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.
