PHILADELPHIA — State policies that make healthcare 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 highest HIV incidence rates and remain a priority population 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 these 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 in the study ranged from measures allowing pharmacy-based PrEP delivery to protections against discrimination and bullying. Rather than examining individual laws in isolation, the researchers grouped policies into three broad areas, two involving supportive policies and one involving punitive policies:
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. In addition, more supportive policies focused on healthcare access were associated with a greater likelihood of having 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. This is concerning as the policies should increase these health practices in the populations with greater need and the 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 healthcare provider who offers PrEP or a convenient place to get an HIV test.”
Additional analyses suggested that white participants living in states with supportive policies could get healthcare 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 also 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 healthcare 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 preventive outcomes. However, it cannot verify what is cause and what is effect. The analysis relied on policies in place as of January 2024 and did not examine how changes in policies were followed by changes in prevention outcomes over time. The next step is to investigate the impact of policy changes.
The study, “State HIV Prevention Policy Environments and HIV Prevention Outcomes: Racial and Ethnic Differences in the United States,” was published July 14, 2026, in AIDS and Behavior. In addition to Farkhad and Albarracín, the study was co-authored by Feng Yi Chew and Angela Zhang of the University of Pennsylvania’s Annenberg School for Communication, and Janet Lopez and Yubo Zhou of the university’s Department of Psychology. Albarracín also is director of the Social Action Lab , which conducted this work.
The Annenberg Public Policy Center was established in 1993 to educate the public and policy makers about communication’s role in advancing public understanding of political, science, and health issues at the local, state, and federal levels.
AIDS and Behavior
Data/statistical analysis
People
State HIV Prevention Policy Environments and HIV Prevention Outcomes: Racial and Ethnic Differences in the United States
14-Jul-2026