24th EMIS article suggests that national homophobia reduces both capability to prevent HIV as well as opportunities for infection

In collaboration with John Pachankis from Yale and Mark Hatzenbuehler from Columbia University we asked what impact national homophobia had on the use of HIV prevention services, on MSM’s capability of dealing with HIV, the kinds of sex they had, and ultimately on whether they contracted HIV. The study was published Open Access in AIDS, June 2015.

Men living in homophobic countries were less likely to have tested for HIV and were less likely to have talked about their sexuality with health services. They also knew less about HIV and were less likely to use condoms. Homophobia suppresses service use and compromises its quality for MSM. What was most surprising was that men in homophobic countries also had fewer sex partners and were less likely to have HIV. We could show that this contradiction arises through the operation of ‘the closet’ – what they call ‘sexual orientation concealment’.
Whether or not men were ‘out’ about their sexuality is the mechanism by which national homophobia has these contradictory effects on HIV, both hindering and helping it. Homophobia keeps men in the closet and suppresses (but does not eliminate) opportunity for men to meet and organise sexually. While not good for men’s sex lives or mental health, this does suppress HIV transmission. However, homophobia also keeps men ignorant, careless, and unskilled when it came to dealing with a sex life and HIV. This facilitates HIV transmission when opportunity for it arises.
 
The EMIS network warns about the vulnerability of men in homophobic countries who are denied the knowledge, skills, and resources to deal with HIV but whose opportunities for sex are greatly expanding due to increasing mobility and travel as well as rapid developments in technologies such as the internet, social media and mobile apps.