State Legal Protections and HIV Risk Behaviors among Men who have sex with Men in the United States Open Access

Abstract

Health-related outcomes are negatively affected by stigmatizing environments; however, due to historic homogeneity of State-level legal protections, few studies have examined the association between state legal protections and HIV related behaviors among MSM. In late 2013 to early 2014, 10,368 MSM from the United States were recruited from social and sexual networking sites to complete a cross-sectional, online survey about HIV-related practices. States were categorized by greater and weaker legal protections for marriage, adoption, employment, and hate crime protections for same sex couples. We assessed the relationship between state laws and HIV related risk factors with multivariate generalized estimating equation logistic regression models accounting for within state clustering. Greater state-level legal protections were associated with decreased odds of being diagnosed positive at last HIV test (adjusted odds ratio (aOR): 0.82, 95% confidence interval (CI): 0.68, 0.89) and increased odds of being out to a healthcare provider (aOR: 1.59; 95% CI: 1.20, 2.09), being offered an HIV test at last healthcare visit (aOR: 1.43; 95% CI: 1.23, 1.66), and having a 1-on-1 conversation about HIV prevention with casual partners (aOR: 1.15; 95% CI: 1.01, 1.31) after adjusting for potential confounders. MSM living in states with greater legal protections had greater levels of protective and health-seeking HIV-related behaviors than those living in states with fewer protections. State legal protections for sexual minorities should be evaluated and could impact HIV incidence among MSM.

Table of Contents

Introduction...............................................................................1

Methods.....................................................................................4

Results.......................................................................................9

Discussion.................................................................................14

References.................................................................................17

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	HIV MSM
Committee Chair / Thesis Advisor	Siegler, Aaron J, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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