1254. Association of Structural Stigma Due to Sexual Orientation and HIV Diagnosis/PrEP Use in the United States: An Ecological Analysis

BACKGROUND: Structural stigma has the potential to reduce engagement in HIV prevention and care, particularly for sexual and gender minorities (SGM) who account for the highest proportion of new HIV diagnosis in the United States. We considered if structural stigma related to sexual orientation, that is the social/cultural norms and institutional policies/practices that constrain the lives of the stigmatized, is associated with state-level HIV diagnosis and use of pre-exposure prophylaxis (PrEP). METHODS: We used a composite measure of structural stigma that was previously developed; components included proportion of same-sex couples, gay-straight alliances in public schools, policies related to discrimination of sexual orientation, and public perception toward homosexuality. Proportion of HIV diagnosis from 2008 to 2017 and PrEP use from 2012 to 2017 per 100,000 population were extracted from AIDSVu. To account for overdispersion and the hierarchical structure of our data, we used a Poisson model with robust standard errors using generalized estimating equations. RESULTS: States with higher (vs. lower) levels of structural stigma related to sexual orientation had lower rates of HIV diagnosis (β = −0.550; 95% CI: −0.628, −0.472) and PrEP use (β = −0.165; 95% CI: −0.203, −0.119), after adjusting for state-level covariates such as median age, percentage black race, and legislative majority party in 2013. CONCLUSION: State-level stigma has been shown to reduce SGM visibility, therefore, restricting access to prevention services. These findings suggest that states with higher levels of structural stigma toward same-sex sexuality may also have lower rates of engagement in HIV prevention services. DISCLOSURES: All authors: No reported disclosures.