HIV prevention among high-risk and hard-to-reach rural residents

HIV infection and HIV risk behaviors are primarily considered to be urban problems. However, rural areas are also experiencing HIV. Because the criminal justice system has a disproportionate number of persons at high risk for HIV, rural probationers were targeted. This article (1) describes an intervention designed to change the high-risk drug use and sexual behaviors of rural residents on probation; and (2) presents information on 200 rural probationers who entered a project to reduce drug use and risky sex. After informed consent was obtained, participants were randomly assigned to either the NIDA standard HIV intervention or a "rural-focused" HIV intervention that incorporates the NIDA intervention as well as thought mapping and structured stories. The rural focused intervention is grounded in the Stages of Change theory and motivational interviewing. Initial findings indicate that participants reported high levels of lifetime illicit drug use and risky sexual behaviors. Participants also reported limited knowledge about protection from HIV and hepatitis. These findings suggest that the project is reaching a group of rural residents who engage in high-risk drug and sexual behaviors.