Population Council Research that makes a difference

Abstract

Factors affecting internalized homophobia and its relationship with HIV risk behaviors among men who have sex with men in Pretoria, South Africa 
Poster presentation at the XVIII International AIDS Conference, Vienna, 20 July
Lung Vu; Tun,Waimar; Nel,Dawie; Sheehy,Meredith
Publication date: 2010


Background
Little is known about internalized homophobia among men who have sex with men (MSM) in South Africa. Because such negative attitudes can lead to psychological distress, low self-esteem, and low self-efficacy that increase vulnerability to HIV infection, we sought to understand factors associated with internalized homophobia among these men.

Methods
A cross-sectional study was conducted among MSM in Pretoria, South Africa, in 2009. A total of 339 men aged 18 years and older were recruited through respondent-driven sampling. Internalized homophobia was measured using nine questions (four-point scale; Cronbach's alpha=0.89) asking how often a person feels shame and discomfort with being homosexual. One example statement is: "I wish I didn't want to have sex with men." A composite homophobia index was computed and dichotomized at the median for analysis.

Results
The sample had a median age of 24 years (range: 18-42), 91 percent were black, 86 percent were single, 32 percent had more than 12 years of schooling, 74 percent self-identified as homosexual, and 79 percent had tested for HIV. About 15 percent of MSM stated that they often feel denial, discomfort, or shame for being homosexual. MSM who lived in non-townships (adjusted odds ration [AOR]=2.0, p< .05), identified as bi/heterosexual (AOR=3.4, p< .001), had less than 12 years of schooling (AOR=1.9, p< .05), had high levels of misinformation (AOR=2.0, p< .01), and had sex with both men and women (AOR=3.4, p< .01) were more likely to report having a higher level of internalized homophobia. Higher level of internalized homophobia was significantly associated with negative attitudes toward condom use (OR=4.3, p< .001) and never having been tested for HIV (OR=2.0, p< .01).

Conclusions
Education, misinformation, and sexual identity are significantly associated with higher levels of internalized homophobia. Mental health counseling and HIV risk-reduction interventions for MSM must reduce misinformation and improve their sense of self-worth and self-acceptability around their sexual identity.