BACKGROUND: To examine trends in state-level policy support for sexual minorities and HIV outcomes among MSM.
METHODS: This longitudinal analysis linked state-level policy support for sexual minorities (N=94 Metropolitan Statistical Areas [MSAs] in 38 states) to 7 years of data (2008-2014) from CDC on HIV outcomes among MSM. Using latent growth mixture modeling, we combined 11 state-level policies (e.g., non-discrimination laws including sexual orientation as a protected class) from 1999-2014, deriving 3 latent groups: consistently low policy support; consistently high policy support; and increasing trajectory of policy support. Outcomes were HIV diagnoses per 10,000 MSM; late diagnoses (number of deaths within 12 months of HIV diagnosis and AIDS diagnoses within three months of HIV diagnosis) per 10,000 MSM; AIDS diagnoses per 10,000 MSM with HIV; and AIDS-related mortality per 10,000 MSM with AIDS.
RESULTS: Compared to MSAs in states with low levels and increasing policy support for sexual minorities, MSAs in states with the highest level of policy support had lower risks of HIV diagnoses (Risk Difference [RD]=-37.9, 95% Confidence Interval [CI]: -54.7, -21.0), late diagnoses (RD=-12.5, 95% CI: -20.4, -4.7), and AIDS-related mortality (RD=-33.7, 95% CI: -61.2, -6.2), controlling for time and 7 MSA-level covariates. In low policy support states, 27% of HIV diagnoses, 21% of late diagnoses, and 10% of AIDS deaths among MSM were attributable to policy climate.
CONCLUSION: State-level policy climate related to sexual minorities was associated with HIV health outcomes among MSM and could be a potential public health tool for HIV prevention and care.
Trends in state policy support for sexual minorities and HIV-related outcomes among men who have sex with men in the United States, 2008-2014
Journal of Acquired Immune Deficiency Syndromes [Epub 2020 May 7]. doi: 10.1097/QAI.0000000000002395.