Internal homonegativity among men having sex with men: a comparative cross-national study

MAXIM KASIANCZUK - Candidate of Sciences in Chemistry, Monitoring and Evaluation Coordinator at the Eurasian Coalition on Male Health, Tallinn, Estonia

OLESIA TROFYMENKO - Leading sociologist at the Department of Social Expertise, Institute of Sociology, National Academy of Sciences of Ukraine, Kyiv

GULBARSHYN CHEPURKO - Doctor of Sciences in Sociology, Head of the Department of Social Expertise, Institute of Sociology, National Academy of Sciences of Ukraine, Kyiv. https://orcid.org/0000-0001-7540-5174

VITALY DJUMA - Master of International Public Health, Executive Director of the Eurasian Coalition on Male Health, Tallinn, Estonia

SEAN HOWELL - co-founder and President of Hornet Networks Ltd., USA

Abstract. The paper studies internalized homonegativity (IH) and its predictors among men who have sex with men (MSM) in 12 countries of Eastern Europe and Central Asia (EECA). Internalized homonegativity (sometimes called internal homophobia) is a negative attitude to own same-sex attractions. It arises when gays and other people with homosexual attractions interiorize predominant negative attitudes and assumptions about homosexuals and homosexuality.

Internalized homonegativity is a significant factor of poorer health (including vulnerability to HIV infection), and lower inclusion in the community in Western countries. It remains highly understudied in post-Soviet countries, although there is a sufficient ground to suppose its higher prevalence here.

Cross-sectional online survey of MSM was conducted in August–October, 2017. Convenience sample was recruited via dating apps and websites, other partner sites, and MSM-service organizations. Analytical sample size was 8239 respondents from Russia, Ukraine, Belarus, Kazakhstan, Kyrgyzstan, Estonia and Lithuania (which were merged), Armenia, Georgia, Azerbaijan, Macedonia, and Moldova.

IH was measured by the 8-item Short Internalized Homonegativity Scale (SIHS) in all main languages of the countries. According to results of Cronbach’s a test and multi-group confirmatory factor analysis, adaptation of SIHS showed satisfactory to good reliability, and partial scalar invariance across EECA.

IH was not predominant in all countries’ samples. However, average IH was significantly different by countries. That could be attributed to both sampling design and differences in societal homophobia. Results of structural equation modeling of SIHS predictors also varied between countries. However, in most countries IH was lower among self-identified gays, those who were more open about own homosexual attractions, and was less religious. The unexpected findings included negative associations between IH and higher education, and contradictory associations with age in some countries.

Results showed that internalized homonegativity is a common and comparable phenomenon among MSM in Eastern Europe and Central Asia. Its prevalence is presumably different across the countries. IH relates, first of all, to own sexual orientation (gay, bi- etc.), and acknowledgement of own same-sex attractions. Also, the SIHS measure is good enough for use in further studies of male health and possibilities for LGBTIQ mobilization in the region.

Keywords: internalized homonegativity, homosexuality, MSM, EECA, homophobia, measurement invariance, structural equation modeling

Publication in: eng

References

Barnes, D. M., & Meyer, I. H. (2012). Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals. The American Journal of Orthopsychiatry, 82(4), 505–515. https://dx.doi.org/10.1111/j.1939-0025.2012.01185.x.

Bell, A. P., & Weinberg, M. S. (1978). Homosexualities: a study of diversity among men and women. New York, NY: Simon & Schuster.

Berg, R. C., Lemke, R., & Ross, M. W. (2017). Sociopolitical and cultural correlates of internalized homonegativity in gay and bisexual men: findings from a Global Study. International Journal of Sexual Health, 29(1), 97–111. https://dx.doi.org/10.1080/19317611.2016.1247125.

Berg, R. C., Munthe-Kaas, H. M., & Ross, M. W. (2016). Internalized homonegativity: a systematic mapping review of empirical research. Journal of Homosexuality, 63(4), 541–558. https://dx.doi.org/10.1080/00918369.2015.1083788.

Berg, R. C., Ross, M. W., Weatherburn, P., & Schmidt, A .J. (2013). Structural and environmental factors are associated with internalised homonegativity in men who have sex with men: findings from the European MSM Internet Survey (EMIS) in 38 countries. Social Science & Medicine, 78, 61–69. https://dx.doi.org/10.1016/j.socscimed.2012.11.033.

