Comparison of the Influence of Internalized Homonegativity on Sexual Risk Behavior of Men Who Have Sex with Men in Spain and Turkey

Abstract

Objectives: This study aimed to understand how the association between internalized homonegativity (IH) and sexual risk behavior differed in Spain (N = 3,336) and Turkey (N = 550). Methods: We used multigroup structural equation modeling. Results: HIV and pre-exposure prophylaxis (PrEP) knowledge mediated the relationship between IH and sexual risk behavior among MSM in Spain, but not among men in Turkey. Higher HIV/PrEP knowledge was associated with higher sexual risk behavior among MSM in Spain, while among MSM in Turkey the association was in the opposite direction. Conclusions: The meaning of safe-sex may differ across contexts, and this should be taken into consideration when tailoring HIV prevention programs.

Keywords:

• Internalized homonegativity
• sexual risk behavior
• HIV knowledge
• MSM
• structural equation modeling

Acknowledgments

EMIS-2017 was coordinated by Sigma Research at the London School of Hygiene and Tropical Medicine (LSHTM) in association with the Robert Koch Institute (RKI) in Berlin. EMIS core team @ Sigma Research (LSHTM): Dr. Axel J. Schmidt, Dr. Ford Hickson, David Reid, and Peter Weatherburn, in association with Dr. Ulrich Marcus and Dr. Susanne B. Schink @ RKI. We thank all participants and all our partners for being part of something huge. In particular, we would like to thank the following companies and organisations: Europe: PlanetRomeo, Stop Sida (Spain) European AIDS Treatment Group (EATG), European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs & Drug Addiction (EMCDDA), European Commission (DG SANTE). ES: Stop Sida, CEEISCAT, Ministerio de Sanidad. TR: Pozitif Yaşam, Sami S. Yazıcılaroğlu.

Ethical approval

The Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine approved the original study (reference 14421/RR/8805).

Informed consent

All participants included in this analysis indicated online, prior to providing their answers, that they understand the nature and purpose of the study and consented to take part.

Authors’ contributions

Methodology, formal analysis and investigation: İbrahim Sönmez. Conceptualization and design: İbrahim Sönmez, Axel J. Schmidt, Rigmor Berg. Resources and data: Axel J. Schmidt. Writing—original draft preparation: İbrahim Sönmez. Writing—introduction: İbrahim Sönmez, Rigmor Berg, Sami Sarper Yazıcılaroğlu. Writing—sample and data: Axel J. Schmidt. Writing—methodology and results: İbrahim Sönmez. Writing—discussion: İbrahim Sönmez, Rigmor Berg, Sami Sarper Yazıcılaroğlu, Axel J. Schmidt. Supervision of development: Axel J. Schmidt. Supervision of statistical analysis: Natalie Thurlby.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data is property of the LSHTM and can be accessed upon reasonable request to [email protected].

Additional information

Funding

EMIS-2017 was carried out as part of ESTICOM, under the service contract 2015 71 01 with The Consumers, Health, Agriculture and Food Executive Agency (Chafea), acting under powers delegated by the Commission of the European Union. The contract arises from the Call for tender No Chafea/2015/Health/38.