Internalized homophobia, mental health, sexual behaviors, and outness of gay/bisexual men from Southwest China

BACKGROUND Social attitudes toward male homosexuality in China so far are still not optimistic. Sexual minorities in China have reported high levels of internalized homophobia. METHODS This Internet-based study examined the associations among internalized homophobia, mental health, sexual behaviors, and outness among 435 gay/bisexual men in Southwest China from 2014 to 2015. Latent profile analysis, confirmatory factor analysis, univariate logistic regression, and separate multivariate logistic regression analyses were conducted. RESULTS This descriptive study found the Internalized Homophobia Scale to be suitable for use in China. The sample demonstrated a high prevalence of internalized homophobia. Latent profile analysis suggested a 2-class solution as optimal, and a high level of internalized homophobia was significantly associated with greater psychological distress (Wald = 6.49, AOR = 1.66), transactional sex during the previous 6 months (Wald = 5.23, AOR = 2.77), more sexual compulsions (Wald = 14.05, AOR = 2.12), and the concealment of sexual identity from others (Wald = 30.70, AOR = 0.30) and parents (Wald = 6.72, AOR = 0.49). CONCLUSIONS These findings contribute to our understanding of internalized homophobia in China, and highlight the need to decrease gay-related psychological stress/distress and improve public health services.