Berg, R. C., Weatherburn, P., Ross, M. W., & Schmidt, A .J. (2015). The relationship of internalized homonegativity to sexual health and well-being among men in 38 European countries who have sex with men. Journal of Gay & Lesbian Mental Health, 19(3), 285–302. https://dx.doi.org/10.1080/19359705.2015.1024375.

Berghe, W. V., Dewaele, A., Cox, N., & Vincke, J. (2010). Minority-specific determinants of mental well-being among lesbian, gay, and bisexual youth. Journal of Applied Social Psychology, 40(1), 153–166. https://dx.doi.org/10.1111/j.1559-1816.2009.00567.x.

Bolshov, Ye. S., Kasianchuk, M. G., Leshchynskyi, Ye. B., Trofymenko, L. V., & Shvab, I. A. (2012). Behavior monitoring and HIV-prevalence among men who have sex with men as a component of second generation surveillance (Analytical report). Retrieved from HIV/AIDS Alliance in Ukraine website: http://www.aidsalliance.org.ua/ru/library/our/.../msm_en_2011.pdf.

Byrne, B. M. (2012). Structural equation modeling with Mplus: basic concepts, applications, and programming. New York, NY: Routledge/Taylor & Francis Group.

Byrne, B. M., Shavelson, R. J., & Muthen, B. (1989). Testing for the equivalence of factor covariance and mean structures: the issue of partial measurement invariance. Psychological Bulletin, 105(3), 456–466. https://dx.doi.org/10.1037/0033-2909.105.3.456.

Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334.

Currie, M. R., Cunningham, R. G., & Findlay, B. M. (2004). The Short Internalized Homonegativity Scale: examination of the factorial structure of a new measure of internalized homophobia. Educational and Psychological Measurement, 64(6), 1053–1067. https://dx.doi.org/10.1177/0013164404264845.

Dubov, A., Fraenkel, L., Yorick, R., Ogunbajo, A., & Altice, F. L. (2018). Strategies to implement pre-exposure prophylaxis with men who have sex with men in Ukraine. AIDS and Behavior, 22(4), 1100–1112. https://dx.doi.org/10.1007/s10461-017-1996-y.

Hequembourg, A. L., & Dearing, R. L. (2013). Exploring shame, guilt, and risky substance use among sexual minority men and women. Journal of Homosexuality, 60(4), 615–638. https://dx.doi.org/10.1080/00918369.2013.760365.

Herek, G. M. (2004). Beyond “homophobia”: thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research & Social Policy, 1(2), 6–24.

Herek, G. M., Cogan, J. C., Gillis, J. R., & Glunt, E. K. (1998). Correlates of internalized homophobia in a community sample of lesbians and gay men. Journal of the Gay & Lesbian Medical Association, 2(1), 17–25.

Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: insights from a social psychological perspective. Journal of Counseling Psychology, 56(1), 32–43. https://dx.doi.org/10.1037/a0014672.

Huebner, D. M., Davis, M. C., Nemeroff, C. J., & Aiken, L. S. (2002). The impact of internalized homophobia on HIV preventive interventions. American Journal of Community Psychology, 30(3), 327–348. https://dx.doi.org/10.1023/A:1015325303002.

IBM Corp. Released. (2013). IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

Johnson, M. O., Carrico, A. W., Chesney, M. A., & Morin, S. F. (2008). Internalized heterosexism among HIV-positive, gay-identified men: implications for HIV prevention and care. Journal of Consulting and Clinical Psychology, 76(5), 829–839.

Kasianchuk, M., Trofymenko, O., Bilous, Ye., & Sazonova, Ya. (2017). Monitoring behavior and HIV-prevalence among men having sex with men (National analytical report). [In Ukrainian]. Kyiv. Ukraine: Alliance for Public Health. [= Касянчук 2017]

Kasianczuk, M. (2014). The internal homophobia of bisexual men. [In Russian]. In A. A. Kondakov (Ed.), At a crossroads: methodology, theory and practice of LGBT and queer studies (pp. 391–409). Saint Petersburg, Russian Federation: Centre for Independent Social Research. [= Касянчук 2014]

Kharchenko, I. (2014). Adapting to adverse conditions: LGBT coming out strategies in Ukraine (Master’s thesis, Central European University). Retrieved from www.etd.ceu.hu/2014/kharchenko_ievgeniia.pdf.

