Findings from a new study of people with HIV who live in rural communities suggest they may be more likely to continue having unprotected sex than people living with HIV in urban areas, a problem study authors blame on a lack of HIV-prevention programs and other health and social services in rural America.

"Studies of continued high-risk sex in urban samples of people living with HIV disease typically find that one-third of persons continue to engage in high-risk sex. In our rural sample, 43 percent of participants were at elevated risk for transmitting their HIV infection," said Timothy Heckman, an associate professor of health psychology at Ohio University, who presented the research today at the Annual Conference of the Society of Behavioral Medicine in Washington, D.C.

The study, which included 159 HIV-positive participants in 12 states, found that those who had unprotected sex in the last three months were more likely to suffer from depression and high levels of stress, which Heckman said may have contributed to their risky sexual behavior. About half were in long-term, monogamous relationships and many others reported only one or two sexual encounters in the past three months.

"Much of the high-risk behavior we are witnessing in our sample is taking place in the context of long-term, committed relationships, so when I think of these findings, I don't think about rural persons actively seeking sex and then irresponsibly practicing high-risk sex," Heckman said. "Instead, I think of rural couples who are isolated by the stigma of their illness and who lack access to programs that can strengthen their risk-reduction behavioral motivation, intentions and behavioral skills."

The findings are the latest from a $1.3 million study of HIV and AIDS in rural America, which is funded by the National Institutes of Mental Health. Participants are recruited through AIDS service organizations and must live in towns of fewer than 50,000 people that are at least 20 miles from a city of 100,000 or more.

Many of these small communities often lack HIV-prevention programs ­ especially for people already infected with the virus, Heckman said, and in towns that do offer these programs, HIV-positive residents may be reluctant to ask for information for fear that word of their infection will spread through their hometowns. In either case, many rural residents are not receiving information about the dangers of unprotected sex.

For example, some HIV-infected rural residents in the study who are in relationships with another HIV-positive partner may assume that because both people are infected, there is no danger.

"That clearly is not the case," Heckman said. "They may expose their partners or themselves to other STDs or different strains of HIV. The latter is cause for concern since it may impact their response to antiretroviral therapies."

This new data only strengthen Heckman's assertion that more attention should be paid to the estimated 50,000 people living with AIDS in rural America. Toward that end, Heckman has enrolled 320 people from 13 states in his NIMH-supported project, which is collecting data on an "emotionally vulnerable" population he maintains is largely overlooked by AIDS researchers, and to test the feasibility of delivering badly needed mental health support services via telephone to individuals who lack access to support programs available in urban centers.

Other study authors were Monica Silverthorn, project coordinator of the NIMH study and Andrea Waltje and Melissa Meyers, graduate psychology students at Ohio University.