TUAD0201 - Oral Abstract Session
Criminalization of same-sex behavior is harmful to public health: significant reductions in access to HIV prevention and care services associated with arrest and convictions for sex between men
Presented by Glenn-Milo Santos (United States).
G.-M. Santos1,2, K. Makofane3, S. Arreola3, J. Beck3, P. Wilson4, P. Hebert3, T. Do2, G. Ayala3
1San Francisco Department of Public Health, Center for Public Health Research, San Francisco, United States, 2University of California San Francisco, Epidemiology and Biostatistics, San Francisco, United States, 3Global Forum on MSM and HIV, Oakland, United States, 4Columbia University, New York, United States
Background: Men who have sex with men (MSM) are disproportionately
impacted by HIV and scale up of evidence-based HIV prevention and care services
are urgently needed to ameliorate this HIV pandemic. However, structural
barriers and institutional discrimination continue to impede access to these
services; 76 countries worldwide criminalize consensual sexual activity between
adult men. Little is known about the magnitude of effect these punitive laws
have on access to health services. We sought to evaluate the impact of arrests
and convictions on access to services, using a global survey among MSM.
Methods: Using data from a 2012 global online survey in six
languages, we evaluated differences in accessibility to health
services between MSM who have been arrested or convicted for being gay/MSM, and
MSM who have not been arrested or convicted. We fitted GEE logistic regression
models with robust standard errors, accounting for clustering by country, among
4020 MSM with complete data available.
Results: Eight percent of MSM reported ever being arrested or
convicted for being gay/MSM. By region, arrests and convictions for being
gay/MSM were most commonly reported by MSM from Sub-Saharan Africa (23.6%),
Eastern Europe/Central Asia (18.1%), Middle East/North Africa (13.2%), and
Latin America (9.7%). MSM who have been arrested or convicted for being gay/MSM
had significantly lower access to sexually transmitted infections (STI) testing
(OR=0.80; 95%CI=0.65-0.98), STI treatment (OR=0.84; 95%CI=0.72-0.98), condoms
(OR=0.76; 95%CI=0.60-0.96), mental health services (OR=0.77; 95%CI=0.62-0.96),
medical care (OR=0.70; 95%CI=0.55-0.88), sex education (OR=0.72; 95%CI=0.55-0.96),
and HIV testing (OR=0.79; 95%CI=0.64-0.98), compared to other MSM. In addition,
among HIV-positive MSM (n=693), those who have been arrested or convicted for
being gay/MSM had significantly lower access to HIV treatment (OR=0.48;
95%CI=0.26-87), compared to other HIV-positive MSM.
Conclusions: Enforcement of punitive laws for sex between men has a
strong negative impact in access to HIV-prevention and care services among MSM.
Those subjected to arrests and convictions for being gay/MSM reported
significantly lower access to evidence-based interventions proven to reduce HIV
acquisition and transmission. The criminalization of same sex behaviors need to
be overturned to effectively address HIV among MSM and respond to the public
health needs of this population.
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