Lapshina, T. N., & Kochetkova, A. S. (2016). The mental health of LGB teenagers and young adults as a challenge to Russian psychologists. [In Russian]. Psychology. Journal of the Higher School of Economics, 13(1), 40–59. [= Лапшина 2016]

Lingiardi, V., Baiocco, R., & Nardelli, N. (2012). Measure of internalized sexual stigma for lesbians and gay men: a new scale. Journal of Homosexuality, 59(8), 1191–1210. https://dx.doi.org/10.1080/00918369.2012.712850.

Lohmus, L., Murd, M., & Trummal, A. (2012). European MSM Internet Survey (EMIS): the results for Estonia (Analytical report). [In Estonian]. Tallinn, Estonia: Tervise Arengu Instituut (National Institute for Health Development). Retrieved from http://rahvatervis.ut.ee/bitstream/1/4960/1/TAI2012_3.pdf.

Lottes, I. L., & Alkula, T. (2011). An investigation of sexuality-related attitudinal patterns and characteristics related to those patterns for 32 European countries. Sexuality Research and Social Policy, 8(2), 77–92. https://dx.doi.org/10.1007/s13178-011-0038-1.

Malyon, A. K. (1982). Psychotherapeutic implications of internalized homophobia in gay men. Journal of Homosexuality, 7(2–3), 59–69. https://dx.doi.org/10.1300/J082v07n02_08.

Mayfield, W. (2001). The development of an Internalized Homonegativity Inventory for gay men. Journal of Homosexuality, 41(2), 53–76. https://dx.doi.org/10.1300/J082v41n02_04.

Meyer, I., & Dean, L. (1998). Internalized homophobia, intimacy, and sexual behavior among gay and bisexual men. In G. M. Herek (Ed.), Psychological perspectives on lesbian and gay issues, Vol. 4. Stigma and sexual orientation: understanding prejudice against lesbians, gay men, and bisexuals (pp. 160–186). https://dx.doi.org/10.4135/9781452243818.n8.

Morell-Mengual, V., Gil-Llario, M. D., Ballester-Arnal, R., & Salmeron-Sanchez, P. (2017). Spanish adaptation and validation of the Short Internalized Homonegativity Scale (SIHS). Journal of Sex & Marital Therapy, 43(4), 298–305. https://dx.doi.org/10.1080/0092623X.2016.1149128.

Moskotina, R., Dmitruk, N., Trofimenko, O., Privalov, Yu., & Kasianczuk, M. (2017). Study on the attitudes of staff of key social services of five countries of Central and Eastern Europe and Central Asia towards LGBT people, conducted within the framework of ECOM’s regional program “Right to Health” (Analytical report).Tallinn, Estonia: Eurasian Coalition on Male Health.

Muthen, L. K., & Muthen, B. O. (1998–2012). Mplus user’s guide. Seventh edition. Los Angeles, CA: Muthen & Muthen.

Newcomb, M. E., & Mustanski, B. (2011). Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Archives of Sexual Behavior, 40(1), 189–199. https://dx.doi.org/10.1007/s10508-009-9573-8.

Nungesser, L. G. (1983). Homosexual acts, actors, and identities. Santa Barbara, CA: Praeger.

Parker, R. D., Lohmus, L., Mangine, C., & Ruutel, K. (2016). Homonegativity and associated factors among men who have sex with men in Estonia. Journal of Community Health, 41(4), 717–723. https://dx.doi.org/10.1007/s10900-015-0145-7.

Pew Research Center. (2017). Religious belief and national belonging in Central and Eastern Europe (Survey report). Retrieved from http://www.pewforum.org/2017/05/10/religious-belief-and-national-belonging-in-central-and-eastern-europe.

Pyun, T., Santos, G. M., Arreola, S., Do, T., Hebert, P., Beck, J., ... Ayala, G. (2014). Internalized homophobia and reduced HIV testing among men who have sex with men in China. Asia Pacific Journal of Public Health, 26(2), 118–125. https://dx.doi.org/10.1177/1010539514524434.

