Behaviors associated with HIV transmission risk among rural sexual and gender minority and majority residents

ABSTRACT

Multiple rural states and communities experience elevated rates of human immunodeficiency virus (HIV), often associated with diminished healthcare access and increased drug use. Though a substantial proportion of rural populations are sexual and gender minorities (SGM), little is known of this group regarding substance use, healthcare utilization, and HIV transmission behaviors. During May–July 2021, we surveyed 398 individuals across 22 rural Illinois counties. Participants included cisgender heterosexual males (CHm) and females (CHf) (n = 110); cisgender non-heterosexual males and females (C-MSM and C-WSW; n = 264); and transgender individuals (TG; n = 24). C-MSM participants were more likely to report daily-to-weekly alcohol and illicit drug use prescription medication misuse (versus CHf; aOR = 5.64 [2.37–13.41], 4.42 [1.56–12.53], and 29.13 [3.80–223.20], respectively), and C-MSM participants more frequently reported traveling to meet with romantic/sex partners. Further, more C-MSM and TG than C-WSW reported healthcare avoidance and denial due to their orientation/identity (p < 0.001 and p = 0.011, respectively); 47.6% of C-MSM and 58.3% of TG had not informed their provider about their orientation/identity; and only 8.6% of C-MSM reported ever receiving a pre-exposure prophylaxis (PrEP) recommendation. More work is needed to explore the substance use and sexual behaviors of rural SGM, as well as their healthcare interactions, to better target health and PrEP engagement campaigns.

KEYWORDS:

• Rural
• sexual and gender minorities
• HIV risk
• pre-exposure prophylaxis

Acknowledgements

We gratefully acknowledge the time and consideration to this work given by participants; and also thank our Community Advisory Board for their insight into survey instrument design and assisting with advertising the study among their social networks. Jenkins provided overall leadership in concept development, implementation, data analysis and manuscript development; Phillips contributed to the study design, data interpretation, and manuscript development; Rodriguez contributed to the study development, data collection, and review of final manuscript; White provided assistance in data collection and review of final manuscript; Agosto provided consultation in study design and review of final results and manuscript; Luckey provided statistical analysis expertise and contributed to review of the final manuscript.

Consent to participate

All participants provided informed consent prior to participation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

This project was reviewed and approved by the institutional review board at Southern Illinois University School of Medicine (Springfield Committee for Research Involving Human Subjects; #21-808).

Data availability statement

De-identified data can be made available upon request.

Additional information

Funding

This work was funded by a grant from Blue Cross and Blue Shield of Illinois (no number; Jenkins)