Department of Psychological Sciences, Texas Tech University, Lubbock, Texas.
Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma.
J Rural Health. 2020 Jun;36(3):416-422. doi: 10.1111/jrh.12416. Epub 2020 Feb 14.
Men who have sex with men (MSM) face persistent risk of stigma, with past studies showing unequal treatments of MSM in health care settings. Contextual factors, such as internalized homophobia and connectedness to one's community, have shown to serve as a barrier or facilitator (respectively) with regard to MSM's decisions to seek preventative treatment. These studies, however, predominately feature urban populations, with less consideration given to rural MSM. The current study comparatively investigates these contextual factors between rural and urban MSM to detect differences in the frequency of doctor's visits.
A 2-by-2 (rural/urban × doctor visit yes/no) multivariate analysis of variance (MANOVA) was conducted to investigate if significant differences and/or interactions existed for internalized homophobia and community connectedness.
Results show a significant interaction between rurality and doctor's visits in our sample of predominantly white, self-identified gay men. Higher levels of internalized homophobia and lower levels of community connectedness were seen in rural individuals who had visited a doctor in the past 12 months and in urban individuals who had not seen a doctor in the past 12 months.
Study findings have implications for future public health research and for health promotion interventions, practices, and policies for MSM in rural areas. Social exclusion reinforces the invisibility of lesbian, gay, bisexual, and transgender (LGBT) populations, particularly in rural areas. Stigma and marginalization of MSM promote structural barriers inhibiting care. Our results give evidentiary support for programs which inform the work of clinicians on mechanisms to create LGBT-inclusive practice settings.
男男性行为者（MSM）一直面临着污名化的风险，过去的研究表明，在医疗保健环境中，MSM 受到不平等的对待。内化的恐同和与社区的联系等背景因素已被证明是 MSM 寻求预防治疗决策的障碍或促进因素（分别）。然而，这些研究主要以城市人群为特征，对农村 MSM 的考虑较少。本研究比较了农村和城市 MSM 之间的这些背景因素，以检测医生就诊频率的差异。
采用 2×2（农村/城市×医生就诊是/否）多元方差分析（MANOVA）来调查内化的恐同和社区联系是否存在显著差异和/或相互作用。
结果表明，在我们的研究样本中，主要是白人、自我认同的男同性恋者，农村和医生就诊之间存在显著的交互作用。在过去 12 个月内看过医生的农村个体和过去 12 个月内没有看过医生的城市个体，其内化的恐同程度较高，社区联系程度较低。
研究结果对未来的公共卫生研究以及农村地区 MSM 的健康促进干预、实践和政策具有重要意义。社会排斥加剧了女同性恋、男同性恋、双性恋和跨性别（LGBT）人群的隐形现象，特别是在农村地区。MSM 的污名化和边缘化促进了阻碍护理的结构性障碍。我们的研究结果为告知临床医生创造 LGBT 包容实践环境的机制的项目提供了证据支持。
