Black men who have sex with men (MSM) have been consistently reported to have the highest estimated HIV incidence and prevalence among MSM. Despite broad theoretical understanding that discrimination is a major social and structural determinant that contributes to disparate HIV outcomes among Black MSM, relatively little extant research has empirically examined structural discrimination against sexual minorities as a predictor of HIV outcomes among this population. The present study therefore examines whether variation in policies that explicitly discriminate against lesbian, gay, and bisexual (LGB) people and variation in policies that explicitly protect LGB people differentially predict metropolitan statistical-area-level variation in late HIV diagnoses among Black MSM over time, from 2008 to 2014. HIV surveillance data on late HIV diagnoses among Black MSM in each of the 95 largest metropolitan statistical areas in the United States, from 2008 to 2014, were used along with data on time-varying state-level policies pertaining to the rights of LGB people. Results from multilevel models found a negative relationship between protective/supportive laws and late HIV diagnoses among Black MSM, and a positive relationship between discriminative laws and late HIV diagnoses among Black MSM. These findings illuminate the potential epidemiological importance of policies pertaining to LGB populations as structural determinants of HIV outcomes among Black MSM. They suggest a need for scrutiny and elimination of discriminatory policies, where such policies are currently in place, and for advocacy for policies that explicitly protect the rights of LGB people where they do not currently exist.

据报道，男男性行为者 (MSM) 中的黑人男性的艾滋病毒发病率和患病率在 MSM 中估计最高。尽管广泛的理论认识认为，歧视是导致黑人男男性接触者中艾滋病毒结果不同的一个主要社会和结构性决定因素，但现有研究相对较少，实证检验了针对性少数群体的结构性歧视，作为该人群中艾滋病毒结果的预测因素。因此，本研究探讨了明确歧视女同性恋、男同性恋和双性恋 (LGB) 人群的政策变化以及明确保护 LGB 人群的政策变化是否会差异预测黑人 MSM 中晚期艾滋病毒诊断的都市统计区域水平随时间的变化，从 2008 年到 2014 年。使用了 2008 年到 2014 年美国 95 个最大的都市统计区中黑人 MSM 晚期艾滋病毒诊断的艾滋病毒监测数据，以及随时间变化的州级相关政策的数据。 LGB 人的权利。多层次模型的结果发现，保护性/支持性法律与黑人 MSM 中的晚期 HIV 诊断之间存在负相关关系，而歧视性法律与黑人 MSM 中的晚期 HIV 诊断之间存在正相关关系。这些发现阐明了与 LGB 人群相关的政策作为黑人 MSM 中艾滋病毒结果的结构性决定因素的潜在流行病学重要性。他们建议，如果目前存在歧视性政策，则需要审查和消除歧视性政策；如果目前尚不存在歧视性政策，则需要倡导明确保护 LGB 人群权利的政策。