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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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Glenn milo santos phd mph research scientist san francisco dept public health

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

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

Approach for an effective HIV response

Schwartländer et al, Lancet 2011


Glenn milo santos phd mph research scientist san francisco dept public health

  • 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

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

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

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

    Results:


    Glenn milo santos phd mph research scientist san francisco dept public health

    1in12

    MSM worldwide reported

    being arrested / convicted for

    same-sex behavior


    Glenn milo santos phd mph research scientist san francisco dept public health

    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

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


    Limitations

    Limitations

    • Convenience sample

    • Cross sectional survey

    • Self-reported data


    Conclusions

    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


    Conclusions1

    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

    Thank you!

    contact: [email protected]


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