Down Low Under the Big Sky: HIV Prevention with Closeted Rural Men Who Have Sex with Men (MSM)

Background: Multiple studies have been dedicated to understanding sociocultural factors influencing the HIV epidemic among urban gay men. Yet, few studies have explored behaviors and risks specific to rural MSM despite known differences in social and cultural environments. With the difficulty in accessing MSM who are closeted or do not consider themselves gay, even less information is available on this population. The purpose of this study was to increase understanding of factors influencing the transmission of HIV among this population. Methods: From 2010-2011, in-depth qualitative interviews were conducted with 45 self-identified closeted MSM living in Montana. With the difficulty of finding closeted men, recruitment occurred utilizing the Internet. Interviews were analyzed to elicit overall themes influencing men's sexual behaviors and prevention needs. Mohr and Fassinger's Outness Inventory was administered to determine perceived level of “outness.” Results: “HIV fatigue” and a false sense of security leading to increased risky sexual behaviors including anonymous sex and decreased risk communication and testing frequency were found. Married men in the study reported higher use of condoms for fear of being “outed” by “bringing home” STDs. Lack of discrete and anonymous HIV testing facilities influenced delayed testing decisions. Men reported looking for out-of-town or out-of-state sexual partners indicating widespread sexual networks. Conclusions: Feelings of “HIV fatigue” and a false sense of security in rural areas have led to increased sexual risk behaviors among the men in this study further supporting the need for continued social support services, HIV testing, and prevention funding in rural areas.