Factors affecting internalized homophobia and its relationship with HIV-risk behaviors among men who have sex with men in Pretoria, South Africa

Published: July 21, 2010

L. Vu1, W. Tun1, D. Nel2, M. Sheehy1

1Population Council, HIV and AIDS Program, Washington, United States, 2OUT, Pretoria, South Africa

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 339 men aged 18 years and older were recruited through respondent driven sampling. Internalized homophobia was measured using 9 questions (4-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 (range: 18-42), 91% was black, 86% was single, 32% had more than 12 years of schooling, 74% self-identified as homosexual, and 79% had tested for HIV. About 15% of MSM stated that they often feel denial, discomfort or shame for being homosexual. MSM who lived in non-townships (AOR (adjusted odds ratio)=2.0, p< .05); identified as bi/heterosexual (AOR=3.4, p< .001); had less than 12 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 level of internalized homophobia. Mental health counseling and HIV risk-reduction interventions for MSM must reduce misinformation and improve sense of self-worth and self-acceptability around their sexual identity.

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