Anne Bowen - US grants

This proposal is in response to the NIMH RFA MH-01-003, "Communication and HIV/STD Prevention". Seventy-four percent of male HIV cases in Wyoming are among men who have sex with men (MSM). MSM in rural areas are isolated and tend to be secretive about their sexual preferences. Primary means of socializing and meeting sexual partners is by electronic communication and traveling to urban areas. Fear of discovery and/or lack of self- identification as gay or bisexual may inhibit rural MSM from attending face-to-face interventions. Fear, homophobia, and distance prohibit rural MSM from creating identifiable communities, may make community level interventions irrelevant. Although intensive interventions may be cost effective in cities, it is doubtful that small, rural jurisdictions will ever have sufficient funds to implement extensive HIV risk reduction interventions. The development of Internet risk reduction interventions targeting MSM in rural areas presents a unique and cost effective means for intervention delivery. Although Internet interventions have been shown to be useful for assessing sexuality issues, little is known about the dynamics of recruiting and retaining MSM in internet interventions or about the efficacy of internet delivered sexual risk reduction interventions. The Wyoming Rural AIDS Prevention Research Project will be implemented in 2 phases and accomplish the following specific aims: Phase l) Determine the dynamics of Internet use by MSM and develop a typology of HIV risk among rural MSM, and Phase 2) Determine the acceptability and effectiveness of 4 Internet interventions (Information, Self- efficacy, Expert system, Social Network). Social Cognitive theory will be used as an organizing tool for identifying precursors to behavior change. In phase 1 a purposeful sample of 60 men for focus groups and 480 MSM for the Internet assessment will be recruited. The elicitation data from Phase 1 will be used to refine the Phase 2 Internet assessment and interventions. In Phase 2, 960 MSM will be recruited to participate in the intervention efficacy study. This research study is designed as a completely randomized factorial design that will permit comparing the effects of each intervention separately as well as combinations of interventions. If the Internet is an effective medium for delivering HIV risk reduction messages to rural MSM, it will have important implications for many under served rural jurisdictions.

[unreadable] DESCRIPTION (provided by applicant): The Wyoming Meth Use and AIDS: Exploring Culture and Context of Rural Risk (WyMAR) is a revised small grant (RO3) submitted in response to the PA, "Drug Abuse Aspects of HIV/AIDS and other infections". This research is important because of the high prevalence of methamphetamine (MA) use in rural areas and little research has examined HIV risk for MA users in rural areas, nor among heterosexuals. MA has been a problem in Wyoming since 1992 and continues to be, as seen by the outbreak of hepatitis among heterosexual methamphetamine injectors in 2003. Drug abuse and HIV/AIDS treatment and prevention issues in extremely rural areas are related to geographic isolation, stigma, strong individualism, and lack of treatment facilities. Little is known about cultural and contextual factors unique to rural recruiting and drug use and sexual risk for HIV among rural users. The WyMAR project will recruit MA users and female sexual partners of MA users for in-depth interviews to accomplish the following Specific Aims: 1) To identify individual, social, community and rural cultural factors that affect HIV risk taking behavior among rural heterosexual injecting and non-injecting methamphetamine users; and 2) To identify individual, social, community, and rural cultural factors that facilitate successful recruiting of rural heterosexual methamphetamine users to participate in research activities. This qualitative study includes in-depth interviews with 40 male and 40 female not-in-treatment heterosexual MA users. In addition, since we assume many of the MA users will also be sexual partners of MA users, we will recruit 20 female non-meth using sexual partners who live in the rural state of Wyoming. These women may provide unique information about pressures to initiate MA use, high risk unprotected sex and may represent an important bridge group for HIV infection. In-depth inerviews will be completed, using Bronfenbrenners bio-ecological model as a guide to identifying themes unique to rural culture and context that place rural MA users at risk for contracting HIV. Quantitative questions, field notes, and in-depth interview data will be triangulated to develop a comprehensive picture of themes across the layers of Bronfenbrenners model and to identify facilitators and barriers to research participation. Finally, in addition to interview questions about individual, community and cultural facilitators and barriers to recruiting, we will examine the results of our targeted sampling and pilot a small version of Respondent Driven Sampling to better explicate Aim 2. Data will be used to inform the development of an RO1 to conduct an epidemiology of rural MA use. [unreadable] [unreadable] [unreadable]