PDF(Pubmed)
Abstract：
OBJECTIVE: The aim of this study was to estimate the longitudinal associations of state-level anti-LGBTQ+ policies and county-level politics with individual HIV prevention outcomes among sexual and gender minoritized (SGM) youth.
METHODS: Keeping it LITE-1 prospectively enrolled 3330 SGM youth and young adults (ages 13-34) at increased risk of HIV throughout the United States from 2017 to 2022.
METHODS: Semiannual surveys collected self-reported HIV prevention measures [current preexposure prophylaxis (PrEP) use, weekly PrEP adherence, HIV/STI testing in the past 6 months]. Geolocation was linked with state-level LGBTQ+ policy data and county-level election data. Generalized linear models with GEE estimated the single and joint longitudinal associations for two exposures [state-level policy climate (more discriminatory vs. less discriminatory) and county-level political majority (Democratic/swing vs. Republican)] with each outcome.
RESULTS: Among participants living in a state with more discriminatory laws, those in a Democratic/swing county had a 6-percentage point increase in PrEP use (95% confidence interval: 0.02, 0.09) compared to those in a Republican county. Those living in a Republican county but a state with less discriminatory laws saw a similar increase (0.05; -0.02,0.11). Residing in both a Democratic/swing county and a state with less discriminatory laws, relative to a Republican county and a state with more discriminatory laws, was associated with a 10-percentage point increase in PrEP use (0.10; 0.06,0.14) and a 5-percentage point increase in HIV/STI testing (0.05; 0.00,0.09).
CONCLUSIONS: More progressive state and local policies were each associated with increased PrEP use, and together, doubled the magnitude of this association. PrEP is underutilized among SGM youth, and anti-LGBTQ+ policies may exacerbate this gap in coverage.
METHODS: Keeping it LITE-1 prospectively enrolled 3330 SGM youth and young adults (ages 13-34) at increased risk of HIV throughout the United States from 2017 to 2022.
METHODS: Semiannual surveys collected self-reported HIV prevention measures [current preexposure prophylaxis (PrEP) use, weekly PrEP adherence, HIV/STI testing in the past 6 months]. Geolocation was linked with state-level LGBTQ+ policy data and county-level election data. Generalized linear models with GEE estimated the single and joint longitudinal associations for two exposures [state-level policy climate (more discriminatory vs. less discriminatory) and county-level political majority (Democratic/swing vs. Republican)] with each outcome.
RESULTS: Among participants living in a state with more discriminatory laws, those in a Democratic/swing county had a 6-percentage point increase in PrEP use (95% confidence interval: 0.02, 0.09) compared to those in a Republican county. Those living in a Republican county but a state with less discriminatory laws saw a similar increase (0.05; -0.02,0.11). Residing in both a Democratic/swing county and a state with less discriminatory laws, relative to a Republican county and a state with more discriminatory laws, was associated with a 10-percentage point increase in PrEP use (0.10; 0.06,0.14) and a 5-percentage point increase in HIV/STI testing (0.05; 0.00,0.09).
CONCLUSIONS: More progressive state and local policies were each associated with increased PrEP use, and together, doubled the magnitude of this association. PrEP is underutilized among SGM youth, and anti-LGBTQ+ policies may exacerbate this gap in coverage.
摘要：
目标：估计州一级的反LGBTQ政策和县级政治与性和性别小型化（SGM）青年中个人艾滋病毒预防结果的纵向关联。
方法：保持LITE-1在2017-2022年期间，在美国招募了3,330名SGM青年和年轻人（13-34岁）感染艾滋病毒的风险增加。
方法：每半年调查收集自我报告的艾滋病毒预防措施（目前使用的PrEP，每周PrEP依从性，过去6个月的HIV/STI检测)。地理位置与州级LGBTQ+政策数据和县级选举数据相关联。具有GEE的广义线性模型估计了2个风险敞口的单一和联合纵向关联[州级政策气候(更具歧视性与歧视性较低)和县级政治多数(民主/摇摆与共和党）]每个结果。
结果：在居住在具有更多歧视性法律的州的参与者中，与共和党县相比,民主党/摇摆县的PrEP使用率提高了6个百分点(95%CI:0.02,0.09).那些生活在共和党县但歧视性法律较少的州的人也出现了类似的增长（0.05；-0.02,0.11）。居住在民主/摇摆县和歧视性法律较少的州，相对于共和党县和更具歧视性法律的州，与PrEP使用增加10个百分点(0.10;0.06,0.14)和HIV/STI检测增加5个百分点(0.05;0.00,0.09)相关。
结论：更进步的州和地方政策都与PrEP使用的增加有关，一起,这种联系的规模翻了一番。PrEP在SGM青年中没有得到充分利用，反LGBTQ+政策可能会加剧这一覆盖范围的差距。
方法：保持LITE-1在2017-2022年期间，在美国招募了3,330名SGM青年和年轻人（13-34岁）感染艾滋病毒的风险增加。
方法：每半年调查收集自我报告的艾滋病毒预防措施（目前使用的PrEP，每周PrEP依从性，过去6个月的HIV/STI检测)。地理位置与州级LGBTQ+政策数据和县级选举数据相关联。具有GEE的广义线性模型估计了2个风险敞口的单一和联合纵向关联[州级政策气候(更具歧视性与歧视性较低)和县级政治多数(民主/摇摆与共和党）]每个结果。
结果：在居住在具有更多歧视性法律的州的参与者中，与共和党县相比,民主党/摇摆县的PrEP使用率提高了6个百分点(95%CI:0.02,0.09).那些生活在共和党县但歧视性法律较少的州的人也出现了类似的增长（0.05；-0.02,0.11）。居住在民主/摇摆县和歧视性法律较少的州，相对于共和党县和更具歧视性法律的州，与PrEP使用增加10个百分点(0.10;0.06,0.14)和HIV/STI检测增加5个百分点(0.05;0.00,0.09)相关。
结论：更进步的州和地方政策都与PrEP使用的增加有关，一起,这种联系的规模翻了一番。PrEP在SGM青年中没有得到充分利用，反LGBTQ+政策可能会加剧这一覆盖范围的差距。