Ross, M. W., Berg, R. C., Schmidt, A. J., Hospers, H. J., Breveglieri, M., Furegato, M., & Weatherburn, P. (2013). 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. BMJ Open, 3(2), e001928. https://dx.doi.org/10.1136/bmjopen-2012-001928.

Ross, M. W., Kajubi, P., Mandel, J. S., McFarland, W., & Raymond, H. F. (2013). Internalized homonegativity/homophobia is associated with HIV-risk behaviors among Ugandan gay and bisexual men. International Journal of STD & AIDS, 24(5), 409–413. https://dx.doi.org/10.1177/0956462412472793.

Ross, M., & Simon Rosser, B. R. (1996). Measurement and correlates of internalized homophobia: a factor analytic study. Journal of Clinical Psychology, 52(1), 15–21. https://dx.doi.org/10.1002/(SICI)1097-4679(199601)52:1<15::AID-JCLP2>3.0.CO;2-V.

Ross, M. W., Simon Rosser, B. R., Neumaier, E. R., & Positive Connections Team (2008). The relationship of internalized homonegativity to unsafe sexual behavior in HIV seropositive men who have sex with men. AIDS Education and Prevention, 20(6), 547–557. https://dx.doi.org/10.1521/aeap.2008.20.6.547.

Ross, M. W., Smolenski, D. J., Kajubi, P., Mandel, J .S., McFarland, W., Raymond, F. H. (2010). Measurement of internalized homonegativity in gay and bisexual men in Uganda: cross-cultural properties of the Internalized Homonegativity scale. Psychology, Health & Medicine, 15(2), 159–165.

Rosser, S. (2011, November). The relationship between discrimination, homophobia, mental health and HIV risk: findings from the SILAS study. Paper presented at FEMP Conference. Retrieved from https://www.folkhalsomyndigheten.se/contentassets/ce6e1b196d2541e6a3b417a6b4bcb031/femp-2011-future-european-prevention-men-have-sex-with-men.pdf.

Rosser, B. R., Bockting, W. O., Ross, M. W., Miner, M. H., & Coleman, E. (2008). The relationship between homosexuality, internalized homo-negativity, and mental health in men who have sex with men. _Journal of Homosexuality, 5_5(2), 185–203. https://dx.doi.org/10.1080/00918360802129394.

Sabunaieva, M. L. (2011). Internalized homophobia: Do I fear myself? [In Russian]. Saint Petersburg, Russian Federation. [= Сабунаева 2011]

Santos, G. M., Beck, J., Wilson, P. A., Hebert, P., Makofane K., Pyun, T., ... Ayala, G. (2013). Homophobia as a barrier to HIV prevention service access for young men who have sex with men. JAIDS: Journal of Acquired Immune Deficiency Syndrome, 63(5), e167–e170.

Shestakovskii, O., & Kasianczuk, M. (2018). A study on internalized homonegativity (Analytical report). [In Russian]. Tallinn, Estonia: Eurasian Coalition on Male Health. Retrieved from https://ecom.ngo/wp-content/uploads/2018/09/Issledovanie-internalizirovannoj-gomonegativnosti-_RU.pdf. [= Шестаковский 2018]

Shestakovskyi, O., Kasianchuk, M., Garner, A., Howell, S., Djuma, V., & Sabelashvili, P. Internalized homonegativity decreases access to condoms among MSM in 10 countries of Eastern Europe and Central Asia. (2018, July). Paper presented at AIDS 2018 Conference. Retrieved from https://programme.aids2018.org//PAGMaterial/eposters/5139.pdf.

Shidlo, A. (1994). Internalized homophobia: Conceptual and empirical issues in measurement. In B. Greene & G. M. Herek (Eds.), Psychological perspectives on lesbian and gay issues, Vol. 1. Lesbian and gay psychology: theory, research, and clinical applications (pp. 176–205). Thousand Oaks, CA: Sage. https://dx.doi.org/10.4135/9781483326757.n10.

