Safe Connections: Planning, Organizing, and Running an HIV Prevention Workshop for MSM in a Rural Region

David H. Whitcomb, Ph.D.
Patricia Pahl, M.A.

University of North Dakota

ABSTRACT

Despite recent medical advances that have increased the life-expectancy and quality of life for persons living with AIDS, people still prefer not to talk about HIV or AIDS. This paper focuses on lack the of perceived relevance by men who have sex with men (MSM) in a rural region. In contrast to regional inattention, national authorities have recognized the importance of developing HIV prevention programming for MSM throughout the country and have urged every state to implement such programs. The purpose of this paper is to describe the process of planning, organizing, and running an HIV Prevention Workshop for MSM in a rural region where HIV and AIDS have not significantly affected many men or social service providers. It is hoped that the narrative style describing obstacles faced and lessons learned will be useful to rural health service professionals interested in initiating a similar project. A summary of results from participant evaluations and a research survey will be provided.

Safe Connections: Planning, Organizing, and Running an HIV Prevention Workshop for MSM in a Rural Region

Twenty years into the Acquired Immune Deficiency Syndrome (AIDS) epidemic, people still don’t like to talk about AIDS or human immunodeficiency virus (HIV). Although being HIV-positive is no longer equated with an imminent decline in health and, in many professional and non-professional circles, is no longer seen as a death sentence, the fact remains that most of us would rather focus our attention elsewhere. The purpose of this paper is to describe the process of planning, organizing, and running an HIV prevention workshop for men who have sex with men (MSM), in a rural region where HIV and AIDS are typically perceived as irrelevant and where public discourse on these topics is rare.

In contrast to major urban centers the incidence of HIV in many rural regions remains very low. Whereas many gay and bisexual men in major metropolitan centers endured multiple losses to AIDS during the 1980s and early 1990s, there are still rural gay and bisexual men of the same age cohort who never lost a friend or loved one to AIDS. It seems that the motivation for not talking about HIV/AIDS in the former situation might be a way to avoid rekindling the feelings of loss, whereas the motivation for rural men would be to keep the threat as far away as possible. After all, AIDS is something that happens to “them,” to “those people out there,” not to you and me in rural America. The same attitude may hold true for social service providers who are likely to work with or administer programs for HIV-positive men. Despite these attitudes, HIV and AIDS pose a definite health threat outside of the major cities. For the year ending in June 2001, there were 5.4 new cases of AIDS per 100,000 persons living in non-metropolitan areas (under 50,000), compared to rates of 9.4 per 100,000 in smaller metropolitan areas (50,000 – 499,999 population) and 18.3 per 100,000 in larger metropolitan areas (500,00 and above; Centers for Disease Control & Prevention [CDC], 2002).

The same data set (CDC, 2002) reveals that the rates of new AIDS cases are virtually the same in the outlying counties of both large and small metropolitan areas as they are in non-metropolitan areas (i.e., between 5.0 and 5.6 cases per 100,000). To demonstrate that MSM are at risk outside of major metropolitan areas, figures from the state with the lowest incidence of HIV and AIDS, North Dakota, reveal that through June 2001, 52% of the 270 reported HIV/AIDS cases were through male to male sexual contact, with another 10% stemming from intravenous drug use among MSM (North Dakota Department of Health, n.d.).

The preceding review of the numbers demonstrates that MSM are indeed at risk for HIV in rural America. There are, nevertheless, few programs to address the special HIV prevention needs of rural MSM. Recently, a small group of health service professionals and university students initiated one such program. This project involved partnerships among a state agency, a local not-for-profit community HIV/AIDS network with access to university resources, and consultant from large metropolitan area. The authors are the project director and graduate assistant; we try to offer the perspective of our local agency throughout the steps of seeking funding, providing training to regional health care providers, publicizing the event, and delivering an HIV program to MSM in a rural region. We hope that the narrative style describing obstacles faced and lessons learned will be useful to rural psychologists interested in initiating a similar project. In addition, we provide program evaluation results in Table 1.