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

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.