HIV criminalization exacerbates subpar diagnosis and treatment across the United States

Sah, Pratha; Fitzpatrick, Meagan C.; Pandey, Abhishek; Galvani, Alison P.

doi:10.1097/qad.0000000000001636

Cited by 9 publications

(1 citation statement)

References 5 publications

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“…Sexual behavior stigmas may have a more direct impact on the uptake of HIV testing accounting for the perceived consequences of HIV criminalization. This finding contributes to limited existing literature from the US and Canada that has linked HIV criminalization laws to decreased HIV testing [ 11 , 16 , 18 , 44 , 45 ], and supports long-held concerns on the impact of enshrining HIV stigma into law [ 15 , 46 – 49 ]. Being guided by successful advocacy work by persons living with (PLHIV) and others thus far, in the US and elsewhere (e.g., HIV Justice Network, Global Network of People Living with HIV), will be integral moving forward [ 46 ].…”

Section: Discussionsupporting

confidence: 71%

Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Dibble

Murray

Wiginton

et al. 2022

BMC Health Serv Res

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Background Complex manifestation of stigma across personal, community, and structural levels and their effect on HIV outcomes are less understood than effects in isolation. Yet, multilevel approaches that jointly assesses HIV criminalization and personal sexual behavior stigma in relation to HIV testing have not been widely employed or have only focused on specific subpopulations. The current study assesses the association of three types of MSM-related sexual behavior-related stigma (family, healthcare, general social stigma) measured at both individual and site levels and the presence/absence of laws criminalizing HIV transmission with HIV testing behaviors to inform HIV surveillance and prevention efforts among HIV-negative MSM in a holistic and integrated way. Methods We included nine National HIV Behavioral Surveillance (NHBS) 2017 sites: Baltimore, MD; Denver, CO; Detroit, MI; Houston, TX; Long Island/Nassau-Suffolk, NY; Los Angeles, CA; Portland, OR; San Diego, CA; and Virginia Beach and Norfolk, VA. Multivariable generalized hierarchical linear modeling was used to examine how sexual behavior stigmas (stigma from family, anticipated healthcare stigma, general social stigma) measured at the individual and site levels and state HIV criminalization legislation (no, HIV-specific, or sentence-enhancement laws) were associated with past-year HIV testing behaviors across sites (n = 3,278). Results The majority of MSM across sites were tested for HIV in the past two years (n = 2,909, 95.4%) with the average number of times tested ranging from 1.79 (SD = 3.11) in Portland, OR to 4.95 (SD = 4.35) in Los Angeles, CA. In unadjusted models, there was a significant positive relationship between stigma from family and being tested for HIV in the past two years. Site-level HIV-specific criminalization laws were associated with an approximate 5% reduction in the prevalence of receiving any HIV test in the past two years after individual level stigma and sociodemographic covariate adjustments (PR = 0.94, 95% CI, 0.90–0.99). Conclusions Structural barriers faced by MSM persist and ending the HIV epidemic in the US requires a supportive legal environment to ensure effective engagement in HIV services among MSM. Home-based solutions, such as self-testing, used to deliver HIV testing may be particularly important in punitive settings while legal change is advocated for on the community and state levels.

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