MSM who are living with HIV fared better in U.S. states with the highest degree of policy-level support for people who are not cisgender or heterosexual compared to states with low policy support, a longitudinal analysis published in Journal of Acquired Immune Deficiency Syndromes showed.
The study looked at laws relating to nondiscrimination based on sexual orientation, same-sex marriage, joint adoptions, hate crimes based on sexual orientation, HIV criminalization, and related issues. It then compared the policy landscape in each area to local U.S. Centers for Disease Control data on overall and late HIV diagnoses, AIDS diagnoses, and mortality. Researches included data from 2008-2014 on 94 metropolitan statistical areas in 38 states.
Overall, states with high policy support had 39% fewer HIV diagnoses, 31% fewer late diagnoses, and 14% lower AIDS mortality among MSM compared to low policy support states. Further, 27% of all HIV diagnoses, 21% of all late HIV diagnoses, and 10% of all AIDS-attributed deaths could be attributed to low policy support, the researchers found.
One possible explanation for the observed associations is that MSM may hide their sexual identity in states without protections for sexual minorities and are then less likely to seek HIV testing or care. Thus, fewer MSM are virally suppressed, increasing the likelihood of onward transmission, the study authors theorized.
An alternative explanation is that relatively healthy MSM leave unsupportive states and move to states with a more favorable policy climate. However, such migratory patterns have not been observed in other studies.
“The 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,” study authors concluded.