Association of MSM/ Non-MSM Disclosure and Internalized Homonegativity among Black/African-American Men Enrolled at Boston Healthcare Clinics

Background: We report findings of internalized homophobia among men who have sex with men (MSM) and non-MSM in a sample of Black/African-American men attending five Boston healthcare clinics.

Methods: We recruited 703 Black/African-American men aged 18-65 years who reported more than one sex partner in the past year. Black/African-American men were surveyed on demographics, homonegative attitudes, and behaviors. Men were classified into 3 groups: MSM with reported male sex partners, MSM who denied male sex partners but reported homosexual behaviors, and non-MSM. A seven item homonegativity scale was created and summed, with higher scores representing increased homonegativity.

Results: 18.2% of our sample (128/703) were behaviorally homosexual. The majority of participants were of low income (53% earning <$5,000), unemployed (62%), and homeless (76%). When quartile cut-offs were used for homonegativity scores, MSM who denied male sex partners (n=56) had much higher (p=0.0005) homonegativity scores than MSM who reported male sex partners (n=72) or non-MSM (n=575). MSM who acknowledged (adjOR = 5.3, 95%CI=2.4-11.6) or denied male partners (adjOR = 3.7, 95%CI=1.36-10.1) were more likely to report HIV infection than non-MSM. Similarly, MSM who acknowledged (adjOR = 3.1, 95%CI=1.8-5.1) and or denied male sex partners (adjOR = 1.6, 95%CI=0.9-2.9) were more likely to report lifetime STIs.

Conclusions: Our findings suggest that denial of MSM identity is associated with sharply higher homonegativity. This group remains at higher risks for HIV and STIs compared with non-MSM. In assessing HIV/STI risk among non-MSM, clinicians should identify strongly homonegative attitudes as potentially indicating MSM behaviors.