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

Glenn-Milo Santos, PhD, MPH•Research Scientist | San Francisco Dept. Public Health•Assistant Professor | University of California San Francisco

Co-Authors: Keletso Makofane, Sonya Arreola, Jack Beck, Patrick Wilson, Pato Hebert, Tri Do, George Ayala

Background

•Men who have sex with men (MSM) disproportionately impacted by HIV worldwide

•Scale up of evidence-based HIV prevention, treatment and care needed

•Structural barriers and legislated discrimination impede access to these services

Schwartländer et al, Lancet 2011

Approach for an effective HIV response

76+ countries criminalize same-sex intimacy

http://en.wikipedia.org/wiki/LGBT_rights_by_country_or_territory

2.79+ billion people live within countries that

criminalize same-sex behavior – International Lesbian and Gay Assoc., 2014

Homophobia and access to HIV prevention and treatment

greater levels of homophobia, significant reductions in:

Ayala G, Makofane K, Santos GM, et al.,  J Sex Trans Diseases 2013

Research Aims1. To evaluate the

prevalence of arrests/convictions for same-sex behavior among MSM

2. To assess the impact of these arrest/convictions on access to HIV prevention and care services

Methods•Secondary Data analysis: GMHR online survey

2012

•Self-reported measures: lifetime arrests/convictions for being gay/MSM

levels of accessibility of HIV services

•GEE regression models robust standard errors accounted for clustering by country adjusted for potential confounders

Results:Characteristics %

Age, mean 35.2

Region ▫Asia Pacific ▫Caribbean ▫Eastern Europe / Central Asia ▫Latin America ▫Middle East / North Africa ▫Oceania ▫Sub-Saharan Africa ▫Western Europe / North America

26%3%

17%15%2%6%6%

26%

College Education 82%

Living with HIV 17%

1 in 12MSM worldwide reported

being arrested / convicted for same-sex behavior

Asia Pacific 4.1%

Oceania2.2%

Middle East/N. Africa13.2%

Eastern Europe/Central Asia18.1%

Latin America

9.7%

N. America / W. Europe 2.3%

Caribbean15%

Sub-Saharan Africa23.6%

Lifetime prevalence of arrests/convictions for same-sex behavior among MSM, by region

Association between arrests/convictions for same-sex behavior and access to services

Limitations•Convenience sample•Cross sectional survey•Self-reported data

Conclusions •Prevalence of arrests/convictions for same-sex

behaviors high

•Enforcement of punitive laws for sex between men significantly and independently associated with reduced access to HIV-prevention, treatment and care services

Conclusions •Those subjected to arrests and convictions for

being gay/MSM reported significantly lower access to interventions and services

•Decriminalization of same-sex behaviors

needed to effectively address HIV among MSM and respond to the public health needs of this key population

Thank you!

contact: glenn-milo.santos@ucsf.edu