The relationship of internalized homonegativity to unsafe sexual behavior in HIV-seropositive men who have sex with men.

Abstract

We studied internalized homonegativity (IH) in 675 HIV-positive men who have sex with men (MSM) from six epicenters across the United States who attended an HIV prevention workshop. Participants included 300 African American and over 150 Hispanic White and White non-Hispanic men. Higher IH was significantly associated with African American race. Compulsive sexual behavior, openness as MSM, sexual comfort, depression, education level, and importance of religion also were associated with IH and independently predicted a third of this outcome's variance. For those with higher IH, two significant paths led to unsafe sexual behavior: first, to serodiscordant unprotected anal intercourse (SDUAI) through being less "out"--thus disclosing serostatus to secondary partners less frequently, and second, to lower condom self-efficacy and SDUAI through lower sexual comfort. These data provide information on the demographic, sexual and mental health variables associated with IH. They offer an indication of the paths through which IH is associated with serodiscordant risk behavior in HIV-positive MSM.