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Differences between rural and urban America that inform HIV prevention messaging
Williams, P. A., Uhrig, J. D., Zulkiewicz, B. A., Johnson, M., Anderson, S. K. E., & August, E. M. (2025). Differences between rural and urban America that inform HIV prevention messaging. AIDS and Behavior, 29(8), 2496-2508. https://doi.org/10.1007/s10461-025-04710-1
HIV prevention efforts have traditionally focused on urban areas, yet about one-fourth of new HIV diagnoses in the U.S. are in non-urban areas. This study explored rural and urban differences in perceived HIV risk; perceived HIV stigma; and pre-exposure prophylaxis (PrEP) awareness, attitudes, beliefs, communication behaviors, and use to inform the development of communication messages to promote informed decision-making among available HIV prevention options, including PrEP. We conducted interviews, preceded by a brief survey, with 255 adults in 5 rural and 6 urban locations throughout the U.S. with high HIV burden. Participants from rural areas more frequently described their risk of getting HIV as low compared with those from urban areas, although partly due to differences in gender/sexual identity and sexual risk. Participants from rural areas more frequently reported perceived stigma around getting tested for HIV, taking PrEP to prevent HIV, or having HIV and less frequently reported having heard of PrEP and having a healthcare provider talk with them about PrEP compared with those from urban areas. No participants from rural areas reported using PrEP, although 48% of those with HIV-negative or unknown status were at substantial risk based on reported risk factors. Our findings highlight notable differences in perceived HIV risk; perceived HIV stigma; and PrEP awareness, attitudes, beliefs, communication behaviors, and use between individuals residing in rural and urban areas, suggesting that HIV prevention messaging needs to be tailored for rural audiences to support receptivity.Los esfuerzos de prevenci & oacute;n del VIH se han centrado tradicionalmente en las & aacute;reas urbanas, sin embargo, alrededor de una cuarta parte de los nuevos diagn & oacute;sticos de VIH en los Estados Unidos se encuentran en & aacute;reas no urbanas. Este estudio explor & oacute; las diferencias rurales y urbanas en la percepci & oacute;n del riesgo de VIH; el estigma percibido del VIH; y la concienciaci & oacute;n, las actitudes, las creencias, los comportamientos de comunicaci & oacute;n y el uso de la profilaxis preexposici & oacute;n (PrEP, por sus siglas en ingl & eacute;s) para informar el desarrollo de mensajes de comunicaci & oacute;n que promuevan la toma de decisiones informadas entre las opciones disponibles de prevenci & oacute;n del VIH, incluida la PrEP. Realizamos entrevistas, precedidas por una breve encuesta, a 255 adultos en 5 localidades rurales y 6 localidades urbanas de los Estados Unidos con alta carga de VIH. Los participantes de las zonas rurales describieron con mayor frecuencia que su riesgo de contraer el VIH como bajo en comparaci & oacute;n con los de las zonas urbanas, aunque en parte debido a las diferencias en las identidades de g & eacute;nero o sexuales y el riesgo sexual. Los participantes de las zonas rurales informaron con mayor frecuencia sobre el estigma percibido en torno a hacerse la prueba del VIH, tomar la PrEP para prevenir el VIH o tener el VIH, y con menos frecuencia informaron haber o & iacute;do hablar de la PrEP y tener un proveedor de atenci & oacute;n m & eacute;dica que les hablara sobre la PrEP en comparaci & oacute;n con los de las & aacute;reas urbanas. Ning & uacute;n participante de las zonas rurales inform & oacute; haber usado la PrEP, aunque el 48% de los que ten & iacute;an un estado seronegativo o desconocido del VIH corr & iacute;an un riesgo sustancial seg & uacute;n los factores de riesgo informados. Nuestros hallazgos ponen de manifiesto diferencias notables en la percepci & oacute;n del riesgo de contraer el VIH; el estigma percibido del VIH; y la concienciaci & oacute;n, las actitudes, las creencias, los comportamientos de comunicaci & oacute;n y el consumo de la PrEP entre las personas que residen en zonas rurales y urbanas, lo que sugiere que los mensajes de prevenci & oacute;n del VIH deben adaptarse a las audiencias rurales para apoyar la receptividad.
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