A systematic review of instruments that measure attitudes toward homosexual men

Measures of Health Care Providers' Knowledge, Clinical Skills, or Prejudice Toward Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Sexual and Gender Minority Populations: A Scoping Review

Purpose: Assessing health care providers' knowledge, clinical skills, and prejudice toward lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority populations (LGBTQIA+) can help identify areas for improvement in health care provider training. The aim of this study was to map the range of studies that report measures of health care providers' knowledge, clinical skills, or prejudice toward LGBTQIA+ populations. Methods: A scoping review adopting the Joanna Briggs Institute methodology was conducted. Electronic database searches were conducted in CINAHL via EBSCO Host, Epistemonikos, LILACS via Virtual Health Library Regional Portal, PubMed, Scopus, and Web of Sciences. The samples of other reviews were screened. Studies that validated, translated, and/or cross-culturally adapted measures of the knowledge, clinical skills, and prejudice of health care providers and students toward LGBTQIA+ individuals were selected. Scholars were consulted to ensure that no relevant studies were missing. Data were extracted by two independent reviewers and presented in tabular form along with narrative summaries. Results: This scoping review identified 27 measures that have been validated, translated, and/or adapted with health care providers or students as the target population, distributed across 33 studies. Conclusions: Psychometric studies involving LGBTQIA+ patients and health care professionals have increased in recent years, with North American countries being the most frequent location. However, a growing number of studies are being conducted in Latin American countries such as Brazil and Colombia.

Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties

Stigma against sexual and gender minorities (SGM) populations has serious negative health effects for SGM populations. Despite the growing need for accurate stigma measurement in SGM, there are insufficient valid measurement instruments. Moreover, the lack of consistency in construct usage makes comparisons across studies particularly challenging. A critical review and comparative evaluation of the psychometric properties of the various stigma measures for SGM is necessary to advance our understanding regarding stigma measurement against/among SGMs. Based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted in 4 bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) for empirical articles published from 2010 to 2022 that evaluated the psychometrics properties of measurement instruments assessing stigma against SGMs. The screening, extraction, and scoring of the psychometric properties and methodological quality of selected instruments were performed by following the established standards and COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist, respectively. Of the 2031 studies identified, 19 studies were included that reported psychometric properties of 17 measurement instruments. All instruments, except two, were developed for SGMs (n = 15/17). Most instruments included men who have sex with men (MSM) or gay men (n = 11/15), whereas less than half of the instruments assessed stigma among SGM women (n = 6/15). Internal consistency (Cronbach's alpha) and content validity was reported for all instruments (n = 17); construct and structural validity was also reported for majority of the instruments (n = 15 and 10, respectively). However, test-retest reliability and criterion validity was reported for very few instruments (n = 5 each). Based on the COSMIN checklist, we identified the most psychometrically and methodologically robust instruments for each of the five stigma types: combined stigma, enacted stigma, internalized stigma, intersectional stigma, and perceived stigma. For each stigma type, except anticipated stigma, at least one instrument demonstrated strong promise for use in empirical research; however, the selection of instrument depends on the target population and context of the study. Findings indicated a growing use of instruments assessing multiple stigma types. Future studies need to develop intersectional stigma instruments that account for the multiple and intersecting social identities of SGMs. Additionally, most existing instruments would benefit from further psychometric testing, especially on test-retest reliability, criterion validity, adaptability to different LGBTQIA + populations and cultures.

Does Internalized Stigma Change the Way that Religiousness Relates to Depression for People with Marginalized Sexualities?

