20th International AIDS Conference - Melbourne, Australia


TUAD0201 - Oral Abstract

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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