The Geography of Sexual Orientation: Structural Stigma and Sexual Attraction, Behavior, and Identity Among Men Who Have Sex with Men Across 38 European Countries

Abstract

While the sexual identity and behavior of men who have sex with men (MSM) varies across countries, no study has examined country-level structural stigma toward sexual minorities as a correlate of this variation. Drawing on emerging support for the context-dependent nature of MSM’s open sexual self-identification cross-nationally, we examined country-level structural stigma as a key correlate of the geographic variation in MSM’s sexual attraction, behavior, and identity, and concordance across these factors. Data come from the European MSM Internet Survey (EMIS), a multi-national dataset containing a multicomponent assessment of sexual orientation administered across 38 European countries (N=174,209). Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes towards sexual minorities held by the citizens of each country. Results demonstrate that in more stigmatizing countries, MSM were significantly more likely to report bisexual/heterosexual attractions, behaviors, and identities, and significantly less likely to report concordance across these factors, than in less stigmatizing countries. Settlement size moderated associations between country-level structural stigma and odds of bisexual/heterosexual attraction and behavior, such that MSM living in sparsely populated locales within high structural stigma countries were the most likely to report bisexual or heterosexual behaviors and attractions. While previous research has demonstrated associations between structural stigma and adverse physical and mental health outcomes among sexual minorities, this study is the first to show that structural stigma is also a key correlate not only of sexual orientation identification, but also of MSM’s sexual behavior and even attraction. Findings have implications for understanding the ontology of MSM’s sexuality and suggest that a comprehensive picture of MSM’s sexuality will come from attending to the local contexts surrounding this important segment of the global population.

Sexual orientation disparities in the co-occurrence of substance use and psychological distress: a national population-based study (2008–2015)

“…Future research can build on these findings by testing the causal sequence from stress exposure to these co-occurring outcomes and the potential causal influence of these outcomes on each other. Further, given that the social climate surrounding sexual minorities varies widely across world countries [ 59 – 61 ], future studies should also explore the extent to which the current findings generalize across countries. Such studies, for instance, might take advantage of the wide variation in social climates surrounding sexual minorities to predict sexual orientation disparities in psychosocial health outcomes and mediators from this variation.…”

Socio-demographic Characteristics, Sexual and Test-Seeking Behaviours Amongst Men Who have Sex with Both Men and Women: Results from a Bio-behavioural Survey in 13 European Cities

“…Non-disclosure of sexual orientation amongst MSMW has been attributed to high levels of perceived stigma, as well as certain legal, cultural, and social norms (22). Such barriers to disclosure have been argued to drive MSMW underground and place them out of reach of HIV-preventative services, knowledges, and behaviours, thereby increasing their risk for HIV infection (23) (24).…”

Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men

“…Although the change in social norms can be difficult to estimate the most relevant changes include the change in Massachusetts State law allowing for same sex marriage in 2013 and the repeal by the Federal Supreme Court of portions of the Defense of Marriage Act in 2015. There is emerging evidence that the changing political climate can exert a positive influence on sexual minority mental health (e.g., Hatzenbuelher et al, 2010; Pachankis et al, 2017) and may impact the present day relevance of the current findings. In addition the passing of the Affordable Care Act, and subsequent legislation has changed access to health insurance and health care for many Americans, which may limit the current applicability of our findings.…”

“…In particular, recent research on structural stigma and sexual orientation-related health disparities has demonstrated that improving social climates—including social policies that differentially target gays and lesbians (e.g., same-sex marriage and adoption)—may reduce mental health problems within sexual minority populations (Hatzenbuelher et al, 2010; Oldenburg et al, 2015; Pachankis et al, 2017). Thus, developing and evaluating structural interventions that reduce sexual minority stigma and discrimination, the major drivers of syndemic processes, represent an important avenue for future research.…”