Drawing on minority stress and intersectionality theories, we examine whether the relationship between religiousness and depression among people with marginalized sexualities changes as a function of their experience of internalized stigma. Analyses of a sample of 260 people with marginalized sexualities suggested that the relationship between religiousness and depression was moderated by internalized homonegativity. Simple slopes analyses revealed that when people with marginalized sexualities reported higher degrees of internalized homonegativity, the relationship between religiousness and depression was positive. Conversely, when people with marginalized sexualities reported lower degrees of internalized homonegativity, religiousness was negatively related to depression. Dismantling analyses using subscales of the Internalized Homonegativity Inventory suggested that these effects are largely driven by personal homonegativity and participants' views of the morality of homosexuality. Taken together, these results suggest that religiousness may be positive for people with marginalized sexualities when they experience low degrees of internalized stigma. Further, results suggest that both people with marginalized sexualities' negative self-views and negative views of people with marginalized sexualities generally may affect the ways in which people with marginalized sexualities experience religiousness, and how it ultimately impacts them psychologically.

Health Care Access and Lived Experience of American Indian/Alaska Native Two Spirit and LGBTQ+ Participants in the Pride and Connectedness Survey, 2020

OBJECTIVE

To better understand health experiences among Two Spirit and lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ+) American Indian/Alaska Native (AI/AN) people, we examined experiences with access to health care of 223 AI/AN Two Spirit and LGBTQ+ people.

METHODS

Participants of the Pride and Connectedness 2020 survey, conducted through the Northwest Portland Area Indian Health Board, were asked about barriers to seeking and accessing care through a 10-question scale. We compared cisgender and gender-diverse participant demographic and scale responses to explore potential differences based on gender identity using the Pearson χ2 test of independence and ordinal logistic regression, respectively.

RESULTS

Both cisgender and gender-diverse participants experienced at least some difficulties accessing health care. Finances, lack of psychologists/other mental health support, and lack of psychological support groups for Two Spirit and LGBTQ+ communities were the top 3 barriers to care experienced by all participants (84%, 82%, and 80%, respectively). Compared with cisgender participants, gender-diverse participants were more likely to report difficulties accessing care for nearly all questions on the 10-question scale and nearly 3 times more likely to report fear of being mistreated within the health care system based on their gender identity (adjusted odds ratio = 2.9; 95% CI, 1.8-4.9; P < .001).

CONCLUSIONS

Increased access to mental health services and improved health care provider training that focuses on culturally relevant and gender-affirming practices would benefit the health and well-being of AI/AN people who identify as Two Spirit and LGBTQ+.

Impacts of psychological wellbeing with HIV/AIDS and cancer among sexual and gender minorities: A systematic review and meta-analysis

Background

The agony and economic strain of cancer and HIV/AIDS therapies severely impact patients' psychological wellbeing. Meanwhile, sexual minorities experience discrimination and mental illness. LGBT individuals with cancer and HIV/AIDS play two roles. It is important to understand and examine this groups mental wellbeing.

Objective

The purpose of this study is to synthesize current studies on the impact of HIV/AIDS and cancer on LGBT patients' psychological wellbeing.

Methods

This research uses a systematic literature review at first and later stage a meta-analysis was run on the same review. In this study, data from Google academic and Web of Science has been used to filter literature. PRISMA 2020 Flow Diagram seeks research on LGBT cancer and HIV/AIDS patients. The above sites yielded 370 related papers, some of which were removed due to age or inaccuracy. Finally, meta-analyses was done on 27 HIV/AIDS and 33 cancer patients's analyse.

Results

The research included 9,898 LGBT cancer sufferers with AIDS and 14,465 cancer sufferers with HIV/AIDS. Using meta-analysis, we discovered the gap in psychological wellbeing scores between HIV/AIDS LGBT and non-LGBT groups ranged from -10.86 to 15.63. The overall score disparity between the HIV/AIDS LGBT and non-LGBT groups was 1.270 (95% CI = 0.990-1.560, Z = 86.58, P < 0.1). The disparity in psychological wellbeing scores between cancer LGBT group and general group varies from -8.77 to 20.94 in the 34 papers examined in this study. Overall, the psychological wellbeing score disparity between the cancer LGBT subset and the general group was 12.48 (95% CI was 10.05-14.92, Test Z-value was 268.40, P-value was <0.1).

Conclusion

Inflammation and fibrosis in HIV/AIDS and cancer sufferers adversely affect their psychological wellbeing.

