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Study: How Homophobia May Drive Acquisition of HIV and STIs

Encountering homophobia may predispose gay and bisexual men to acquire HIV and sexually transmitted infections (STIs), according to a new study published in the journal AIDS.

The study enrolled 1,480 Nigerian gay and bisexual men and classified them into three subgroups (low, medium, high) based on their experience of nine homophobia indicators (e.g. rejection from friends and family, harassment, physical violence). Compared to men who had experienced a low level of homophobia, those with medium homophobia severity were 34% more likely to acquire HIV and STIs, and those with high homophobia severity were 79% more likely to acquire HIV and STIs.

Study authors conducted a path analysis to understand precisely how homophobia drives STIs. The link between homophobia and STIs can be partially explained by the finding that homophobia is associated with suicidal ideation, which is associated with condom-less sex with casual sex partners. In other words, the potential effects of homophobia on gay and bisexual men’s mental health may drive riskier sexual behavior, which would explain the increased rate of HIV and STIs in the medium- and high-homophobia groups.

“This study adds nuance to what we know by explicating one pathway by which stigma contributes to the HIV/STI epidemic among men who have sex with men (MSM), illustrating multiple points at which public health programming could intervene to prevent stigma’s negative impact,” says Cristina Rodriguez-Hart, the lead author of the study and epidemiologist at the New York City Department of Health and Mental Hygiene.

“Sexual stigma, often called homophobia, is a potentially important structural driver of poor mental health and the acquisition of HIV and STIs among MSM in Nigeria,” added Rodriguez-Hart. “Few studies have looked at both the outcomes of mental health and HIV/STIs within the same model pertaining to MSM.”

Poor mental health as a result of homophobia can manifest in feelings of hopelessness, a need for emotional contact, and fatalism, all of which may hinder gay and bisexual men from paying attention to their sexual health. Finding creative ways to simultaneously provide mental health support and reduce HIV/STIs among gay and bisexual men would be especially valuable in resource-constrained settings, like Nigeria where the study was conducted.

Although researchers are confident that homophobia is statistically correlated to HIV/STI incidence, they advised that the current data are insufficient to determine whether homophobia actually causes HIV/STIs. Still, the pathway proposed in their study does appear plausible in light of previous theoretical and empirical work.

From a broader public health perspective, this study bolsters over a decade of research implicating the social environment in individuals’ physical health. The notion that verbal harassment and homophobic remarks from one’s family could result in poorer sexual health fits the paradigm shift towards acknowledging the effects of social interactions on well-being.

Future research is required to confirm whether the association between homophobia and acquiring HIV/STIs is also found in gay and bisexual men in the U.S. But for now, the findings provide a credible reason to call out homophobia and actively promote global LGBTQ equality.