, D., & HNRC Group. (2001). Circuit party attendance, club drug use, and unsafe sex in gay men. Journal of Substance Abuse, 13, 119–126. Crossref Medline, Google ScholarMills , T., Stall, R., Pollack, L., Paul, J., Binson, D., Canchola, J., et al. (2001). A comparison of health-related characteristics of “gay ghetto” dwelling men who have sex with men and those who live elsewhere. American Journal of Public Health, 91, 980–983. Crossref Medline, Google ScholarMulry , G., Kalichman, S. C., Kelly, J. A., Ostrow, D. G., & Heckman, T. G. (1997). Grouping gay men on dimensions reflecting sexual behavior preferences: Implications for HIV-AIDS prevention. Psychology and Health, 12, 405–415. Crossref, Google Scholar- National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial. (2002). Predictors of sexual behavior patterns over one year among persons at high risk for HIV. Archives of Sexual Behavior, 31, 165–176. Crossref Medline, Google Scholar
- Ostrow, D. G., DiFranceisco, W., & Wagstaff, D. (1998). The Coping and Change Study of Men at Risk of AIDS: Sexual Behavior and Behavior Change Questionnaire. In C. M. Davis, W. L. Yarber, R. Bauserman, G. Sheer, & L. Davis (Eds.), Handbook of sexuality-related measures (pp. 547–553). Thousand Oaks, CA: Sage. Google Scholar
Paul , J., Catania, J., Pollack, L., & Stall, R. (2001). Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Man's Health Study. Child Abuse and Neglect, 25, 557–584. Crossref Medline, Google ScholarPreston , D. B., Forti, E. M., Kassab, C., & Koch, P. B. (2000). Personal and social determinants of rural nurses' willingness to care for persons with AIDS. Research in Nursing and Health, 23, 67–78. Crossref Medline, Google ScholarPreston , D. B., Young, E. W., Koch, P. B., & Forti, E. M. (1995). The Nurses' Attitudes About AIDS Scale (NAAS): Development and psychometric analysis. AIDS Education and Prevention, 7, 443–454. Medline, Google Scholar- Rosenberg, M. (1979). Conceiving the self. New York: Basic Books. Google Scholar
Schwanberg , S. L. (1996). Health care professionals' attitudes toward lesbian women and gay men. Journal of Homosexuality, 31, 71–83. Crossref Medline, Google Scholar- Shidlo, A. (1994). Internalized homophobia: Conceptual and empirical issues in measurement. In B. Greene & G. Herek (Eds.), Lesbian and gay psychology: Theory, research and clinical applications (pp. 176–205). Thousand Oaks, CA: Sage. Google Scholar
- Smith, D. (1997). Working with larger systems: Rural lesbians and gays. In J. D. Smith & R. J. Mancoske (Eds.), Rural gays and lesbians: Building on the strengths of communities (pp. 37–52). New York: Haworth Press. Google Scholar
Sowell , R., & Christensen, P. (1996). HIV infection in rural communities. Nursing Clinics of North America, 31, 107–123. Medline, Google ScholarStokes , J. P., & Peterson, J. L. (1998). Homophobia, self-esteem, and risk for HIV among African American men who have sex with men. AIDS Education and Prevention, 10, 278–292. Medline, Google ScholarWagner , G. J., Remien, R. H., & Carballo-Dieguez, A. (1998). “Extramarital” sex: Is there an increased risk for HIV transmission? A study of male couples of mixed HIV status. AIDS Education and Prevention, 10, 245–256. Medline, Google ScholarWoods , W. J., Binson, D., Mayne, T. J., Gore, L. R., & Rebchook, G. M. (2001). Facilities and HIV prevention in bathhouses and sex club environments. The Journal of Sex Research, 38(1), 68–74. Crossref, Google Scholar

