Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Association of Religion Data Archives. (2006). State membership report. Retrieved from http://www.thearda.com/mapsReports/reports/selectState.asp
Bayer, R. (1989). Private Acts, Social Consequences: AIDS and the Politics of Public Health. New Brunswick, NJ: Rutgers University Press.
Blankenship, K. M., Bray, S. J., & Merson, M. H. (2000). Structural interventions in public health. AIDS, 14(suppl 1), S11–S21.
Bowen, A. M., Horvath, K., & Willimas, M. L. (2007). A randomized control trial of Internet-delivered HIV prevention targeting rural MSM. Health Education Research, 22(1), 120–127.
Centers for Disease Control and Prevention (2000a). HIV/AIDS in urban and nonurban areas of the United States. HIV/AIDS Surveillance Supplemental Report, 6(2), 1–16.
Centers for Disease Control and Prevention (2000b). HIV/AIDS Surveillance Supplemental Report, 6(2), 16.
Centers for Disease Control and Prevention. (2001a). HIV Prevention Strategic Plan Through 2005. Atlanta, GA: CDC.
Centers for Disease Control and Prevention. (2001b). HIV/AIDS Prevention Research Synthesis Project. Compendium of HIV prevention interventions with evidence of effectiveness. Available at www.cdc.gov/hiv/pubs/hivcompendium.htm
Centers for Disease Control and Prevention. (2002). HIV/AIDS Surveillance Report;14. Also available at: http://www.cdc.gov/hiv/stats/hasrlink.htm
Centers for Disease Control and Prevention (2005). HIV/AIDS in urban and nonurban areas of the United States. HIV/AIDS Surveillance Report, 17, 1–53. Available at: http://cdc.gov/hiv/topics/surveillance/resources/reports/
De Wit, J. B. F., De Vroome, E. M., Sanfort, T., & Van Griensven, G. J. (1997). Homosexual encounters in different venues. Int J STD AIDS, 8, 130–134.
Des Jarlais, D. C. (2000). Structural interventions to reduce HIV transmission among injecting drug users. AIDS, 14(suppl 1), S41–S46.
Elifson, K. W., Klein, H., & Sterk, C. E. (2003). Religiosity and HIV risk behavior involvement among “at risk” women. Journal of Religion and Health, 42, 47–68.
Encyclopedia Britannica. (2002). At: www.britannica.com, vers. 2001.
Family Education Network. United States—States. Retrieved July 1, 2002 from http://www.infoplease.com
Fehrs, L. J., Fleming, D., Foster, L. R., McAlister, R. O., Fox, V., Modesitt, S., & Conrad, R. (1988). Trial of anonymous versus confidential human immunodeficiency virus testing. Lancet, 2, 379–382.
Hall, I. H., Li, J., & McKenna, M. T. (2005). HIV in predominantly rural areas of the United States. The Journal of Rural Health, 21, 245–253.
Horvath, K. J., Bowen, A. M., & Williams, M. L. (2006). Virtual and physical venues as context for HIV risk among rural men who have sex with men. Health Psychology, 25, 237–242.
Jones, D. E., Doty, S., Glammich, J. E., Horsch, R. H., Marcum, J. P., Sanchagrin, K. M., & Taylor, R. H. (2000). Religious congregations and membership in the United States. Nashville, TN: Glenmary Research Center.
JW Publishing, Inc. (2002). United States—States. At: www.gayscape.com
Matthews, D. A., McCullough, M. E., Larson, D. B., Koenig, H. G., Swyers, J. P., & Milano, M. G. (1998). Religious commitment and health status: A review of the research and implications for family medicine. Archives of Family Medicine, 7, 118–124.
Morris, M., & Dean, L. (1994). Effect of sexual behavior change on long-term human immunodeficiency virus prevalence among homosexual men. American Journal of Epidemiology, 140, 217–232.
National Institutes of Health. (1997). NIH Consensus Statement on Interventions to Prevent HIV Risk Behaviors. 15(2), 11–13, At http://consensus.nih.gov/cons/104/104_statement.pdf).
O’Leary, A., & Martins, P. (2000). Structural factors affecting women’s HIV risk: a life-course example. AIDS, 14(suppl 1), S68–S72.
Parker, R. G., Easton, D., & Klein, C. H. (2000). Structural barriers and facilitators in HIV prevention: a review of international research. AIDS, 14(suppl 1), S22–S32.
Preston, D. B., D’Augelli, A. R., Cain, R. E., & Schulze, F. W. (2002). Issues in the development of HIV-preventive interventions for men who have sex with men (MSM) in rural areas. The Journal of Primary Prevention, 23, 199–214.
Rotheram-Borus, M. J. (2000). Expanding the range of interventions to reduce HIV among adolescents. AIDS, 14(suppl 1), S33–S40.
Shriver, M., Everett, C., & Morin. S. F. ( 2000). Structural interventions to encourage primary HIV prevention among people living with HIV. AIDS, 14(suppl 1), S57–S62.
Spartacus International Gay Guide. 2002.
Sumartojo, E., Doll, L., Holtgrave, D., Gayle, H., & Merson, M. (2000). Enriching the mix: incorporating structural factors into HIV prevention. AIDS, 14(suppl 1), S1–S2.
Sumartojo, E. (2000). Structural factors in HIV prevention: concepts, examples, and implications for research. AIDS, 14(suppl 1), S3–S10.
Taussig, J. A., Weinstein, B., Burris. S., & Jones, T. S. (2000). Syringe laws and pharmacy regulations are structural constraints on HIV prevention in the US. AIDS, 14(suppl 1), S47–S51.
U.S. Census Bureau (2000). United States Census 2000. At: www.census.gov
U.S. Census Bureau. (2001). Introduction to Census 2000 Data Products. Accessed electronically on December 19, 2006 from: http://www.census.gov/prod/2001pubs/mso-01icdp.pdf
Williams, M. L., Bowen, A. M., & Horvath, K. J. (2005). The social/sexual environment of gay men residing in a rural frontier state: Implications for the development of HIV prevention programs. The Journal of Rural Health, 21, 48–55.
Wohlfeiler, D. (2000). Structural and environmental HIV prevention for gay and bisexual men. AIDS, 14(suppl 1), S52–S57.
Acknowledgement
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article can be found at http://dx.doi.org/10.1007/s10461-008-9366-4
Rights and permissions
About this article
Cite this article
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). https://doi.org/10.1007/s10461-007-9230-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-007-9230-y