State HIV Prevention Policy Environments and HIV Prevention Outcomes: Racial and Ethnic Differences in the United States.

State governments have adopted policies to improve the uptake of Pre-Exposure Prophylaxis (PrEP), routine HIV testing, and future HIV vaccination when available. However, associations between policy environments and PrEP use, recent HIV testing, and HIV vaccine intentions may differ across racial and ethnic groups, signaling varying effectiveness across populations. We collected HIV prevention policies across the US as of January 2024 and constructed policy indices grouped into access-focused, attitude- or norm-focused, and punitive domains. Linking our policy indices to a national survey of men who have sex with men and transgender women, we examined associations of policy environments with current PrEP use and recent HIV testing, as well as HIV vaccine intentions if a vaccine becomes available. More supportive access-focused and attitude- or norm-focused policy environments were associated with higher PrEP use and recent HIV testing among White participants. In contrast, these associations were not significant for Latinx and Black participants. Exploratory analyses provided suggestive evidence that differences in these associations across groups were consistent with differences in access and norms. These results suggest that supportive policy environments are not necessarily associated with smaller racial and ethnic disparities in HIV prevention outcomes.