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Try out PMC Labs and tell us what you think. Learn More. The relevant data supporting the conclusions of this article were presented in the manuscript. Additionally, questionnaire of this study presented as Additional file 1.

Social attitudes toward male homosexuality in China so far are still not optimistic. Sexual minorities in China have reported high levels of internalized homophobia. Latent profile analysis, confirmatory factor analysis, univariate logistic regression, and separate multivariate logistic regression analyses were conducted. This descriptive study found the Internalized Homophobia Scale to be suitable for use in China. The sample demonstrated a high prevalence of internalized homophobia. The online version of this article doi Internalized homophobia is defined as the self-hatred and shame of homosexually oriented individuals that has been incorporated into their belief system [ 1 ]; it is also a source of stress.

The construct includes negative global attitudes toward homosexuality, discomfort with disclosure of sexual orientation to others, disconnectedness from other lesbian, gay, and bisexual LGB individuals, and discomfort with same-sex sexual activity [ 12 ]. Accordingly, Meyer has developed the Internalized Homophobia Scale, which has been widely used among sexual minorities in Western countries [ 3 — 8 ]. Social attitudes toward male homosexuals in Western society have improved considerably in the past three decades [ 9 ]. The acceptance of legalized same-sex marriage, which almost eliminated partnership differences between homosexual and heterosexual couples in the United States [ 1011 ] and other developed countries [ 1213 ], has been accompanied by a decrease in homophobic behavior and internalized homophobia.

First, Chinese traditional values emphasize the continuity of bloodlines. Second, HIV infection has increased at an alarming rate among gay males in recent years [ 14 ]. Third, same-sex marriage is illegal and sexual minorities still experience stigma, prejudice, and the occurrence of negative events due to their sexual orientation [ 16 ].

As a result, some gay men choose to conceal their same-sex orientation especially from their parents [ 16 ] and choose opposite-sex marriage to ease the stress of being members of this minority i. Little empirical information is available about the associations between internalized homophobia, mental health, sexual behavior, and substance use among Chinese gay and bisexual individuals.

studies of Chinese MSM have indicated that internalized homophobia was a major barrier to accessing HIV prevention and care services, and it was negatively associated with being tested for HIV [ 18 ]. However, that study did not examine the associations between internalized homophobia and mental health. Research studies conducted in developed countries have found that higher levels of internalized homophobia were associated with higher levels of mental health problems i. Additionally, internalized homophobia was found to be associated with practicing HIV at-risk sexual behaviors [ 120 ], such as condomless sex, multiple sex partners, and unprotected anal sex among male homosexuals.

Some studies have found an association between higher levels of internalized homophobia and increased alcohol use [ 21 ], and substance use [ 21 ], such as barbiturates and amphetamines, among male individuals, whereas other studies have reported conflicting findings [ 2223 ].

Understanding the issue of internalized homophobia should improve interventions that raise levels of mental health and public health i. To our current knowledge, two published studies have addressed internalized homophobia among Chinese gay and bisexual men [ 1824 ], both of which were focused on the associations between internalized homophobia and their rates of HIV testing.

However, neither of these studies provided a detailed analysis of internalized homophobia as a risk factor for psychological distress and engaging in unprotected sex among Chinese male sexual minorities. studies have examined internalized homophobia as a correlate of mental health and health risks in developed countries [ 35721 ]. Furthermore, MSM could potentially act as a bridge to transmit HIV to the general female population through unprotected sex with females because of their inconsistent condom use [ 25 ].

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In addition, internalized homophobia has been found to be associated with sexual compulsivity [ 2026 ]. Thus, we first examined the suitability of the Internalized Homophobia Scale. Second, we examined the associations among internalized homophobia, psychological distress, sexual behaviors, and outness. We hypothesized that internalized homophobia would be positively associated with psychological distress, concealment of sexual orientation, sexual compulsivity, and unprotected sex among Chinese gay and bisexual men.

The study was deed to determine the associations between internalized homophobia, mental health, sexual behaviors, outness, and substance use among the gay and bisexual male population in Southwest China. A cross-sectional survey was conducted online in and Participants were recruited over a period of three months using advertisements on gay chat-room websites, Blued and Zank application software two popular gay social software applications in Chinaand QQ groups.

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Participants completed an Internet-based survey questionnaire via the professional survey website, Wenjuan xing. The initial dataset consisted of respondents. Participants were eligible for the study if they were male, age 18 years or older, gay or bisexual, and residents of one of the recruitment regions in Southwest China.

A total of participants were eligible for this study. Basic socio-demographic information, including age, highest educational level attained, occupation, monthly salary, and current relationship status, was collected. Scores range from 9 to 45, with higher scores indicating higher levels of internalized homophobia. The Chinese version of the scale was translated by one English professional translator and two psychology graduate students independently, and then consensus was reached.

research has indicated that the scale has acceptable internal consistency reliability [ 127 ]. The items measure depression and anxiety symptoms. Scores range from 6 to 30, with higher scores indicating higher levels of psychological distress.

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Outness was measured using two questions adapted from a study [ 4 ]. The first question concerned the extent to which the respondents had disclosed their sexual orientation to others, with three optional : never had disclosedpartially disclosedand fully disclosed. The responses were coded dichotomously by occurrence. The second question pertained to the extent to which the respondents had disclosed their sexual orientation to their parents.

Sexual compulsivity was measured using the item Sexual Compulsivity Scale [ 29 ] that assesses compulsive urges to perform specific sexual acts. Responses are made using a 4-point Likert scale ranging from 1 strongly disagree to 4 strongly agree. Scores range from 10 to 40, with higher scores indicating a higher degree of compulsivity. Sexual identity, sexual attraction, and sexual partners were assessed using questions that were adapted from a online survey by Vrangalova and Savin-Williams [ 31 ].

