Grant: Project Grant

THE ISSUE: Social and structural factors, including stigma and discrimination, profoundly shape HIV prevention and care outcomes across global settings and contribute to the disproportionate impact of HIV among gay, bisexual and other men who have sex with men (gbMSM) compared to their heterosexual counterparts. Yet knowledge gaps remain regarding immediate effects of criminalization of gbMSM on HIV prevention (testing, PrEP) and care (viral suppression) outcomes. OUR IDEA: This study focuses on Uganda, where an Anti-Homosexuality Act was passed in May 2023, to document the immediate and long-term effects on HIV prevention and care with gbMSM. OUR APPROACH: We propose the first interrupted time series (ITS) study to look at the effect of an Anti-Homosexuality Act on both HIV prevention (testing, pre-exposure prophylaxis [PrEP]) and care (ART adherence, viral suppression). We also propose an innovative prospective longitudinal mixed-methods study to examine associations between intersectional stigma and HIV prevention and care cascade outcomes over time. This 4-year mixed methods study will leverage retrospective and prospective clinic data from the Most At Risk Population Initiative (MARPI) Clinic at Mulago Hospital in Kampala, Uganda, operated by the Ugandan Ministry of Health. Our central hypothesis is that the May 2023 Anti-Homosexuality Act ('Act') will lead to poorer HIV prevention and care outcomes among gbMSM. Aim 1: Interrupted time series analysis to examine if the Act brought about poorer HIV prevention and care outcomes with gbMSM. Aim 2: Longitudinal mixed-methods to examine effects of stigma over time on HIV prevention and care outcomes with gbMSM. Aim 3: Identify policy relevant and HIV clinical practice intervention opportunities building on our study findings. IMPACT: Novel knowledge of mechanistic pathways from criminalization of same sex practices to gbMSM HIV prevention and care outcomes with actionable findings to inform policy and practice.