Abstract
BackgroundSocial attitudes toward male homosexuality in China so far are still not optimistic. Sexual minorities in China have reported high levels of internalized homophobia.MethodsThis Internet-based study examined the associations among internalized homophobia, mental health, sexual behaviors, and outness among 435 gay/bisexual men in Southwest China from 2014 to 2015. Latent profile analysis, confirmatory factor analysis, univariate logistic regression, and separate multivariate logistic regression analyses were conducted.ResultsThis descriptive study found the Internalized Homophobia Scale to be suitable for use in China. The sample demonstrated a high prevalence of internalized homophobia. Latent profile analysis suggested a 2-class solution as optimal, and a high level of internalized homophobia was significantly associated with greater psychological distress (Wald = 6.49, AOR = 1.66), transactional sex during the previous 6 months (Wald = 5.23, AOR = 2.77), more sexual compulsions (Wald = 14.05, AOR = 2.12), and the concealment of sexual identity from others (Wald = 30.70, AOR = 0.30) and parents (Wald = 6.72, AOR = 0.49).ConclusionsThese findings contribute to our understanding of internalized homophobia in China, and highlight the need to decrease gay-related psychological stress/distress and improve public health services.
Highlights
Social attitudes toward male homosexuality in China so far are still not optimistic
Design and participants The study was designed to determine the associations between internalized homophobia, mental health, sexual behaviors, outness, and substance use among the gay and bisexual male population in Southwest China
AIC Akaike information criterion, Sample size adjusted bayesian information standardized criterion (ssaBIC) sample size adjusted bayesian information criterion, LRT Lo-Mendell-Rubins adjusted likelihood ratio test men who reported higher levels of internalized homophobia were more likely to self-identify as being bisexual (Wald = 1.73, Adjusted odds ratio (AOR) = 1.48, p = 0.06) and less likely to report male sexual attraction (Wald = 3.36, AOR = 0.73, p = 0.07). They were more likely to have had female sex partners during the previous 6 months (Wald = 2.90, AOR = 1.85, p = 0.09) and have condomless sex with females (Wald = 3.47, AOR = 1.83, p = 0.06). This descriptive study first examined the suitability of the Internalized Homophobia Scale using confirmatory factor analysis in a sample of Chinese gay and bisexual men
Summary
Sexual minorities in China have reported high levels of internalized homophobia. The construct includes negative global attitudes toward homosexuality, discomfort with disclosure of sexual orientation to others, disconnectedness from other lesbian, gay, and bisexual (LGB) individuals, and discomfort with same-sex sexual activity [1, 2]. Meyer has developed the Internalized Homophobia Scale, which has been widely used among sexual minorities in Western countries [3,4,5,6,7,8]. HIV infection has increased at an alarming rate among gay males in recent years [14]. In this context, some Chinese people tend to associate gay men with AIDS [15]. Same-sex marriage is illegal and sexual minorities still experience stigma, prejudice, and the occurrence of negative events
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