Social
The relationship between anti-LGBTQ+ legislation and internalized HIV-related stigma among young sexual and gender minorities Nicole K. Kelly* Nicole K. Kelly Shabbar Ranapurwala Brian W. Pence Lisa B. Hightow-Weidman Audrey French Sybil Hosek Audrey Pettifor
Background: A multitude of anti-LGBTQ+ laws targeting young sexual and gender minorities (YSGM) have been introduced in the United States. YSGM experience a high risk of HIV and related stigma, with inequities by race. Stigma is a key barrier to ending the HIV epidemic, but the relationship between structural LGBTQ+ stigma and individual HIV stigma has not been quantified. We examined the association between state-level LGBTQ+ laws and HIV stigma among YSGM, overall and by race and ethnicity.
Methods: Keeping it LITE-1 was a prospective, national cohort of 3,330 HIV-negative YSGM from 2017-2022. Biannual surveys included an internalized HIV stigma scale (range: 7 (low), 28 (high)). Geolocation was linked with state-level LGBTQ+ policy data from the Movement Advancement Project (MAP). LGBTQ+ laws were characterized as less or more discriminatory based on MAP score distributions. We used linear regression with GEE to estimate the longitudinal association between state-level LGBTQ+ policy and individual HIV stigma.
Results: The cohort identified as 10.7% non-Hispanic (NH) Black, 4.6% NH Asian, 19.8% Latine, 53.9% NH White, and 11.0% another race. Living in states with less discriminatory LGBTQ+ policies was associated with a -0.72 mean difference in internalized HIV stigma compared to living in states with more discriminatory laws (95% CI: -0.97,-0.47). NH White YSGM living in less discriminatory states experienced the largest reduction in HIV stigma [White: -1.01 (-1.30,-0.72); Black: -0.36 (-0.90,0.18); Asian: -0.53 (-1.16,0.09); Latine: -0.23 (-0.67,0.21), unknown/multiracial: -0.56 (-1.09,-0.04)].
Conclusions: Living in states with more progressive LGBTQ+ policies was associated with less internalized HIV stigma, particularly among NH White YSGM. Progressive state-level LGBTQ+ policies may not be enough to offset HIV stigma for marginalized racial groups; future studies should examine the intersection of LGBTQ+ laws with ethno-racism, homophobia, and HIV stigma.
