The effects of HIV criminalization laws (and their enforcement) on HIV risk among Black and Hispanic populations

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dc.contributor.advisorNguyen, Quynh Cen_US
dc.contributor.authorKeralis, Jessica Macielen_US
dc.contributor.departmentEpidemiology and Biostatisticsen_US
dc.contributor.publisherDigital Repository at the University of Marylanden_US
dc.contributor.publisherUniversity of Maryland (College Park, Md.)en_US
dc.date.accessioned2022-06-21T05:33:09Z
dc.date.available2022-06-21T05:33:09Z
dc.date.issued2022en_US
dc.description.abstractBackground: In the U.S., 25 states have laws that explicitly criminalize the transmission or exposure of HIV. This study, grounded in Nancy Krieger's ecosocial theory, estimated the association between HIV criminalization laws and state- (Aim 1) and county-level (Aim 2) HIV incidence rates, as well as individual HIV testing history (Aim 3), and assessed effect modification by overpolicing, using incarceration rates as a proxy. Methods: The study uses data from state- and county-level HIV incidence data from AIDSVu (2010-2019), incarceration data from the Vera Institute of Justice (2010-2018), and HIV testing data from BRFSS (2016-2019). For Aim 1, a longitudinal analysis was conducted using multivariate marginal Poisson GEE models to estimate rate ratios. For Aim 2, count-rate hierarchical (multilevel) models were fitted to estimate rate ratios. For Aim 3, logistic regression models were fitted to estimate odds ratios. Results: The presence of a state HIV testing law was associated with a higher state HIV incidence in the general and Hispanic populations (aRR=1.48 and 1.68, respectively), but higher incarceration at the state level did not significantly modify the relationship between the law and HIV incidence. At the county level, being in a state with an HIV-specific criminalization statute was associated with a higher county-wide HIV incidence rate for all three populations (aRR=1.14, 1.30, and 1.32 for the general, Black, and Hispanic populations, respectively). Unlike the state-level analysis, this association was attenuated by a higher jailed population rate for the general and Black populations. The effect modification was statistically significant for the general population (p=0.01) and marginally significant for the Black population (p=0.06). Finally, the presence of a state HIV testing law (aOR=1.06) was associated with a greater likelihood of HIV testing history in the general population. However, in HIV criminalization states, heavier policing negatively modified the effect of the law on the likelihood of having ever received an HIV test (p<0.01). Public health implications: This study contributes to a gap in the literature by using recent data to estimate the association of HIV criminalization laws and their enforcement with HIV incidence rates and HIV testing behavior.en_US
dc.identifierhttps://doi.org/10.13016/yl1c-33zd
dc.identifier.urihttp://hdl.handle.net/1903/28910
dc.language.isoenen_US
dc.subject.pqcontrolledEpidemiologyen_US
dc.subject.pqcontrolledLawen_US
dc.subject.pqcontrolledPublic healthen_US
dc.subject.pquncontrolledHIVen_US
dc.subject.pquncontrolledLegal epidemiologyen_US
dc.subject.pquncontrolledPublic health lawen_US
dc.subject.pquncontrolledSocial determinants of healthen_US
dc.titleThe effects of HIV criminalization laws (and their enforcement) on HIV risk among Black and Hispanic populationsen_US
dc.typeDissertationen_US

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