Information, Motivation and Behavioral Skills as Mediators Between Sexual Minority Stigma and Condomless anal Sex Among Black South African Men Who have Sex with Men

We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences of sexual minority stigma, mental health, alcohol use, information-motivation-behavioral skills (IMB) model constructs, and CAI. Structural equation modeling was used to test whether external and internalized stigma were directly and indirectly associated with CAI. In both studies, external stigma and internalized stigma were associated with CAI through IMB model constructs. These results suggest a pathway through which stigma contributes to HIV risk. For HIV prevention efforts to be effective, strengthening safer sex motivation and thus decreasing sexual risk behavior likely requires reducing sexual minority stigma that MSM experience and internalize.

The Development and Validation of the Heterosexism Erasure Scale

The heterosexism erasure construct captures attitudes, which deny or minimize the systemic oppression of lesbian, gay, bisexual, and queer (LGBQ) persons in the United States. Heterosexism erasure expands the interrogation of denying or minimizing discrimination (Neville at al., 2006) beyond the realm of White supremacy and into the domain of heteronormativity. The purpose of this project was to develop a psychometrically sound measure of heterosexism erasure. Two independent samples were gathered to conduct exploratory ( n = 425) and confirmatory ( n = 367) factor analyses to assess for initial reliability and validity evidence of the Heterosexism Erasure Scale (HES). Results suggest that the final 13-item HES provides a general index of heterosexism erasure as well as assesses two related, but distinct factors named Heterosexism Denial and Heterosexism Minimization. Results support the internal consistency and factor structure of the measure. Expected relationships between the HES and existing measures provide validity evidence for the instrument.

Metrics of sexual behavior stigma among cisgender men who have sex with men in Mexico: exploratory and confirmatory factor analyses

Cisgender gay, bisexual, and other men who have sex with men (MSM) in Mexico experience disparities in sexual health outcomes, perhaps most notably in HIV prevalence, HIV testing and status awareness, and condom use. Sexual behavior stigma, underpinned by socio-structural factors specific to Mexico (e.g., machismo), uniquely shapes these sexual health disparities. However, few reliable, valid measures are available to document, track, and ultimately mitigate sexual behavior stigma in this context. Exploratory and confirmatory factor analyses were performed on responses to a 13-item sexual behavior stigma scale from 15,681 MSM recruited online across Mexico. Associations with extracted factors were tested to assess construct validity. Three subscales were identified in exploratory factor analysis and validated in confirmatory factor analysis: "stigma from family and friends" (α = 0.65), "anticipated healthcare stigma" (α = 0.84), and "general social stigma" (α = 0.70). External construct validity was indicated through each subscale's strong association (all p < 0.001) with perceived community intolerance of MSM and perceived community discrimination toward people living with HIV. These subscales show promise as reliable, valid measures for assessing sexual behavior stigma among MSM in Mexico, and as tools for documenting and tracking sexual behavior stigma trends, comparing regional burdens of sexual behavior stigma, and tracking the progress of stigma-mitigation interventions among MSM in Mexico. Future research is needed to understand the extent to which each subscale is differentially associated with sexual (and other) health outcomes, which can inform the development and implementation of uniquely tailored stigma-mitigation, HIV-prevention, HIV-care, and other needed interventions for MSM in Mexico.

Is Conservative Religiousness Inherently Associated with Poorer Health for Sexual Minorities?

Results of path analysis involving sexual minority participants (N = 1317) from diverse sociopolitical contexts revealed health outcomes to be associated with internalized homonegativity and the resolution of conflict between religious and sexual minority identities. Contrary to expectations, several markers of religiousness were not directly associated with either improved or worsened health outcomes for depression or anxiety. However, religious activity moderated the influence of internalized homonegativity (IH) on depression such that IH was less strongly related to depression among individuals who frequently attended religious services than among individuals who infrequently attended religious services. These findings have special salience for advancing a more accurate understanding of conservatively religious sexual minorities and directing culturally sensitive research, clinical services, and public policy.

