Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., 4th Fl., Office # 432, Atlanta, GA, 30322, USA.
Centers for Disease Control and Prevention, 1600 Clifton Rd., NE (MS-E46), Atlanta, GA, 30333, USA.
AIDS Behav. 2018 Jul;22(7):2127-2136. doi: 10.1007/s10461-017-1912-5.
Rural men who have sex with men (MSM) are heavily affected by HIV, and many lack culturally competent HIV prevention resources. Rural MSM may find sexual partners on the internet, which may also be a way to deliver prevention services to them. To understand the differences between rural and urban MSM with respect to HIV risk factors and behaviors and the utilization of online HIV prevention services, we used data from the 2012 Web-Based HIV Behavioral Survey (WHBS). Using WHBS data collected between June and August 2012, we compared the characteristics of MSM with positive or unknown HIV infection status who had sex with a male in the past 12 months, from rural vs urban areas using Chi square tests and median tests. We used logistic regression and calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to compare self-reported HIV risk behaviors, HIV/STI testing behaviors, use of prevention services, and perceived discrimination. Of the 8166 MSM included in our analysis, 3583 (44%) were from rural areas, and 4583 (56%) were from urban areas. Compared to urban MSM, rural MSM were less likely to ever test for HIV (aPR = 0.94, CI 0.92-0.95), to be tested for HIV in the last year (aPR = 0.83, CI 0.79-0.87), or to receive free condoms (aPR = 0.83, CI 0.79-0.86) or individual prevention counseling in the past year (aPR = 0.86, CI 0.78-0.95). Rural MSM were less likely to have been tested in the last year for syphilis, gonorrhea, or chlamydia (aPR = 0.70, CI 0.62-0.78; aPR = 0.72, CI 0.64-0.81; aPR = 0.75, CI 0.67-0.85, respectively). Rural MSM also reported perceiving less tolerance of gays and bisexuals within their community (aPR = 0.80, CI 0.77-0.84). HIV prevalence is lower among MSM in rural areas compared to MSM in urban areas, but rural MSM report that they are more likely to face intolerance and are less likely to use basic HIV prevention services compared to urban MSM. Therefore, this hard-to-reach population could benefit from prevention services offered through the internet.
农村男男性行为者（MSM）受 HIV 影响严重，且许多人缺乏具有文化适应性的 HIV 预防资源。农村 MSM 可能会在互联网上寻找性伴侣，这也可能是向他们提供预防服务的一种方式。为了了解农村和城市 MSM 在 HIV 风险因素和行为以及在线 HIV 预防服务的利用方面的差异，我们使用了 2012 年基于网络的 HIV 行为调查（WHBS）的数据。我们使用 WHBS 于 2012 年 6 月至 8 月期间收集的数据，通过卡方检验和中位数检验，比较了过去 12 个月内与男性发生性行为的 HIV 感染阳性或未知感染状态的 MSM 中，农村地区和城市地区 MSM 的特征。我们使用 logistic 回归并计算了调整后的患病率比（aPR）和 95%置信区间（CI），以比较自我报告的 HIV 风险行为、HIV/性传播感染（STI）检测行为、预防服务的使用以及感知歧视。在我们的分析中，8166 名 MSM 中，3583 名（44%）来自农村地区，4583 名（56%）来自城市地区。与城市 MSM 相比，农村 MSM 更不可能接受过 HIV 检测（aPR=0.94，CI 0.92-0.95）、在过去一年中接受过 HIV 检测（aPR=0.83，CI 0.79-0.87）或在过去一年中获得过免费避孕套（aPR=0.83，CI 0.79-0.86）或个体预防咨询（aPR=0.86，CI 0.78-0.95）。农村 MSM 在过去一年中接受梅毒、淋病或衣原体检测的可能性也较低（aPR=0.70，CI 0.62-0.78；aPR=0.72，CI 0.64-0.81；aPR=0.75，CI 0.67-0.85）。农村 MSM 还报告称，他们在社区中感受到的同性恋和双性恋者的容忍度较低（aPR=0.80，CI 0.77-0.84）。与城市 MSM 相比，农村地区 MSM 的 HIV 感染率较低，但农村 MSM 报告称，与城市 MSM 相比，他们更有可能面临不容忍的情况，并且更不可能使用基本的 HIV 预防服务。因此，这个难以接触到的人群可能会受益于通过互联网提供的预防服务。
