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HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels. [ABSTRACT FROM AUTHOR]

This community-based study explored the lived experiences of being in and going through the rural HIV care continuum among 15 gay and bisexual men (GBM) with HIV who live in a rural area of a Midwestern state. Our analysis adapted a six-step interpretative phenomenological analysis. Five themes emerged that reflected the five continuum stages: 1) Diagnosis means death, 2) Linkage to care means uncertainty, 3) HIV care improves the quality of life lost pre- or peri-diagnosis, 4) ART implies life, and 5) Undetectable addresses the medical but not social aspects of HIV. Participants recalled they faced and continue to face social determinants, stigma, and chronic and mental health conditions. Findings provide future research directions and practical implications to address social determinants of health, promote chronic and mental health, and reduce interpersonal stigma throughout all HIV care continuum stages. [ABSTRACT FROM AUTHOR]

Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective. [ABSTRACT FROM AUTHOR]