Sex and the country.

Health and medicine explained.
May 29 2008 12:34 PM

Sex and the Country

Forget New York. Samantha should move to the sticks.

Kim Cattrall in Episode 57 of Sex and the City, "Sex and the Country"
Kim Cattrall in Episode 57 of Sex and the City, "Sex and the Country"

Sex and the City, which, as it's hard not to know by now, comes to the big screen this weekend, rarely ventured beyond the island of Manhattan in its six years on television. When the women did find themselves elsewhere, they weren't usually happy about it. This was especially the case in Season 4, when Carrie's boyfriend, Aidan, hamstrings her into a trek to his rustic cabin upstate. Carrie, in turn, pressures Samantha into tagging along, and urban-misfit misadventures ensue—until Samantha spots a hunky, half-naked farmer and seduces him out of his overalls. And thus the show discovers what researchers have been documenting over the last decade or more: It's the country, rather than the city, where more of the sex is.

Several studies have shown that rural teens are more likely to have sex than their urban counterparts, that they lose their virginity earlier, and that they have more sexual partners. This and other research also reveals that country dwellers, both teens and adults, are less likely to use condoms during their rolls in the hay (sorry, couldn't resist). A survey of college students in Indiana, for instance, revealed that students who had grown up in the country were more likely than city natives to skip the love glove when they rendezvous. (The paper doesn't define its terms, but presumably most of the students were from rural or urban Indiana.)


Many factors could contribute to this discrepancy, including rural poverty, limited education, and higher marriage rates for young people in the country. But the city-country gap can't be entirely explained away by these other variables. One study from 2000 controlled for many of these demographic factors and still found that rural high-school males were more likely to have had sex than their urban peers. A 2002 investigation compared the sexual practices of low-income African-American women living in Missouri cities with those living in the Missouri countryside. The groups were relatively well-matched in age (the average in both groups was 26), income, marital status, and other demographic factors. Still, the rural women were twice as likely to report that they never used condoms. And among women in this group, rural women were less likely to say this was because their partners had actually tested negative for HIV. Instead, the country women tended to believe their partners were HIV-negative, without proof.

So, what remains to explain these differences? Maybe boredom. Rural teens may not have the same cornucopia of activities to occupy their free time that their urban counterparts do, experts say. So, researchers suspect that while city teens pack their schedules, their country brethren strip down to their farmers' tans. There's no hard evidence that rural youth are pairing off because of wide-open afternoons, but that's the rationale that researchers tend to mention.

In addition, rural residents seem to believe that their communities are shielded from sexual scourges, maybe because they're geographically isolated. Adolescents have told researchers, for example, that sexually transmitted disease isn't a problem that affects small towns. It doesn't help that many provincial schools offer abstinence-only education, which studies have shown just doesn't work and neither prevents nor delays teens from having sex. Abstinence-only ed may spare students the embarrassment of listening to their gym teachers explain how to put a condom on—but it also means they don't learn how to put a condom on.

All this coupling sans condoms has consequences—teen pregnancy, for one, which is more common among rural girls. (Birth rates, a different category, are also high in the country, where girls are less likely to get abortions.) A high rate of sexually transmitted diseases might also seem inevitable, though the data here are a bit less definitive. National comparisons of STD rates in metropolitan and nonmetropolitan areas are hard to come by. Some researchers, however, have done the analysis at a local level, finding, for instance, that syphilis is more common in rural North Carolina than in urban parts of the state. The same holds true of chlamydia in Georgia.

Cities still have the highest prevalence of HIV—they are home to large populations of gay men and intravenous drug users, the communities in which the epidemic first emerged. However, even these numbers are complicated by the fact that many people who live in the countryside get tested, and potentially treated, for HIV in cities. Since the early 1990s, epidemiologists have been documenting the diffusion of HIV from the cities to the countryside, and HIV infection rates grew far faster in the 1990s in small communities than large ones. Despite this trend, studies conducted at the time found that rural adults were far less likely to report that they'd changed their sexual habits as a result of the AIDS epidemic.

If you do contract an STD in the country, you're generally worse off. Because the itchy and afflicted who live in the sticks struggle to get medical care, are forced to travel farther for treatment, and make do with fewer doctors, especially specialists. Country-dwellers with HIV report more discrimination and more fear of being outed as HIV-positive than their urban counterparts. There's even "patient spotting," in which people who live within sight of STD clinics take photos of and gossip about people who go in. Rural patients also have more reason to fear that among the medical staff treating them might be someone they know socially. And whether for these reasons or others that researchers haven't yet identified, their health can suffer in significant ways: One study revealed that though Atlanta had twice the prevalence of AIDS as less populous regions of Georgia, AIDS patients in the city lived significantly longer.

Maybe Carrie had some unconscious sense of the perils of rural sex when she decided that Aidan's rough-hewn cabin wasn't the place for her. When she returns to the streets of New York, she tries to make a tentative statement of solidarity with her rural sisters, proclaiming, "City girls are just country girls—with cuter outfits." As far as epiphanies go, it's a little pat and not entirely true. Unless, of course, Carrie is talking about condom chic.


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