Depressive symptoms as a link between barriers to care and sexual risk behavior of HIV-infected individuals living in non-urban areas

HIV-infected individuals living in non-urban areas have been proposed to be particularly vulnerable for sexual risk behavior because of barriers to adequate care. The current study examined the association of barriers to care and sexual risk behavior with a focus on depressive symptoms as a link between the two variables. One-hundred-and-one sexually active HIV-infected individuals living in non-urban areas in New England participated by completing self-report measures in a computer-administered format. Four barriers to care were examined: geographical barriers and distance to services; access to and quality of medical and psychological services; community stigma; and personal resources. The results indicated barriers to care, and in particular those pertaining to access to and quality of medical and psychological services were related to depressive symptoms, which, in turn, were related to sexual risk behavior. The findings suggest that interventions to reduce sexual risk behavior in non-urban settings could include not only increasing the availability of quality services but targeting depressive symptoms of HIV-infected individuals.