Different dimensions: Internalized homonegativity and condom use among African-American men who have sex with men

Background: African-American men who have sex with men (AAMSM) are at disproportionate risk for HIV infection. While internalized homonegativity (IH) has been identified as a potential predictor of engagement in sexual risk behaviors, little is known about how it might function differently among AAMSM when compared with majority white populations. This study examined the dimensionality of IH and its associations with condom use among AAMSM. Methods: Participants (n=261) were recruited at Black Gay Prides in the southeastern U.S. through flyers and social media to complete a self-administered, paper-and-pencil survey. The Internalized Homonegativity Inventory (IHNI) was used to measure IH, and condom use was assessed by asking respondents about their frequency of condom use for both insertive and receptive anal intercourse. The factor structure of IH was examined using exploratory factor analysis, and multinomial logistic regression was then used to identify whether IH was associated with condom use. Results: The mean age of participants was 28.7 years. Three-fourths (75.1%) of respondents reported being tested for HIV in the last year, and 20.7% were HIV-positive. Exploratory factor analysis of the IHNI showed evidence of two-factor solution: Personal and Moral Homonegativity, and Gay Affirmation. Gay affirmation was positively associated with both insertive and receptive condom use in the last 3 months. Conclusions: This study provided evidence that the IHNI might function differently for AAMSM than for majority-white populations. Further research is needed to examine how IH can be incorporated into the development of culturally-specific HIV prevention programs for AAMSM.