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Same-Sex Marriage Laws, Provider-Patient Communication, and PrEP Awareness and Use Among Gay, Bisexual, and Other Men Who have Sex with Men in the United States

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Abstract

State-level structural stigma and its consequences in healthcare settings shape access to pre-exposure prophylaxis (PrEP) for HIV prevention among gay, bisexual, and other men who have sex with men (GBMSM). Our objective was to assess the relationships between same-sex marriage laws, a measure of structural stigma at the state level, provider-patient communication about sex, and GBMSM awareness and use of PrEP. Using data from the Fenway Institute’s MSM Internet Survey collected in 2013 (N = 3296), we conducted modified Poisson regression analyses to evaluate associations between same-sex marriage legality, measures of provider-patient communication, and PrEP awareness and use. Living in a state where same-sex marriage was legal was associated with PrEP awareness (aPR 1.27; 95% CI 1.14, 1.41), as were feeling comfortable discussing with primary care providers that they have had sex with a man (aPR 1.63; 95% CI 1.46, 1.82), discussing with their primary care provider having had condomless sex with a man (aPR 1.65; 95% CI 1.49, 1.82), and discussing with their primary care provider ways to prevent sexual transmission of HIV (aPR 1.39; 95% CI 1.26, 1.54). Each of these three measures of provider-patient communication were additionally associated with PrEP awareness and use. In sum, structural stigma was associated with reduced PrEP awareness and use. Policies that reduce stigma against GBMSM may help to promote PrEP and prevent HIV transmission.

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Data Availability

Data were collected and made available by The Fenway Institute, Boston, MA, USA.

Code Availability

Code is available upon reasonable request of the authors.

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Funding

This research was supported by the National Institutes for Health Grant No. K01 MH116817 and Johns Hopkins University Center for AIDS Research (Grant No. P30AI094189).

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Authors and Affiliations

  1. Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA

    Alexandra Skinner, Michael D. Stein & Julia Raifman

  2. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Lorraine T. Dean

  3. Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA

    Catherine E. Oldenburg

  4. Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA

    Matthew J. Mimiaga

  5. Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA

    Philip A. Chan

  6. The Fenway Institute, Fenway Health, Boston, MA, USA

    Kenneth H. Mayer

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  1. Alexandra Skinner
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Contributions

AS, MDS, LTD, PAC, KHM, and JR contributed to study conception and design. CEO, MJM, and KHM contributed to data collection. Data analysis was performed by AS and JR. The first draft of the manuscript was written by AS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Alexandra Skinner.

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The authors have no competing interests to declare that are relevant to the content of this article.

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This is an observational study. The Boston University Medical Campus Institutional Review Board has confirmed that no ethical approval is required.

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Skinner, A., Stein, M.D., Dean, L.T. et al. Same-Sex Marriage Laws, Provider-Patient Communication, and PrEP Awareness and Use Among Gay, Bisexual, and Other Men Who have Sex with Men in the United States. AIDS Behav 27, 1897–1905 (2023). https://doi.org/10.1007/s10461-022-03923-y

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