Yale: Gay and bisexual men living in European countries with strong attitudes and policies against homosexuality are far less likely to use HIV-prevention services, test for HIV, and discuss their sexuality with health providers, according to research led by Yale School of Public Health (YSPH). The study is published online in the journal AIDS.
about homosexuality vary greatly across Europe, noted YSPH associate
professor and lead author John Pachankis and his colleagues. The
research team wanted to investigate the impact of homophobia on gay and
bisexual men’s health — specifically their sexual behavior, use of
HIV-prevention services, HIV status, and ability to cope with HIV.
conduct the study, the researchers used data from the European MSM
Internet Survey (EMIS), a joint project of academic, governmental,
non-governmental, and online media partners from 35 European countries.
EMIS is a 25-language study that assessed HIV-related knowledge,
behaviors, and health-service use among 174,000 gay and bisexual men.
The researchers combined the EMIS data with a measure of country-level
laws, policies, and social attitudes toward homosexuality.
study authors found stark differences in how countries treat and view
homosexuality. They also found that men living in countries with higher
levels of homophobia knew less about HIV and were less likely to use
condoms, leading the researchers to conclude that homophobia reduces the
use of health services and compromises health-service quality.
also noted a heightened risk of disease for gay and bisexual men in
homophobic countries, where appropriate prevention services are limited
but the opportunity for sexual contact is increasing.
findings suggest that rather than primarily being the result of personal
failure, HIV risk is largely determined by national laws, policies, and
attitudes toward homosexuality,” said Pachankis. “This study shows that
gay and bisexual men in homophobic countries are denied the resources,
including psychological resources like open self-expression, that are
necessary to stay healthy.”
An additional finding is that gay and
bisexual men in countries where homophobia is more pronounced have
fewer sex partners and were less likely to have HIV. The researchers
concluded that this finding was the result of efforts by gay and
bisexual men to conceal their sexual orientation, or stay in “the
closet.” While homophobia keeps men in the closet and suppresses their
opportunities to meet and have sex, noted the researchers, it also keeps
them uneducated about the risks of unprotected sex and unskilled in the
use of condoms in their sexual relationships, which can facilitate HIV
The research raises new concerns about the
vulnerability of men in homophobic countries since they are denied the
knowledge, skills, and resources needed to avoid or cope with HIV, the
study authors noted. At the same time, opportunities for sex are
expanding due to increasing mobility and travel, as well as rapid
developments in technology, such as hook-up websites and mobile apps.
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.