Gay and bisexual men living in European countries with strong attitudes and policies against homosexuality are far less likely to avail themselves of HIV prevention services, test for HIV and openly discuss their sexuality with health providers.
A new publication led by a researcher from the Yale School of Public Health also found that men living in homophobic countries knew less about HIV and were less likely to use condoms, leading researchers to conclude that homophobia reduces the use of health services and compromises its quality. Researchers also cite the heightened risk of disease for gay and bisexual men in homophobic countries, where appropriate prevention services are highly limited but the opportunity for sexual contact is increasing.
These findings from the European MSM Internet Survey (EMIS), a joint project of academic, governmental, non-governmental and online media partners from 35 European countries and believed to be the largest study of men who have sex with men, are published in this month’s issue of the journal AIDS.
“Our findings suggest that rather than primarily being the result of personal failure to protect oneself, HIV risk is largely determined by national laws, policies, and attitudes toward homosexuality,” said John Pachankis, an associate professor at the School of Public Health and the paper’s lead author. “This study shows that gay and bisexual men in homophobic places are denied the resources, including psychological resources like open self-expression, necessary to stay healthy.”
Noting that the levels of homophobia vary greatly across Europe, Pachankis and colleagues wanted to find out what impact this had on the use of HIV prevention services, on men’s capability to deal with HIV, the kind of sex they had and on whether they contracted HIV. The research team used the data of the EMIS, a 25-language study of 174,000 men who have sex with men that assessed HIV-related knowledge, behaviors and health service use among gay and bisexual men in 38 countries. They combined this with a measure of country-level laws, policies and social attitudes toward homosexuality. The researchers found stark differences in how countries treat and view homosexuality, even those in close proximity.
“Sweden and Russia are much further apart in homophobia than they are in kilometres,” said study co-author Ford Hickson at the London School of Hygiene & Tropical Medicine.
The study also found that men in countries where homophobia is more pronounced have fewer sex partners and were less likely to have HIV. They concluded that this was the result of “the closet” phenomenon, or the tendency of gay and bisexual men in homophobic countries to conceal their sexual orientation. Homophobia keeps men in the closet and suppresses their opportunities to meet and have sex, but it also keeps men unknowledgeable and unskilled when dealing with sex with other men and HIV, which can facilitate HIV transmission when opportunities arise.
Ultimately, the researchers worry about the vulnerability of men in homophobic countries, because they are denied the knowledge, skills and resources needed to deal with HIV. Meanwhile, opportunities for sex in these countries are expanding due to increasing mobility and travel as well as rapid developments in technologies, such as hook-up websites and mobile apps.
The publication is a joint effort between Yale, Columbia University, the London School of Hygiene & Tropical Medicine, the Norwegian Knowledge Centre for Health Services, the German Robert Koch Institute, and the Swiss Federal Office of Public Health FOPH.
The paper can be viewed online at http://journals.lww.com/aidsonline/Fulltext/2015/06190/Hidden_from_health___structural_stigma,_sexual.15.aspx