The face of HIV/AIDS is changing in the U.S. HIV infection now has spread to heterosexual people, people who use illegal drugs, women, people of color, and importantly for our project, people living in rural areas (Berry, 1993; Heckman, Kelly, Somlai, Kalichman, & Davantes-Heckman, 1999). Little research has been conducted on HIV/AIDS in rural populations. This project will take place mainly in Vermont, which by many indices is the most rural state in the nation. This project will test a model of how the stigma associated with HIV/AIDS affects the HIV risk-related behaviors of people with HIV/AIDS in rural settings. The model proposes that the social and physical ecological characteristics of rural communities make HIV/AIDS particularly stigmatizing and that rural people with HIV/AIDS will perceive this stigmatization. For a variety of reasons, perceived HIV/AIDS stigmatization makes it difficult for people with HIV/AIDS to avoid sexual and drug use behaviors that risk the transmission of HIV. For example, HIV/AIDS stigma makes it difficult for people with HIV/AIDS to communicate with sexual partners about the need to practice HIV preventive behaviors. However, our model also proposes that the effects of HIV/AIDS stigma on risky behaviors depend on how individuals with HIV/AIDS cope with their stigmatized status. We will recruit 200 people with HIV/AIDS residing in Vermont communities or in communities in neighboring states. We will use archival data and community surveys (to assess social and physical ecological variables), self-report measures (to assess how stigmatized HIV/AIDS participants feel, how they cope with this stigma, and the extent to which they engage in HIV risk-related behaviors), a reaction time attention competition test (to assess whether participants avoid HIV/AIDS stigma related stimuli), self-reports about medical conditions, CD4 counts, and viral load (to determine stage of HIV disease), and psychiatric interviews (to assess participant symtomotology). We will use structural equation modeling to test whether rural ecologies promote HIV/AIDS stigma, which, depending on how people with HIV/AIDS cope with that stigma, increases behaviors that risk HIV transmission. HIV infection has the potential to increase dramatically in rural settings unless we understand how the social and physical ecology of these communities affects stigmatization and behaviors that risk the transmission of HIV. ? ? ?
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