Internalized Homonegativity and the Challenges of Having Same-Sex Desires in the Lebanese Context: A Study Examining Risk and Protective Factors

Internalized homonegativity (IH) has received increased attention in the literature on sexual minorities. Nevertheless, there is a lack of research on IH in conservative Arab cultures like Lebanon. The present study aimed to cover this gap by exploring risk and protective factors of IH in Lebanese sexual minorities. A hierarchical multiple regression (N = 210) revealed that religiosity, parental rejection (actual or anticipated), and legal discrimination were significant risk factors of IH, while sense of belonging to the LGBT community was a strong protective factor. Although self-compassion did not emerge as a predictor, it had interesting interactions on the bivariate level. Results, limitations, clinical implications, and recommendations for future research and policy making are discussed.

Suicidal ideation among active and nonactive/former Latter-day Saint sexual minorities

Sexual minorities (SMs) in the Church of Jesus Christ of Latter-day Saints (LDS) experience a number of unique risks related to their religious/spiritual and SM experience that may increase their likelihood of experiencing suicidal ideation (SI) and ultimately dying by suicide. However, it is unclear which aspects of these experiences are responsible for elevated SI. It is further unclear whether religiousness/spirituality and minority stress relate to SI similarly for active and nonactive/former LDS SMs. To address this gap, we examined data from 602 active and nonactive/former LDS SMs. Active and nonactive LDS SMs reported similar degrees of SI and minority stress but differing degrees of religiousness/spirituality with active LDS SMs reporting more religiousness/spirituality than nonactive/former LDS SMs. Several variables were associated with increased SI in both groups including positive religious coping, interpersonal religious struggles, internalized homonegativity, and concealment. Other variables were associated with decreased SI in both groups including resolving conflict between sexual and religious identities, family support, and friend support. Our results suggest that whether LDS SMs are active in their faith is an important factor to consider when understanding how religiousness/spirituality and minority stress relate to SI.

What Shapes Attitudes Toward Homosexuality among European Muslims? The Role of Religiosity and Destination Hostility

Muslim migrants and their descendants in Western Europe have consistently been shown to hold more negative attitudes toward homosexuality, the more religious they are. In this article, we go beyond this mono-dimensional view of religiosity and develop a theoretical framework that combines (a) the role of different dimensions of religiosity in anchoring cultural attitudes and (b) the potential impact of destination hostility and discrimination on the retention of cultural attitudes toward homosexuality among Muslim migrants in Western Europe. For the analysis, we use eight rounds of the European Social Survey, enriched with country-level data. Findings indicate that Muslim migrants’ mosque attendance, as a dimension of religiosity, has the negative effect that was expected. Particularly, Muslims who grew up in Western Europe are negative about homosexuality if they attended mosque regularly, whereas among first-generation Muslim migrants, origin-country norms are a strong predictor of attitudes toward homosexuality. In addition, we find that perceived group discrimination drives the maintenance of negative attitudes toward homosexuality, especially among mosque attendees. These results imply that the development of more liberal attitudes among European Muslims is held back by a combination of socialization in conservative religious communities and hostility from host-country populations.

Stability and change in attitudes towards homosexuality among immigrant-origin adolescents in Norway

This article explores attitudes about the acceptability of homosexuality among immigrant-origin adolescents in Norway. Using a sample of students enrolled in upper secondary school, and comparing the data from the World Value Survey, I discuss the extent to which attitudes towards homosexuality among immigrant-origin youth are predominantly static or subject to change as a result of exposure to Norwegian society. Despite substantial differences between native- and immigrant-origin youth, and between different groups according to regional origin and religious affiliation, I find clear indications of changes in attitudes across all groups in the direction of higher level of tolerance. Immigrant-origin youth in Norway consider themselves more tolerant than their parents; have more positive attitudes towards homosexuality than adolescents residing in their countries of origin have; and family length of residence correlates positively with acceptance of homosexuality. Exposure in the form of school contexts where native-origin adolescents make up a larger proportion of the student body is also positively correlated with more positive attitudes towards homosexuality among immigrant-origin youth, but only at the highest level of native density.