Shmykova, Ye. (2011). European MSM Internet Survey (EMIS): the results for Russia (Analytical report). [In Russian]. Retrieved from http://www.emis-project.eu/sites/default/files/public/publications/EMIS_NationalReport_Russia.pdf. [= Шмыкова 2011]

Shoptaw, S., Weiss, R. E., Munjas, B., Hucks-Ortiz, C., Young, S. D., Larkins, S., ... Gorbach, P. M. (2009). Homonegativity, substance use, sexual risk behaviors, and HIV status in poor and ethnic men who have sex with men in Los Angeles. Journal of Urban Health, 86(Suppl 1), 77–92. https://dx.doi.org/10.1007/s11524-009-9372-5.

Smolenski, D. J., Diamond, P. M., Ross, M. W., & Simon Rosser, B. R. (2010). Revision, criterion validity, and multi-group assessment of the Reactions to Homosexuality Scale. Journal of Personality Assessment, 92(6), 568–576. https://dx.doi.org/10.1080/00223891.2010.513300.

Smolenski, D. J., Ross, M. W., & Simon Rosser, B. R. (2011). Direct and indirect effects between internalized homonegativity and high-risk sex. Archives of Sexual Behavior, 40(4), 785–792. https://dx.doi.org/10.1007/s10508-010-9705-1.

Szymanski, D. M., Kashubeck-West, S., & Meyer, J. (2008). Internalized heterosexism: a historical and theoretical overview. The Counseling Psychologist, 36(4), 510–524. https://dx.doi.org/10.1177/0011000007309488.

The EMIS Network. (2013). EMIS 2010: the European Men-Who-Have-Sex-With-Men Internet Survey. Findings from 38 countries (Technical report). Stockholm: European Centre for Disease Prevention and Control. Retrieved from https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/EMIS-2010-european-men-who-have-sex-with-men-survey.pdf.

Tran, H., Ross, M. W., Diamond, P. M., Berg, R. C., Weatherburn, P., & Schmidt, A. J. (2018). Structural validation and multiple group assessment of the Short Internalized Homonegativity Scale in homosexual and bisexual men in 38 European countries: results from the European MSM Internet Survey. The Journal of Sex Research, 55(4–5), 617–629. https://dx.doi.org/10.1080/00224499.2017.1380158.

Vu, L., Tun, W., Sheehy, M., & Nel, D. (2012). Levels and correlates of internalized homophobia among men who have sex with men in Pretoria, South Africa. AIDS and Behavior, 16(3), 717–723. https://dx.doi.org/10.1007/s10461-011-9948-4.

Wang, J., & Wang, X. (2012). Structural equation modeling: applications using Mplus. Hoboken, NJ: John Wiley & Sons.

Weatherburn, P., Schmidt, A. J., Hickson, F., Reid, D., Berg, R. C., Hospers, H. J., ... EMIS Network. (2013). The European Men-Who-Have-Sex-with-Men Internet Survey (EMIS): design and methods. Sexuality Research and Social Policy, 10(4), 243–257. https://dx.doi.org/10.1007/s13178-013-0119-4.

Weinberg, G. H. (1972). Society and the healthy homosexual. New York, NY: St Martin’s Press.

Wilkerson, J. M., Smolenski, D. J., Brady, S. S., & Simon Rosser, B. R. (2012). Religiosity, internalized homonegativity, and outness in Christian men who have sex with men. Sexual and Relationship Therapy, 27(2), 122–132. https://dx.doi.org/10.1080/14681994.2012.698259.

Williamson, I. R. (2000). Internalized homophobia and health issues affecting lesbians and gay men. Health Education Research, 15(1), 97–107. https://dx.doi.org/10.1093/her/15.1.97.

Xu, W., Zheng, L., Xu, Y., & Zheng, Y. (2017). Internalized homophobia, mental health, sexual behaviors, and outness of gay/bisexual men from Southwest China. International Journal for Equity in Health, _16:_36. https://dx.doi.org/ 10.1186/s12939-017-0530-1.

Yanykin, A. A., & Nasledov, A. D. (2017). Internalized homophobia in Russia. Psychology in Russia: State of the Art, 10(2), 103–116. https://dx.doi.org/10.11621/pir.2017.0207.

Young, S. D., Shoptaw, S., Weiss, R. E., Munjas, B., & Gorbach, P. M. (2011). Predictors of unrecognized HIV infection among poor and ethnic men who have sex with men in Los Angeles. AIDS and Behavior, 15(3), 643–649.https://dx.doi.org/10.1007/s10461-009-9653-8.