Sexual identity was assessed by asking participants to identify their sexual orientation. Sexual partners was assessed using two separate questions: the total of 1 male and 2 female partners with whom the respondent had sexual experiences during the 6 months, including vaginal sex and anal sex. The response was coded as having multiple male sex partners if the of partners was greater than one, and it was coded as having female sex partners if the was greater than 0.

The responses were dichotomized to reflect at least one episode of recent transactional sex. Condom use was measured using two separate questions about the frequency of condom use with male and female sex partners. There were six response options: neverseldomoftenmost of the timeevery timeand not applicable. The response was coded as having condomless sex if never, seldom, often, or most of the time was selected. Similar questions and recoding procedures have been used in published studies [ 32 ]. Each response was dichotomized to reflect at least one episode of recent substance use.

To examine cultural differences, confirmatory factor analysis was performed on the Internalized Homophobia Scale. Descriptive statistics were calculated. Latent profile analysis, which is a superior statistical technique compared to the traditional method of cluster analysis and has a variety of fit indices, was used to determine the of homogenous groups or levels based on data from the Internalized Homophobia Scale [ 3435 ]. Sexual compulsivity and psychological distress responses were later dichotomized by a median split for use in logistic regression.

Univariate logistic regression was performed. Separate multivariate logistic regression analyses using block entry were then used to examine the independent association between internalized homophobia and the factors, controlling for sexual identity, current relationship status, and monthly salary. Table 1 presents the of the confirmatory factor analysis that was performed on the Chinese version of the Internalized Homophobia Scale. The of bisexual respondents was small, so we combined them with the gay sample in our analyses.

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The mean score for internalized homophobia was Table 3 presents the of the latent profile analysis. We examined the plausibility of 2- 3- 4- and 5-class solutions and determined the best model fit. The 2-class solution was better than the 4-class solution according to a larger entropy value, indicating a more accurate classification [ 34 ].

Akaike Information Criterion and the Bayesian Information Criterion both showed a moderate drop from the 2 to 4-class solutions.

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The mean scores for psychological distress, sexual compulsivity, male sexual attraction, and female sexual attraction were However, there were no ificant correlations between internalized homophobia, substance use, the of male sex partners, and condomless sex with males. In the univariate analysis, respondents who had higher levels of internalized homophobia had 1. For separate multivariate analysis, we controlled for current relationship status, and monthly salary.

This descriptive study first examined the suitability of the Internalized Homophobia Scale using confirmatory factor analysis in a sample of Chinese gay and bisexual men. The Chinese version of the instrument was found to have acceptable psychometric properties. More importantly, the study found a relatively high level of internalized homophobia among the Chinese gay and bisexual men, and a positive association between higher levels of internalized homophobia with psychological distress, sexual attraction to females, transactional sex during the past 6 months, having female sex partners and condomless sex with females during the past 6 months, and sexual compulsivity.

The high levels of internalized homophobia among the gay and bisexual men in this study can be explained by the reality that Chinese social attitudes toward male sexual minorities have been negative [ 1636 ]. Even in Shanghai, a highly cosmopolitan city, MSM reported feeling marginalized and experienced many forms of social discrimination and negative attitudes from multiple groups of people, such as their families, colleagues, and employers [ 17 ].

The values of marriage and family responsibilities, which are emphasized in traditional Chinese values, contribute to the development of internalized homophobia among gay and bisexual individuals. These findings are consistent with our hypothesis that internalized homophobia is positively associated with psychological distress.

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The hypothesis is also supported by studies, which reported that individuals experiencing higher levels of internalized homophobia were more likely to have high levels of psychological distress [ 1937 ]. Thus, it begins to threaten their psychological well-being [ 27 ] and may explain why gay and bisexual individuals are more likely to have suicidal ideation and attempts [ 38 ].

In addition, these findings offer an Eastern cultural perspective supporting Southwest Chinese gay and bisexual men and the associations between their internalized homophobia and psychological distress. studies have reported a high proportion of transactional sex among MSM in Africa [ 639 ], but no associations between internalized homophobia and transactional sex [ 39 ]. Although this finding indicates there is a low occurrence of transactional sex among male sexual minorities in China, individuals were more likely to report higher levels of internalized homophobia. Thus, the association between internalized homophobia and transactional sex is inconclusive and might be influenced by race and culture.

Unlike the finding of a study [ 40 ], the present findings suggest that individuals with higher levels of internalized homophobia were more likely to have sex with females, although this finding was not statistically ificant but more away from the null. The study also revealed that men with higher levels of internalized homophobia were to some extent more likely to engage in unprotected sex with females. However, no relationship was found between internalized homophobia and substance use in this sample.

Similar to a review, mixed have been reported in studies of these relationships [ 41 ]. Cultural and social consciousness might determine these associations. Higher levels of internalized homophobia were ificantly associated with a lower level of disclosure to others and parents. It is possible that the men with higher levels of internalized homophobia were more likely to experience sexual minority stress, thereby engaging in behaviors to protect themselves from harm [ 5 ], such as rejection by parents, relatives, and friends, and threats to employment.

They might have also developed coping behaviors to comfort themselves. This information may also be applied to helping members of this population solve problems related to minority stress and to improve the mental health of individuals who cope with concealing their sexual orientation. We also found that respondents with higher levels of internalized homophobia were ificantly less likely to report male sexual attraction and more likely to report female sexual attraction.

studies showed that sexual orientation was generally consistent with sexual attraction [ 31 ]. In addition, we found a relationship between internalized homophobia and sexual compulsivity. The study has several limitations.

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