title: The social/sexual environment of gay men residing in a rural frontier state: implications for the development of HIV prevention programs.
abstract: BACKGROUND
  The incidence and prevalence of HIV/AIDS is increasing among rural men who have sex with men (MSM). Yet little is known about the social/ sexual environment of rural frontier areas.
  
  
  OBJECTIVE
  The purpose of this study was to assess the social/sexual environment of gay men living in rural areas and how this environment contributes to the development of HIV/AIDS prevention programs.
  
  
  METHODS
  A qualitative study was conducted in Wyoming. In-depth guided interviews were conducted with 39 self-identified gay men. Data were analyzed for emergent themes using constant comparative analysis.
  
  
  RESULTS
  Four broadly related themes emerged. Participants perceive that they live in a hostile social environment in which the potential for becoming a target of violence is present. In order to cope with this social reality, men adopt strategies to assimilate into the predominant heterosexual culture and to look for sex partners. These, in turn, are related to their attitudes about HIV/AIDS and prevention activities. Notably, the Internet was discussed by participants as a means for men to connect to a larger gay society and look for sex partners and as a potential venue to HIV/AIDS prevention programs.
  
  
  CONCLUSIONS
  Data provided a number of implications for developing HIV/AIDS prevention programs targeting rural MSM. Especially apparent was the need for programs to be mindful of the desire to keep one's sexual preferences shielded from public knowledge and the effect this may have on recruiting rural MSM to participate in prevention activities. The Internet, because men can access it privately, might provide a venue for prevention projects.
authors.affiliation: Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX 77030, USA. mwilliams@sph.uth.tmc.edu
authors.forename: Mark L
authors.initials: ML
authors.lastname: Williams
authors.forename: Anne M
authors.initials: AM
authors.lastname: Bowen
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Horvath
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012423:Rural Health; D012747:Sexual Partners / Q000523:psychology; D012919:Social Behavior; D012931:Social Environment; D012934:Social Isolation; D011795:Surveys and Questionnaires; D014959:Wyoming