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Research investigating predictors of risky sexual behavior of rural MSM is sparse, even though the prevalence of HIV in rural areas has increased. This study explored two sets of predictors of 93 rural MSM's levels of risky sexual behavior: mental health variables and stigma emanating from men's family members, health care professionals, and people in the rural communities in which they live. Over 47% of the men were found to be at modified high to high risk. Logistic regression using a continuation logit model was used to test the relationship of the predictor variables and the four levels of risk. Findings indicate that self-esteem was predictive of the highest sexual risk behavior but not lower levels of risk. Stigma was predictive of modified high sexual risk when compared to low and no risk categories. No variables differentiated men at low risk from men at no risk.
Although the incidence of HIV/AIDS infection among intravenous drug users, women, heterosexual men, and children continues to increase, men who have sex with men (MSM) and MSM who inject drugs account for 52% of all cases (Centers for Disease Control and Prevention [CDC], 2001).
After a decline in new HIV infections in the late 1980s and early 1990s among MSM (CDC, 1995), evidence supports a resurgence in the spread of HIV and sexually transmitted infections in many urban areas of the United States (CDC, 1999a; 2001; Koblin, Torian, Ren, MacKellar, & Valleroy, 2000). A recent report of high-risk behaviors among MSM in six U.S. cities shows high rates of unprotected anal intercourse that were significantly associated with alcohol and other drug use (Koblin et al., 2003). Although many gay and bisexual men appear well informed about HIV transmission and safer sex practices, many do not consistently engage in low-risk behavior (Hospers & Kok, 1995). Of major concern is relapse in nonuse of condoms during anal intercourse. Longitudinal studies of changes in sexual risk behavior of MSM show that predictors of relapse are drug use (Halkitis, Parsons, &c Stirratt, 2001), lack of peer support, and fewer limit-setting negotiating skills in sexual encounters (Adib, Joseph, Ostrow, & James, 1991). Other research with MSM has shown that unprotected sex is related to age (younger men engage in more high-risk behavior) (Kelly,...