Gay and bisexual men living in European countries with strong attitudes and policies against homosexuality are far less likely to avail themselves of HIV prevention services, test for HIV and openly discuss their sexuality with health providers.

A new publication led by a researcher from the Yale School of Public Health also found that men living in homophobic countries knew less about HIV and were less likely to use condoms, leading researchers to conclude that homophobia reduces the use of health services and compromises its quality. Researchers also cite the heightened risk of disease for gay and bisexual men in homophobic countries, where appropriate prevention services are highly limited but the opportunity for sexual contact is increasing.

These findings from the European MSM Internet Survey (EMIS), a joint project of academic, governmental, non-governmental and online media partners from 35 European countries and believed to be the largest study of men who have sex with men, are published in this month’s issue of the journal AIDS.

“Our findings suggest that rather than primarily being the result of personal failure to protect oneself, HIV risk is largely determined by national laws, policies, and attitudes toward homosexuality,” said Dr. John Pachankis, an associate professor at the School of Public Health and the paper’s lead author. “This study shows that gay and bisexual men in homophobic places are denied the resources, including psychological resources like open self-expression, necessary to stay healthy.”

[Photo: Dr. John Pachankis]

Noting that the levels of homophobia vary greatly across Europe, Pachankis and colleagues wanted to find out what impact this had on the use of HIV prevention services, on men’s capability to deal with HIV, the kind of sex they had and on whether they contracted HIV. The research team used the data of the EMIS, a 25-language study of 174,000 men who have sex with men that assessed HIV-related knowledge, behaviors and health service use among gay and bisexual men in 38 countries. They combined this with a measure of country-level laws, policies and social attitudes toward homosexuality. The researchers found stark differences in how countries treat and view homosexuality, even those in close proximity.

“Sweden and Russia are much further apart in homophobia than they are in kilometres,” said study co-author Dr. Ford Hickson at the London School of Hygiene & Tropical Medicine.

The paper can be viewed online at http://journals.lww.com/aidsonline/Fulltext/2015/06190/Hidden_from_health___structural_stigma,_sexual.15.aspx