Measurement of gender as a social determinant of health in epidemiology-A scoping review

Background

The relevance of gender as a social determinant of health and its role in the production of health inequalities is now broadly acknowledged. However, the plethora of existing approaches to capture gender, which often stem from disciplines outside of epidemiology, makes it difficult to assess their practicality and relevance for a given research purpose. We conducted a scoping review to 1) map the evidence of how gender can be operationalised in quantitative epidemiology and 2) design a tool to critically evaluate the measures identified.

Methods

We identified peer-reviewed articles in electronic databases (PubMed, Embase and PsycINFO). Eligible sources described the quantitative operationalisation of the social dimension of gender. With the help of a newly developed checklist, we assessed their relevance from an analytical perspective (e.g. intersectionality) and their potential for implementation in epidemiology.

Results

Gender measures principally assessed gender roles and norms, gender-based discrimination and violence, and structural gender (in)equality. Of the 344 measures included in this review, the majority lacked theoretical foundation, and tended to reinforce the binary understanding of gender through stereotypes of femininity and masculinity. Only few measures allowed for an intersectional approach and a multilevel understanding of gender mechanisms. From a practical point of view, gender measures demonstrated potential for use in varied populations and contexts.

Conclusions

A range of gender measures are readily available for epidemiological research, addressing different levels and dimensions of gender as a social construct. With our theory-informed, practice-driven scoping review, we highlighted strengths and limitations of such measures and provided analytical tools for researchers interested in conducting intersectional, gender-sensitive analyses.

A Comparison of Juror Decision Making in Race-Based and Sexual Orientation-Based Hate Crime Cases

Several constructs have been identified as relevant to the juror decision-making process in hate crime cases. However, there is a lack of research on the relationships between these constructs and their variable influence across victim group. The purpose of the current study was to reexamine factors relevant to the juror decision-making process in hate crime cases within a structural model, and across victim group, to gauge the relative strength and explanatory power of various predictors. In the current study, 313 participants sentenced a perpetrator found guilty of a hate crime committed against either a Black man or a gay man; participants also responded to individual difference measures relevant to mock juror hate crime decision making, including prejudice toward the victim's social group. Using path analysis, we explored the role of juror prejudice on sentencing decisions in hate crime cases as well as similarities and differences based on the victimized group. Results indicated that, when the victim was a Black man, modern racism influenced sentencing both directly and indirectly through perpetrator blame attributions, explaining 18% of the variance in sentencing. In contrast, when the victim was a gay man, modern homophobia did not directly predict sentencing, and the overall model explained only 4% of the variance in sentencing, suggesting variables beyond juror prejudice may be better suited to explain juror decision making in sexual orientation-based hate crimes. The current study suggests that the role of juror prejudice in hate crime cases varies as a function of the victimized group and raises questions about the importance of juror prejudice in the sentencing of hate crime cases, particularly antigay prejudice. The importance of blame attributions, social dominance orientation, and juror beliefs regarding penalty enhancements for hate crime cases, as well as policy implications, are also addressed.

Using Scenarios for Measuring the Affective and Behavioral Components of Attitudes Toward Lesbians and Gay Men: Validation of the SABA Scale

Attitude-change research requires sound attitude measures adequately predicting behavior. Most existing attitude measures focus on the cognitive (and some on the affective) attitude component (while neglecting the behavioral component). The present research introduces the SABA, a brief scale that consists of Scenarios measuring the Affective and Behavioral components of Attitudes toward lesbians and gay men. In two studies with student and non-student samples (n₁ = 66, n₂ = 202), we developed a 25-item scale and reduced it by performing exploratory factor analysis. Confirmatory factor analysis yielded two factors (affective and behavioral) for each version (SABA-L for attitudes toward lesbians, SABA-G for attitudes toward gay men). The reduced scales each contained five scenarios showing good reliability. High convergent validity and discriminant validity were shown using explicit and implicit attitude measures in a multitrait-multimethod analysis. Further, SABA scores correlated with the Modern Homonegativity Scale (MHS) and the Attitudes Toward Lesbians (ATL) and Gay Men Scale (ATG), but-as predicted-not with social anxiety and the Homopositivity Scale. The SABA's criterion and incremental validity were demonstrated in predicting attitude-related behavior better than the MHS. SABA scores showed established associations and differences in antigay attitudes based on age, religiousness, male role norms, authoritarianism, openness (SABA-G only), and sexual orientation, confirming (known-group) validity. Further, the SABA correlated less with the motivation to act without prejudice than the MHS, the ATL, and the ATG. Thus, outperforming existing attitude scales, the SABA appears to be a psychometrically sound instrument to measure attitudes toward lesbians and gay men.

