title: Reductions in access to HIV prevention and care services are associated with arrest and convictions in a global survey of men who have sex with men.
abstract: OBJECTIVE
  Men who have sex with men (MSM) are disproportionately impacted by HIV. Criminalisation of homosexuality may impede access to HIV services. We evaluated the effect of the enforcement of laws criminalising homosexuality on access to services.
  
  
  METHODS
  Using data from a 2012 global online survey that was published in a prior paper, we conducted a secondary analysis evaluating differences in perceived accessibility to health services (ie, 'how accessible are ____' services) between MSM who responded 'yes'/'no' to: 'have you ever been arrested or convicted for being gay/MSM?'
  
  
  RESULTS
  Of the 4020 participants who completed the study and were included in the analysis, 8% reported ever being arrested or convicted under laws relevant to being MSM. Arrests and convictions were most common in sub-Saharan Africa (23.6% (58/246)), Eastern Europe/Central Asia (18.1% (123/680)), the Caribbean (15% (15/100)), Middle East/North Africa (13.2% (10/76)) and Latin America (9.7% (58/599)). Those arrested or convicted had significantly lower access to sexually transmitted infection treatment (adjusted OR (aOR)=0.81; 95% CI 0.67 to 0.97), condoms (aOR=0.77; 95% CI 0.61 to 0.99) and medical care (aOR=0.70; 95% CI 0.54 to 0.90), compared with other MSM, while accounting for clustering by country and adjusting for age, HIV status, education and country-level income.
  
  
  CONCLUSIONS
  Arrests and convictions under laws relevant to being MSM have a strong negative association with access to HIV prevention and care services. Creating an enabling legal and policy environment, and increasing efforts to mitigate antihomosexuality stigma to ensure equitable access to HIV services are needed, along with decriminalisation of homosexuality, to effectively address the public health needs of this population.
authors.affiliation: San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.|Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Glenn-Milo
authors.initials: GM
authors.lastname: Santos
authors.affiliation: The Global Forum on MSM and HIV (MSMGF), Oakland, California, USA.
authors.forename: Keletso
authors.initials: K
authors.lastname: Makofane
authors.affiliation: The Global Forum on MSM and HIV (MSMGF), Oakland, California, USA.
authors.forename: Sonya
authors.initials: S
authors.lastname: Arreola
authors.affiliation: Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Tri
authors.initials: T
authors.lastname: Do
authors.affiliation: The Global Forum on MSM and HIV (MSMGF), Oakland, California, USA.
authors.forename: George
authors.initials: G
authors.lastname: Ayala
mesh_terms: D000352:Africa, Northern; D017691:Caribbean Region; D005060:Europe; D005061:Europe, Eastern; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000331:legislation & jurisprudence*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D035846:Law Enforcement; D008297:Male; D008877:Middle East; D057545:Social Stigma
keywords: HIV; HIV TESTING; HOMOSEXUALITY; LAW; PUBLIC HEALTH