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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

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

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  1. 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

  2. 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

  3. Approach for an effective HIV response Schwartländer et al, Lancet 2011

  4. 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

  5. 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

  6. 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

  7. 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

  8. Results:

  9. 1in12 MSM worldwide reported being arrested / convicted for same-sex behavior

  10. 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%

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

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

  13. 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

  14. 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

  15. Thank you! contact: glenn-milo.santos@ucsf.edu

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