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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

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Glenn-Milo Santos, PhD, MPH Research Scientist | San Francisco Dept. Public Health

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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: KeletsoMakofane, 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


Approach for an effective HIV response

Schwartländer et al, Lancet 2011


  • 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 Aims

  • To evaluate the prevalence of arrests/convictions for same-sex behavior among MSM

  • 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:


    1in12

    MSM worldwide reported

    being arrested / convicted for

    same-sex behavior


    Lifetime prevalence of arrests/convictions

    for same-sex behavior among MSM, by region

    N. America / W. Europe

    2.3%

    Eastern Europe/Central Asia

    18.1%

    Asia Pacific

    4.1%

    Middle East/N. Africa

    13.2%

    Caribbean

    15%

    Latin

    America

    9.7%

    Sub-Saharan

    Africa

    23.6%

    Oceania

    2.2%


    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


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