State HIV prevention policies may benefit racial and ethnic groups unequally

by Annenberg Public Policy Center of the University of Pennsylvania

edited by Gaby Clark, reviewed by Andrew Zinin

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State policies that make health care easier to obtain and protect LGBTQ+ people from discrimination are associated with greater use of HIV prevention measures among white adults, but those benefits may not extend equally to Black and Latino populations, according to a new study. Black and Latino populations continue to have the highest HIV incidence rates and remain priority populations in the national initiative to eradicate HIV in the United States.

The study, published in the journal AIDS and Behavior, examined 35 HIV-related state policies and linked state-level data with a national survey of 1,041 men who have sex with men and transgender women. A team of researchers from the University of Pennsylvania investigated whether different state policy environments were associated with use of pre-exposure prophylaxis, or PrEP, HIV testing within the past year and willingness to receive an HIV vaccine if one becomes available.

The policies ranged from measures allowing pharmacy-based PrEP delivery to protections against discrimination and bullying. Rather than examining individual laws in isolation, the researchers grouped them into three broad areas, two involving supportive policies and one involving punitive policies:

• Supportive, access-focused policies included measures such as allowing pharmacy-based PrEP delivery, protecting access to transgender health care and reducing insurance barriers.
• Supportive, attitude- or norm-focused policies included measures intended to increase social acceptance of LGBTQ+ populations, including nondiscrimination protections based on sexual orientation or gender identity, hate crime laws and protections against bullying.
• Punitive policies included HIV criminalization laws and restrictions on LGBTQ-related discussions in schools.

The policy landscape varied substantially across the country. Supportive access and attitude- or norm-focused policies were more common in the West and Northeast, while punitive policies were more prevalent in the South and Midwest.

The researchers found that more policies to reduce discrimination and increase social acceptance of LGBTQ+ populations (the supportive attitude- and norm-focused policies) were associated with greater PrEP use among white participants. More supportive policies focused on health care access were associated with a greater likelihood of recent HIV testing among white participants.

However, the association between policies addressing discrimination and social acceptance and PrEP use was significantly weaker among Latino participants than among white participants. The associations between both types of policies and HIV testing were significantly weaker among Black participants than among white participants. The findings are concerning because the policies should increase these prevention practices among populations with greater need, and policies to increase social acceptance of and reduce discrimination against LGBTQ+ populations should be effective among ethnic minority groups.

"Supportive state policies are an important foundation for HIV prevention, but our findings raise questions about whether those policies are sufficient to meet the prevention needs across communities," said lead author Bita Fayaz Farkhad, an assistant professor at the University of Arkansas for Medical Sciences and a former assistant research professor at the University of Pennsylvania's Annenberg School for Communication. "We need to understand what prevents Black and Latino communities from accessing prevention services, for example, whether people can find a health care provider who offers PrEP or a convenient place to get an HIV test."

Why supportive policies may not be enough

Additional analyses suggested that white participants living in states with supportive policies could get health care and felt that people around them supported HIV prevention. The analyses did not show the same pattern among Black or Latino participants. The researchers say one possible explanation is that medical infrastructure in historically marginalized communities may remain under-resourced, preventing supportive policies from translating into effective access to HIV prevention services. Stigma and other structural barriers may also play a role.

"Adopting policies that theoretically improve people's access and comfort seeking PrEP is only part of the challenge," said University of Pennsylvania PIK Professor Dolores Albarracín, the study's senior author and director of the Annenberg Public Policy Center. "We also need to understand whether those policies actually translate into greater access to HIV prevention in the most vulnerable communities. This analysis suggests they fall behind. At a time when research on these topics is restricted, our study reminds us of the implications of such restrictions."

The findings suggest that supportive policies may need to be paired with practical steps to help underserved communities obtain HIV prevention services. These could include targeted investments to expand resources in areas with health care shortages and development of community-based prevention services in areas where stigma is high. The authors note, however, that the most effective combination of approaches remains uncertain.

The researchers caution that the study identifies associations between policy environments and HIV prevention outcomes but cannot establish cause and effect. The analysis relied on policies in place as of January 2024 and did not examine whether changes in policies were followed by changes in prevention outcomes over time. The next step is to investigate the impact of policy changes.

Publication details

Bita Fayaz Farkhad et al, State HIV Prevention Policy Environments and HIV Prevention Outcomes: Racial and Ethnic Differences in the United States, AIDS and Behavior (2026). DOI: 10.1007/s10461-026-05230-2

Journal information: AIDS and Behavior

Key medical concepts

HIV Testing

Clinical categories

Infectious diseasesHIV & AIDSCommon illnesses & PreventionPreventive medicine Provided by Annenberg Public Policy Center of the University of Pennsylvania Who's behind this story?

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