WP 64 Social Context and Access to STI Services Among Gay and Bisexual Men

Wednesday, September 21, 2016
Galleria Exhibit Hall
Jami Leichliter, PhD1, Oscar Beltran, PhD1, Ryan Cramer, JD, MPH1, Archana Bodas LaPollo, MPH2, Sarah Hexem, JD2, Penny S Loosier, PhD, MPH1, Patricia Dittus, PhD1 and Harrell Chesson, PhD1, 1Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 2Public Health Management Corporation, Philadelphia, PA

Background: Sexual minorities suffer from numerous health disparities, and social norms favoring heterosexuality can foster policies that may adversely affect sexual minority health.  Therefore, we examined associations between social/policy factors and access to STI services among men in the U.S. by sexual orientation. 

Methods: 2013 state-level policies focusing on protections for sexual minorities regarding relationship recognition, employment, housing, criminal justice, and public accommodations that were established by voters or policymakers (likely a better representation of social context than policies established by judicial decision) were collected and measures for relationship recognition (same-sex marriage recognized, other relationship recognized, not addressed, ban on same-sex marriage) and an overall index of all policies were developed.  We used Mplus to conduct multi-level models (MLMs) for complex survey data to assess associations between policy measures and STI services among heterosexual (n=10,871), gay (n=187) and bisexual (n=180) men using the National Survey of Family Growth. State- and individual-level covariates were included in MLMs.

Results: Among heterosexual men, we found differences in reported STI testing (past 12 months) by marital status, race/ethnicity, insurance and P&S syphilis rate (state-level); however, there were no significant differences in reported STI testing by same-sex relationship recognition.  Conversely, among gay men, reports of STI testing decreased as state-level same-sex relationship prohibitions increased (AOR=0.12, 95%CI=0.03,0.49). The only other significant correlates of STI testing for gay men were state-level (the percentage male population aged 15-24 years and percentage Hispanic population).  Among bisexual men, the only significant finding was lower reports of STI testing as same-sex relationship policies became more prohibitive (AOR=0.44, 95%CI=0.24,0.80).  For all subgroups of men, there were no differences in STI testing by the total index of sexual minority policy protections. 

Conclusions: Social context, specifically the legal recognition of relationships, was associated with receipt of recent STI testing among gay and bisexual men.