The Transgender Identity Survey: A Measure of Internalized Transphobia

Purpose: We describe the development of a measure of internalized transphobia, defined as discomfort with one's transgender identity as a result of internalizing society's normative gender expectations. Methods: An item pool was created based on responses from a small clinical sample (N = 12) to an open-ended questionnaire. Expert judges reviewed the items, resulting in a 60-item instrument for empirical testing. We conducted exploratory factor analysis (EFA) by using a community sample of 430 transgender individuals (aged 18-72, mean [M] = 37.4, standard deviation [SD] = 12.0), and confirmatory factor analysis (CFA) by using an online sample of 903 transgender individuals (aged 18-66, M = 31.6, SD = 11.1). Construct validity was examined by using correlations with instruments assessing related constructs administered to the online sample. Results: EFA resulted in a 52-item instrument with four subscales: Pride, Passing, Alienation, and Shame. CFA, after removal of half of the items, retained the four-factor structure. The final 26-item scale showed excellent internal consistency (0.90) and test-retest reliability (0.93). The factors showed a pattern of association with crossgender identity, gender ideology, outness, felt stigma, self-esteem, and psychological distress consistent with moderate-to-good construct validity. Conclusion: Internalized transphobia can be conceptualized as four inter-related dimensions: pride in transgender identity (reverse scored), investment in passing as a cisgender person, alienation from other transgender people, and shame. The Transgender Identity Survey reliably assesses this construct, useful in research to understand the impact of minority stress on transgender people's health. It can also be used in clinical practice to assess internalized transphobia at intake and follow-up.

Evidence of Validity of a Modern Homonegativity Measure against Gays and Lesbians

Abstract The goal of this research was to adapt and obtain validity evidence of the Modern Homonegativity Scale (MHS), which is set by two parallel forms with 12 items, one of them referring to gays (MHS-G) and the other referring to lesbians (MHS-L). In the first study 418 heterosexuals between 18 and 58 years old (M = 24,9; SD = 7,23), mostly women (66,3%) living at João Pessoa-PB (50,5%) answered. Both scales have shown as unidimensional and containing a high degree of internal consistency. The second study had the participation of 273 heterosexuals between 18 and 55 years old (M = 23,7; SD = 6,33), mostly women (69%). The confirmatory factor analysis showed satisfactory adjustment indexes for the proposed model and the Item Response Theory (IRT) demonstrated a good degree of discrimination and variation of the difficulty parameters. Therefore, we may conclude MHS is psychometrically valid, easily applicable and can be used in research contexts.

"We're Disgusted With Queers, not Fearful of Them": The Interrelationships Among Disgust, Gay Men's Sexual Behavior, and Homonegativity

Using a combination of personal reflections, published literature, and original empirical research, we argue that the disgust triggered by gay men's sexual practices (specifically, anal intercourse) is a critical, though overlooked, contributor to heterosexual men and women's homonegativity (i.e., negative attitudes and behaviors directed toward men who are or are perceived to be gay). We conclude our article by articulating several directions for future inquiry that we believe will advance current understanding of prejudice and discrimination directed toward gay men.

