Using Photovoice to Define the Experiences, Needs, Strengths, and Priorities of Gay Men in South Central Appalachia.

Introduction: Gay, bisexual, queer, and other men who have sex with men and transgender and nonbinary persons living in rural Appalachia experience profound health disparities. Limited research, however, has focused on the needs, strengths, and priorities of these communities.

Purpose: This study sought to better understand the lived experiences of the vulnerable, underrepresented, and underserved Appalachian gay male community by working with a small group of self-identified gay Appalachian men.

Methods: As part of a larger community-based participatory research study (the Appalachian Access Project), four self-identified gay men participated in a photovoice project. Participants took photos based on four group-defined photo assignments that served as discussion triggers to explore experiences and priorities of local LGBTQ+ communities. These discussions were analyzed and member-checked by participants, representatives from community organizations, and academic researchers.

Results: Nine themes emerged. Themes included acknowledgement of the diversity within Appalachian LGBTQ+ community; obstacles faced related to intersectional stigma and discrimination; geographic isolation; community-based peer support to promote belonging, wellbeing, and health; the need for welcoming and safer spaces; peer-to-peer knowledge sharing; self-care strategies; "breaking silences" to raise awareness about underrepresented experiences; and the roles of allyship, advocacy, and activism, to change policies and promote community health.

Implications: This photovoice project sheds light on the needs, strengths, and priorities of gay men living in Appalachia. Those working with these communities could benefit from increasing trust and focus on addressing higher-level environmental factors (e.g., community and policy factors) along with individual and interpersonal factors, to improve health equity for the larger Appalachian LGBTQ+ community.