HIV transmission risk practices in rural persons living with HIV disease.

BACKGROUND: Little is known about continued high-risk sexual behavior of persons living with HIV disease in rural areas of the United States. However, as HIV seroprevalence rates increase in rural communities, there is an urgent need to develop interventions to assist HIV-infected rural individuals who have difficulty refraining from high-risk sex. GOAL: To characterize patterns of continued high-risk sex among 216 men and women living with HIV disease in rural areas of 12 states. STUDY DESIGN: Cross-sectional, self-administered survey. RESULTS: Thirty-two percent of men and 38% of women reported that all of their sex partners in the previous 3 months were HIV-seronegative. Among the 33% of men who engaged in anal sex, 59% never or rarely used condoms. Of the 55% of women who engaged in vaginal sex in the previous 3 months, 31% never used condoms. CONCLUSION: Culturally contextualized interventions are needed to initiate and facilitate the risk-reduction efforts of HIV-infected rural persons.

Thoughts of suicide among HIV-infected rural persons enrolled in a telephone-delivered mental health intervention.

This study characterized rates and predictors of suicidal thoughts among HIV-infected persons living in rural communities of eight U.S. states. Self-administered surveys were completed by 201 HIV-infected persons living in communities of 50,000 or fewer that were located at least 20 miles from a city of 100,000 or more. All participants were clients of rural AIDS service organizations and had recently enrolled into a randomized clinical trial of a telephone-delivered, coping improvement-group intervention designed specifically for HIV-infected rural persons. At baseline, participants reported on thoughts of suicide, psychological symptomatology, life-stressor burden, ways of coping, coping self-efficacy, social support, and barriers to health care and social services. Thirty-eight percent of HIV-infected rural persons had engaged in thoughts of suicide during the past week. A logistic regression analysis revealed that participants who endorsed thoughts of suicide also reported more depressive symptoms (odds ratio [OR] = 2.19; 95% confidence interval [CI] = 1.32-3.63, p < .002), less coping self-efficacy (OR = 0.70; 95% CI = 0.56-0.88, p < .002), more frequently worried about transmitting their HIV infection to others (OR = 1.66, 95% CI = 1.14-2.40, p < .008), and experienced more stress associated with AIDS-related stigma (OR = 1.58, 95% CI = 1.07-2.35, p < .03). As AIDS prevalence rates increase in rural areas, interventions that successfully identify and treat geographically isolated HIV-infected persons who experience more frequent or serious thoughts of suicide are urgently needed.