HIV Prevention among Gay and Bisexual Men in Small Cities

Abstract

One consequence of the emergence of the human immunodeficiency virus (HIV) epidemic over a decade ago among homosexually active men in the largest American cities is that most behavioral research on acquired immunodeficiency syndrome (AIDS) involving gay and bisexual men has been conducted primarily in urban centers. To a very large extent, what we know about gay men’s HIV risk patterns and changes made in behavior in response to AIDS is based upon studies conducted in New York, San Francisco, Chicago, Los Angeles, and a handful of other urban areas traditionally considered as “AIDS epicenters.” Further, behavior change conclusions are often based upon a relatively small number of volunteer cohorts longitudinally followed in those cities. While it is understandable, and was certainly appropriate, to intensively study gay men’s risk behavior in areas where the HIV epidemic struck earliest and most harshly, a byproduct of this focus is that we still know very little about behavior patterns, behavior changes, and intervention approaches pertinent to HIV prevention in other geographical areas. To a large extent, behavioral research to date on HIV risk among gay men is in fact behavioral research among gay men from San Francisco, New York, and Chicago. These findings from urban gay men may or may not be generalizable to homosexually active men who live in smaller cities.