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The relationship between anti-LGBTQ+ legislation and HIV prevention among sexual and gender minoritized youth
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May 14 2024
More progressive state and local policies were each associated with increased PrEP use, and together, doubled the magnitude of this association
Kelly, Nicole K.a; Ranapurwala, Shabbar I.a; Pence, Brian W.a; Hightow-Weidman, Lisa B.b; Slaughter-Acey, Jaimea; French, Audrey L.c; Hosek, Sybilc; Pettifor, Audrey E.a
Abstract
Objective:
Estimate the longitudinal associations of state-level anti-LGBTQ+ policies and county-level politics with individual HIV prevention outcomes among sexual and gender minoritized (SGM) youth.
Design:
Keeping it LITE-1 prospectively enrolled 3,330 SGM youth and young adults (ages 13–34) at increased risk of HIV throughout the United States from 2017-2022.
Methods:
Semiannual surveys collected self-reported HIV prevention measures (current PrEP use, weekly PrEP adherence, HIV/STI testing in the past 6 months). Geolocation was linked with state-level LGBTQ+ policy data and county-level election data. Generalized linear models with GEE estimated the single and joint longitudinal associations for 2 exposures [state-level policy climate (more discriminatory vs. less discriminatory) and county-level political majority (Democratic/swing vs. Republican)] with each outcome.
Results:
Among participants living in a state with more discriminatory laws, those in a Democratic/swing county had a 6-percentage point increase in PrEP use (95% CI: 0.02, 0.09) compared to those in a Republican county. Those living in a Republican county but a state with less discriminatory laws saw a similar increase (0.05; -0.02,0.11). Residing in both a Democratic/swing county and a state with less discriminatory laws, relative to a Republican county and a state with more discriminatory laws, was associated with a 10-percentage point increase in PrEP use (0.10; 0.06,0.14) and a 5-percentage point increase in HIV/STI testing (0.05; 0.00,0.09).
Conclusions:
More progressive state and local policies were each associated with increased PrEP use, and together, doubled the magnitude of this association. PrEP is underutilized among SGM youth, and anti-LGBTQ+ policies may exacerbate this gap in coverage.
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