Immigrants’ Attitudes toward Homosexuality: Socialization) Religion, and Acculturation in European Host Societies

With increasing diversity of migrants in Europe, questions around cultural integration are gaining importance. This study focuses on attitudes towards homosexuality amongst first and second generation immigrants from 186 origin countries to examine the role of religion, origin country socialization and acculturation. There is clear evidence for intra- and intergenerational acculturation of attitudes with declining importance of origin country context. While individual characteristics of migrants and origin country context can explain a substantial part of religious group differences particularly amongst the first generation, Muslims and to a lesser extent other non-Christian and Eastern Orthodox migrants hold overall more negative attitudes.

Examining the Conditions Under Which Internalized Homophobia Is Associated with Substance Use and Condomless Sex in Young MSM: the Moderating Role of Impulsivity

BACKGROUND

Internalized homophobia (IH) is the internalization of homophobic attitudes by sexual minorities due to social bias. IH has been inconsistently related to substance use and condomless sex for young men who have sex with men (YMSM).

PURPOSE

We examined negative urgency (the tendency to act impulsively in response to negative emotional experiences), positive urgency (the tendency to act impulsively in response to positive emotional experiences), and sensation seeking as independent moderators of the association of IH with binge drinking, drug use, and condomless anal sex.

METHODS

Data were collected from 450 YMSM (mean age = 18.9) over the course of 18 months (baseline, 6-, 12-, and 18-month follow-up).

RESULTS

Hierarchical generalized linear modeling revealed that there was a significant moderation for binge drinking and receptive condomless anal sex, with the association between IH and these risk behaviors increased for those with higher levels of negative urgency and positive urgency.

CONCLUSIONS

IH is important to the negative health outcomes of binge drinking and condomless anal sex for individuals high in negative and/or positive urgency, who may act impulsively to avoid subjective negative experiences or in the face of positive emotional experiences. Future research is needed to further establish additional conditions under which IH may be important to understanding risk behaviors in YMSM, which is essential to developing targeted prevention and intervention efforts.

The English Version of the Attitudes Toward Homosexuality Scale

Abstract. The present study reports the psychometric properties of the English version of the short form of the Attitudes Toward Homosexuality Scale (ATHS; Falomir-Pichastor & Mugny, 2009 ). Workers from Amazon’s MTurkTM (n = 235 for validation, n = 60 for test-retest) completed the short form of the ATHS, translated from French, and the Attitudes Toward Lesbians and Gay Men Scale (ATLG; Herek, 1998 ) and responded to a series of demographic questions. In this paper, we present evidence for a single-factor structure of the scale, along with evidence for the validity, internal consistency, and test-retest reliability of the measure. The data revealed distinct patterns in participants’ ATHS scores as a function of their religious affiliation and political conservatism. Finally, positive ATHS scores predicted support for gay rights over and above that predicted by ATLG scores ( Herek, 1984 ). The evidence presented suggests that the ATHS is a psychometrically reliable and valid tool for assessing attitudes toward homosexuality.

Somali American female refugees discuss their attitudes toward homosexuality and the gay and lesbian community

Minnesota is home to the largest population of Somalis in the USA - most arriving as refugees from the civil war in Somalia. As Somali Americans adjust to life in the USA, they are likely to undergo shifts in their belief systems - including changes in their attitudes toward gays and lesbians. We examined the attitudes of 29 Somali American women in the Minneapolis-St. Paul metropolitan area toward homosexuality via face-to-face, semi-structured interviews. Transcripts were translated, transcribed and analysed using an approach informed by grounded theory. Three major themes were identified: (1) Islamic prohibitions against homosexuality; (2) homosexuals exiled to a hidden community; and (3) community members exploring tolerance. Participants' attitudes toward homosexuality were heavily influenced by religious doctrines and cultural contexts. This is the first known study in the USA of Somali American attitudes toward gays and lesbians. As people mass migrate from nations with negative attitudes toward homosexuality to countries with more progressive attitudes toward varied sexual orientations, refugee attitudes about homosexuality will undergo change. Through research and education, we can better understand how to increase tolerance toward and opportunities for visibility among gay and lesbian refugees throughout the diaspora.

