Internalised homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country cross-sectional study: some public health implications of homophobia

Abstract

ObjectivesInternalised homonegativity (IH) is hypothesised to be associated with HIV risk behaviour and HIV testing in men who have sex with men (MSM). We sought to determine the social and individual variables associated with IH and the associations between IH and HIV-related behaviours.Design and settingWe examined IH and its predictors as part of a larger Internet-delivered, cross-sectional study on HIV and health in MSM in 38 European countries.Participants181 495 MSM, IH data analysis subsample 144 177. All participants were male, over the age of consent for homosexual activity in their country of domicile, and have had at least one homosexual contact in the past 6 months.MethodologyAn anonymous Internet-based questionnaire was disseminated in 25 languages through MSM social media, websites and organisations and responses saved to a UK-based server. IH was measured using a standardised, cross-culturally appropriate scale.ResultsThree clusters of European countries based on the level of experienced discrimination emerged. IH was predicted by country LGB (lesbian, gay and bisexual) legal climate, Gini coefficient and size of place of settlement. Lower IH was associated with degree the respondent was ‘out’ as gay to others and older age. ‘Outness’ was associated with ever having an HIV test and age, education and number of gay friends, while IH (controlling for the number of non-steady unprotected sex partners and perceived lack of control over safe sex) was associated with condom use for anal intercourse.ConclusionsIH is associated with LGB legal climate, economic development indices and urbanisation. It is also associated with ‘outness’ and with HIV risk and preventive behaviours including HIV testing, perceived control over sexual risk and condom use. Homonegative climate is associated with IH and higher levels of HIV-associated risk in MSM. Reducing IH through attention to LGB human rights may be appropriate HIV reduction intervention for MSM.

Frequency and correlates of late presentation for HIV infection in France: older adults are a risk group – results from the ANRS-VESPA2 Study, France

“…Such a finding is consistent with a result from the 2011 report on HIV epidemiology in Denmark, where among MSM who self-declared as homosexuals 34% had a CD4 cell count below 350 at diagnosis vs. 60% for MSMs who self-declared as bisexuals (EPI-NEWS, 2011). This result can be explained by a lower uptake of HIV testing among bisexual males ( Fernández-Dávila et al, 2013;Ross et al, 2013), which might be due to a greater fear of social consequences among those men with high levels of internalised homophobia (Herek, Gillis, & Cogan, 2009). Those associations were no longer significant after adjustment for age at diagnosis, suggesting that these factors might be combined to explain LP, since older generations were less educated and less inclined to self-declare as gay.…”

Sexual inactivity among men who have sex with men living with hiv in europe

“…This in turn impacts on their overall health (Meyer, 1995(Meyer, , 2003. One example of this social context is the high level of homophobia in certain Central and Eastern European (C/EE) countries (Berg, Ross, Weatherburn, & Schmidt, 2013;Ross et al, 2013;Stulhofer & Rimac, 2009). Mental health problems may be more common in these areas with high levels of homophobia, and this may in turn lead to sexual inactivity of MSM living with HIV, as argued by Bancroft (2009).…”

Emotional Intimacy Among Coupled Heterosexual and Gay/Bisexual Croatian Men: Assessing the Role of Minority Stress

“…Corroborating the findings from anumberofstudies(e.g., Mohr&Daly,2008;Otisetal.,2006;Ross et al, 2013;Szymanski & Hilton, 2013), internalized homonegativitywas showntobe themostsalientoftheminoritystressors measured in this study.…”

“…To explore the possibility that the hypothesized effect of minority stress on same-sex couples' intimacy may be more important in countries characterized by comparatively high levels of homonegativity (cf. Ross et al, 2013), this study examined the relationship between minority stressors and relationship intimacy among coupled gay/bisexual Croatian men. Due to minority stressors, we hypothesized sexual orientation-specific differences in the levels of emotional intimacy and its relationship with sexual satisfaction.…”