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: Keletso Makofane, 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. Schwartländer et al, Lancet 2011 Approach for an effective HIV response

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 1.To evaluate the prevalence of arrests/convictions for same-sex behavior among MSM 1.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: Characteristics% Age, mean35.2 Region ▫Asia Pacific ▫Caribbean ▫Eastern Europe / Central Asia ▫Latin America ▫Middle East / North Africa ▫Oceania ▫Sub-Saharan Africa ▫Western Europe / North America 26% 3% 17% 15% 2% 6% 26% College Education82% Living with HIV17%

9. 1 in 12 MSM worldwide reported being arrested / convicted for same-sex behavior

10. Asia Pacific 4.1% Oceania 2.2% Middle East/N. Africa 13.2% Eastern Europe/Central Asia 18.1% Latin America 9.7% N. America / W. Europe 2.3% Caribbean 15% Sub-Saharan Africa 23.6% Lifetime prevalence of arrests/convictions for same-sex behavior among MSM, by region

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