AEGiS-14IAC: Evaluating HIV prevention in rural America: A 13-state comparative study of 'successful' and 'failing' states in HIV prevention for men who have sex with men (MSM).

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Evaluating HIV prevention in rural America: A 13-state comparative study of 'successful' and 'failing' states in HIV prevention for men who have sex with men (MSM).

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. TuOrD1198)

Rosser BR, Barnes V
Division of HIV/AIDS Prevention - IRS, Center for HIV/STD/TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, United States

BACKGROUND: As part of the first study of HIV prevention in rural states of the USA, we sought to identify state-level characteristics of successful HIV prevention.

METHODS: In 2001, in 13 states with MSM-dominant epidemics, the author conducted structured interviews with 80 key informants (state AIDS directors, CDC project officers, planning group co-chairs, prevention workers, and MSM community leaders) and over 200 community volunteers. Religious affiliation and other demographics were obtained from the Bureau of Census (1998, 2000).

RESULTS: Informants in seven states rated their state 'average'/'above average' in HIV prevention, while in six states, informants rated the state as 'failing.' The 7 more successful states had both a wider variety and more MSM-targeted interventions (14.7 vs. 5.5; t(11)=3.09; p=.01). Overall funding, race/ethnicity, HIV/AIDS prevalence, poverty, and 'rural-ness' did not differentiate 'successful' and 'failing' states. Rather, more successful states had a lower percentage of 'religious adherents' (47% vs 64%; t(11)=3.14; p=.009), less 'Evangelical Protestant' adherents (8% vs 33%; t(5.7)=3.30; p=.017), more 'gay community' infrastructure ('good' vs 'poor', t(11)=6.41; p<.001) and less political barriers at the state government and health department levels (t(11)=5.25; p<.001). More successful states spent a greater proportion of funds contracting community-based organizations for HIV prevention (42% vs. 15%; t(11)=2.49; p=.03), and a greater proportion of overall funds on MSM programs (13% vs. 3%; t(11)=3.02; p<.012). More successful states named both more strengths (t(7.4)=2.76; p=.028) and more barriers (t(11)=2.32; p=.04) than less successful states.

CONCLUSIONS: In the US, key informants felt HIV prevention is succeeding in some states and failing in others. Key informants identified fiscal, social and political factors as the major barriers to success. Promising interventions for MSM in rural states were identified.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Homosexuality, Male, Coitus, HIV Infections, Sex, Prevalence, Safe Sex, HIV Seropositivity, Homosexuality, Residence Characteristics, Disease Outbreaks, Americas, Greece, Human, Male, prevention & control

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