Predictors of Success in Implementing HIV Prevention in Rural America: A State-Level Structural Factor Analysis of HIV Prevention Targeting Men who have Sex with Men


Relatively few studies have examined the impact of modifying structural factors on HIV prevention efforts in the United States despite their high potential for lowering HIV prevalence rates. The aim of this study was to identify state-level characteristics of successful HIV prevention implementation. Structured interviews with 73 key informants in 13 rural states identified ‘more successful’ and ‘less successful’ states in HIV prevention. States were compared on demographic, religious, gay community, and funding variables. The 7 more successful states had both a wider variety and more MSM-targeted interventions. Overall funding, degree of epidemic, and “ruralness” were not significantly associated with success. Rather, successful states had less religious and Evangelical Protestant adherents and more ‘gay community’ infrastructure. They also spent a greater proportion of funds contracting community-based organizations and on MSM-targeted programming. Success in HIV prevention varies across rural states. Key demographic, social and economic indicators distinguish success in HIV prevention.

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This research was undertaken as part of an Interagency Personnel Agreement at the Centers for Disease Control and Prevention (CDC), who sponsored this research. The assistance of Dr. David Holtgrave, Dr. Victor Barnes, and Ms. Bonita Johnson is gratefully acknowledged. The authors wish to thank the state AIDS directors who volunteered their state’s participation and helped in planning the key informant interviews, the participants for their expert evaluations and the National Association of State and Territorial AIDS Directors (NASTAD) for facilitating dissemination of the results.

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Correspondence to B. R. Simon Rosser.

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Rosser, B.R.S., Horvath, K.J. Predictors of Success in Implementing HIV Prevention in Rural America: A State-Level Structural Factor Analysis of HIV Prevention Targeting Men who have Sex with Men. AIDS Behav 12, 159–168 (2008) doi:10.1007/s10461-007-9230-y

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  • Rural HIV prevention
  • Prevention planning
  • structural research
  • MSM