London School of Hygiene: Europe’s most homophobic countries may be paving the way for a rise in HIV cases among gay and bisexual men, according to new research published in the journal AIDS. An international team of researchers from Europe and the US looked at HIV-related service use, need and behaviours among 175,000 gay or bisexual men living in 38 European countries with differing levels of national homophobia. They found that men in homophobic countries had fewer sexual partners and were less likely to be diagnosed with HIV. However, they also found those men knew less about HIV, were less likely to use condoms and are at greater potential risk of getting HIV when they do have sex.
As technological advancements such as mobile sex-seeking apps mean
men in the most homophobic countries have increasing opportunities for
sexual contact, they are quickly overcoming the relative lack of
brick-and-mortar sex venues such as bars and saunas. The researchers
warn the effects of homophobia could therefore have a very concerning
impact on the spread of HIV.
Co-author Dr Ford Hickson
from the London School of Hygiene & Tropical Medicine, said: "Our
findings are surprising as it may appear it's effectively safer for men
to stay in the closet in the most homophobic countries because their
HIV-risk is lower there. But the closet is a difficult, shameful place
which is particularly harmful to mental health and wellbeing. It’s also a
place where men are kept ignorant, under-resourced and poorly skilled
when dealing with sex and HIV. As the way people meet changes with
technology, the homophobia that may have appeared to be protecting these
men will now be exposing them to huge risk.”
The research was conducted by the Yale School of Public Health,
Columbia University, the London School of Hygiene & Tropical
Medicine, the Norwegian Knowledge Centre for Health Services, and the
German Robert Koch Institute.
Researchers measured national homophobia across Europe using a
combination of the laws of a country and the results of social attitudes
surveys. They then analysed data from 175,000 gay or bisexual men in 38
European countries who completed the European MSM Survey (EMIS)
in 2010 to compare the level of HIV-related service use, need and
behaviours among groups of men living in more homophobic and less
homophobic countries. EMIS is believed to be the largest study on men
who have sex with men (MSM).
The researchers say their findings suggest new approaches need to be
considered to reduce oppression without increasing the HIV risk.
Dr Hickson added: “Previous research on HIV prevention in Europe has
shown there are four key interventions in suppressing HIV: condom
distribution, peer-led group education, peer-outreach education
projects, and universal access to anti-retrovirals for men with HIV. All
health authorities could be commissioning these services as well as
working to protect the human rights of sexual minorities.”