Young Sexual Minority Males' Perceptions and Experiences of Sexual Healthcare in Urban and Rural Areas

Introduction Young men who have sex with men (YMSM) are at disproportionate risk for HIV and STIs. Research has made progress in understanding and mitigating disparities in access to sexual healthcare; however, YMSM outside major metropolitan areas remain understudied. This study aims to better understand the unique experiences and needs of non-urban YMSM as they seek sexual healthcare services. Methods Twenty-five YMSM from across the USA took part in semi-structured interviews between 2020 and 2021 exploring barriers, facilitators, and experiences utilizing sexual healthcare services. The sample was 52% racial/ethnic minority. A thematic analytic approach guided analysis and identification of themes across interviews. Participant localities were defined continuously, then split into quartiles to compare themes across the urban-rural continuum. Results Compared to urban YMSM, rural YMSM often described community non-acceptance, a lack of knowledgeable or affirming providers, and finances as barriers to sexual healthcare. Many participants reported that parental insurance coverage is or was a barrier, commonly due to concerns about confidentiality. For racial/ethnic-minority YMSM, having multiple minority identities commonly impacted their experiences using sexual healthcare services. Conclusions Non-urban YMSM experience unique barriers to competent, affirming sexual healthcare compared to their urban counterparts. Research and intervention should be tailored to non-urban contexts to assist YMSM who remain at disproportionate risk for HIV and STIs. Policy Implications Reducing stigma in communities and clinics; training more competent providers; and providing affordable, community-specific services will be essential to curb disparate rates of HIV and STIs among more rural YMSM.