Findings showed the IHNI scale to have adequate psychometric properties and similar factor structure to the scale’s original sample2
. IHNI scores averaged ten points or more higher than the original sample, which suggests aspects of internalized homonegativity are more pronounced in poor, urban MSM and MSM/W of color than white middle-class, Midwest gay men. The IHNI total score and the three subscales captured distinct aspects of internalized homonegativity and described meaningful differences along meaningful participant characteristics, including social indicators of the participant’s “outness.” Levels of internalized homonegativity increased with age, with lower educational levels, with African American ethnicity, with experiences of poverty and homelessness, with recent use of cocaine (lower levels of homonegativity with methamphetamine use), with experiences of being incarcerated, with being a man who is behaviorally bisexual, and with being HIV seronegative.
The sampling frame involving RDS did not promote immediate convergence of IHNI scores for participants enrolled in the first versus the latter halves of each Wave of data collection. In both Waves of data collection, enrollment of African Americans (and concomitant higher IHNI scores) increased as the linked referrals proceeded. IHNI scores for each Wave, however, were similar. This application of RDS did not yield a sample that could be considered representative of the general population of MSM or MSM/W in Los Angeles County, particularly along the factors of ethnicity/race, poverty and HIV. Hence, findings are understood to reflect a unique sample of very poor MSM and MSM/W of color in Los Angeles County.
Drug-specific behaviors interacted with the IHNI scores and ethnicity/race such that African American MSM/W were more likely to have positive urine cocaine screens and higher IHNI scores, while White and Hispanic MSM were more likely to provide positive urine methamphetamine screens and lower IHNI scores. Although substance use is an efficient method to cover over feelings of internalized homophobia17
, its functions appear to be divergent for cocaine and for methamphetamine using men. Another distinction is the finding that African American men reported similar levels of drug use as White and Latino men, which contrasts with work showing lower levels of substance use in African American MSM/W15
High IHNI scores for African American MSM/W validates the work of many and indicates that the sociocultural milieu of most African American men prohibit expressions of non-heterosexual behaviors and identities10,17,18
. African American MSM/W may face potential rejection of cultural affiliation when openly acknowledging either male–male sexual behaviors or gay or bisexual identities7,19
Consistent with prior work15
, the highest homonegativity scores were reported by MSM/W who reportedly had no prior tests for HIV; HIV prevalence in this group was high. As such, homonegativity may function within this group of men as a barrier to HIV testing. Still, this sample of men with high homonegativity scores completed their rapid tests and learned their results. Design of prevention strategies with the goal of increasing HIV testing among men who have never tested may benefit from rapid testing procedures and/or monetary incentives.
IHNI scores generally did not predict HIV-related sexual risk behaviors after controlling for race/ethnicity and self sexual identification. One exception is that high scores on the Gay Affirmation subscale significantly predicted low numbers of sexual partners, particularly for men who self-identified as “straight.” That only one model showed significant associations between IHNI scores and behavioral outcomes after holding race/ethnicity and self sexual identification constant indicates that there is no homogenous experience of sexual behaviors and internalized homonegativity for MSM and MSM/W of differing racial/ethnic groups who adhere to differing sexual identification labels.
Findings were limited by several factors. These include collecting all data from a single convenience sample in Los Angeles County and reliance primarily on subject reports. Yet, participants were scattered throughout the Los Angeles basin and comprised a coherent sample of predominantly low-income MSM and MSM/W of color. The size of the sample allowed sufficient design effect for findings to be considered significant, even if some participants misrepresented self-reports. As well, ACASI was used to increase privacy and findings comparing urine data with self-report of drug use indicating participants approached the questionnaire straightforwardly. Finally, there is a limitation to the concept of internalized homonegativity that involves emphasis on individual pathology rather than on institutional/societal oppression3
Other limitations to these findings deserve mention that are related to the RDS method. In our use of dual cores of drug users and/or MSM in the RDS procedure, we compiled a sample that showed high levels of similarity between participants and the recruits they referred into the study (i.e., homophily) for most of the variables measured. These included HIV status, race/ethnicity, drug use, and levels of income, even though the sample was overwhelmingly poor. Implementation of RDS failed to yield a “representative” sample of drug users and/or MSM in both this and another RDS study in Los Angeles20
, which also recruited a very poor sample with high HIV prevalence. This suggests findings should be constrained to similar urban groups of older MSM and MSM/W of color with high HIV prevalence and who are drug users.
Despite these limitations, findings still show internalized homonegativity to correlate significantly and strongly with a variety of demographic factors, drug use, sexual behaviors, and HIV status in this sample of very poor, largely minority MSM and MSM/W, which provide a rare glimpse into associations between internalized homonegativity, sexual behaviors, and drug use for the men in this understudied group. Findings also emphasize the value of using rapid testing procedures with those who do not know their HIV status and imply that optimally effective prevention interventions that address homonegativity and sexual risk may be constructed differently for MSM methamphetamine users than for MSM/W cocaine users.