Differences Between Rural and Urban America that Inform HIV Prevention Messaging.

Area of Science:

• Public Health
• Epidemiology
• Behavioral Science

Background:

• HIV prevention efforts traditionally concentrate on urban settings, despite a significant proportion of new HIV diagnoses occurring in non-urban areas.
• Understanding rural-urban disparities in HIV risk perception, stigma, and pre-exposure prophylaxis (PrEP) awareness is critical for effective public health strategies.

Purpose of the Study:

• To explore differences between rural and urban populations regarding perceived HIV risk, stigma, and pre-exposure prophylaxis (PrEP) awareness, attitudes, beliefs, communication behaviors, and usage.
• To inform the development of targeted communication messages promoting informed decision-making about HIV prevention options, including PrEP, for diverse populations.

Main Methods:

• Interviews preceded by a brief survey were conducted with 255 adults across 5 rural and 6 urban U.S. locations with high HIV burden.
• Data collection focused on perceived HIV risk, stigma, PrEP awareness, attitudes, beliefs, communication behaviors, and PrEP use.

Main Results:

• Rural participants reported lower perceived HIV risk and higher perceived stigma related to HIV testing, PrEP use, and HIV status compared to urban participants.
• Rural participants demonstrated lower awareness of PrEP and less frequent discussions about PrEP with healthcare providers.
• No rural participants reported using PrEP, despite a significant percentage being at substantial risk for HIV.

Conclusions:

• Significant disparities exist in HIV risk perception, stigma, and PrEP awareness and use between rural and urban populations.
• HIV prevention communication strategies must be tailored to address the specific needs and contexts of rural communities to enhance receptivity and uptake of prevention methods like PrEP.