Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Maryann Littleton

Committee Members

Robert Pack, Kathleen Rayman



Health Service Utilization and Stigma among

HIV-Positive Men-Who-Have-Sex-With-Men (MSM) in Rural Appalachia


Roger Lee Blackwell

The world has now entered the third decade of the AIDS epidemic. Men-who-have-sex-with-men continue to be disproportionately affected by HIV/AIDS. The United States still struggles in its response to this ongoing crisis in many areas: disease prevention, treatment, and HIV related stigma, prejudice and discrimination. Much of the information reported on MSM living with HIV has come from urban population centers, but only a few studies have focused on HIV positive MSM living in rural areas. Therefore, the overall aim of this dissertation was to explore the lived experiences of MSM living with HIV/AIDS, in particular the intersection of HIV related stigma with social, behavioral and health outcomes in rural, South Central Appalachia.

For this dissertation, data were collected via semi-structured, face-to-face interviews with 23 HIV-positive MSM living in South Central Appalachia. Using a descriptive narrative approach, the researcher sought to address the influence of HIV/AIDS related stigma in the lives of these men and provide a forum for their voices. Qualitative data were sorted into various categories from which emergent themes and topics were generated using Nvivo software for data management and manipulation. In addition to qualitative interviews, demographic data were gathered and analyzed to produce basic, descriptive statistics.

Results indicated that MSM participating in this study accessed health services through various agencies. MSM also experienced stigma in multiple and overlapping ways; MSM described stigmatizing experiences stemming from religious sources, communities, family and friends, and from the medical establishment. Moreover, it was revealed that homophobia and HIV-related stigma were related; participants did not differentiate between the two. Homophobia and HIV related stigma were specifically contextualized in relation to rurality and religiosity. The use of health related services was not mediated by stigma.

The results within this dissertation are intended to inform health professionals in the planning and implementation of interventions and treatments for this hidden population in Appalachia. This exploratory dissertation provides insight and contextual information for a highly stigmatized population. Lastly, this project provided rural MSM with a voice.

Document Type

Dissertation - unrestricted


Copyright by the authors.