Sociocultural and individual manifestations of sexual stigma: The role of political ideology and prejudice in discrimination against sexual minorities

Understanding the complex manifestations of sexual stigma is crucial in helping to prevent discrimination toward sexual minorities. In this research, we examined the role of heterosexism within political ideology systems and the process through which these systems promote discrimination by focusing on sexual prejudice. Across four studies, we tested the predictions that more conservative political ideologies and greater levels of sexual prejudice will be associated with more negative evaluations of an applicant with a sexual stigma, and that prejudice will mediate the link between ideology and evaluation. We employed an experimental paradigm such that participants were presented nearly identical information in an intern applicant evaluation context, however, cues to sexual stigma were either present or absent. Overall, conservative ideology negatively predicted evaluation in the stigma, but not the control, condition and greater levels of sexual prejudice more strongly negatively predicted evaluations in the stigma, relative to control, condition. Finally, whereas ideology indirectly predicted candidate evaluation through prejudice generally, the effect was stronger for the applicant with the sexual stigma. This research extends the scholarship linking ideology to sexual stigma by examining employment discrimination and testing the mediating role of prejudice linking ideology to discrimination. By examining the role of ideology, it also broadens the research on bias in employment contexts. Understanding the role of both political ideology as well as individual sexual prejudice in discrimination may facilitate efforts to dismantle discrimination.

Trajectories of Internalized Heterosexism among Young Men Who have Sex with Men

Minority stress, or the unique stressors encountered by sexual minorities, has a significant impact on the mental health and well-being of this population. One minority stressor, internalized heterosexism, refers to incorporating stigma against sexual minorities into one's self-concept as a product of social bias. This minority stressor has been consistently related to worse mental health in sexual minorities. We evaluated experiences of internalized heterosexism longitudinally, over 24 months, in a sample of 450 young men who have sex with men (YMSM; age range = 16-20 years old at baseline). Latent class growth analyses revealed three classes: individuals with low-decreasing internalized heterosexism (57.1%), medium-stable internalized heterosexism (37.3%), and high-stable internalized heterosexism (5.6%). Multinomial logistic regression analyses revealed that some racial/ethnic minorities, non-gay identified individuals (i.e., bisexual/other), and individuals with less femininity and greater masculinity were significantly more likely to be in the medium- and high-stable internalized heterosexism classes. Higher victimization, as well as lower gay/bisexual community involvement, peer support, and outness predicted membership in the medium-stable internalized heterosexism class (relative to the low-decreasing class). Further, higher past 6-month victimization and lower outness were also predictive of high-stable internalized heterosexism class membership (relative to the low-decreasing class). These findings reveal that there is not a single trajectory of internalized heterosexism-the degree to which it changes differs across men and depends on demographic characteristics and interpersonal experiences. Furthermore, the results indicate interpersonal targets for future work aimed at promoting positive identity development and decreased internalized heterosexism for sexual minority youth.

Measuring stigma affecting sex workers (SW) and men who have sex with men (MSM): A systematic review

Background

Stigma involves discrediting a person or group based on a perceived attribute, behaviour or reputation associated with them. Sex workers (SW) and men who have sex with men (MSM) are key populations who are often at increased risk for the acquisition and transmission of HIV and who are affected by stigma that can negatively impact their health and well-being. Although stigma was included as an indicator in the US National HIV/AIDS Strategic Plan and there have been consultations focused on adding a stigma indicator within PEPFAR and the Global Fund in relation to potentiating HIV risks among key populations, there remains limited consensus on the appropriate measurement of SW- or MSM-associated stigma. Consequently, this systematic review summarizes studies using quantitative, qualitative, or mixed methods approaches to measure stigma affecting sex workers and men who have sex with men.

Methods and findings

This systematic review included English, French, and Spanish peer-reviewed research of any study design measuring SW- or MSM-associated stigma. Articles were published from January 1, 2004 to March 26, 2014 in PsycINFO, PubMed, EMBASE, CINAHL Plus, Global Health, and World Health Organization Global Health Library Regional Indexes.

Of the 541 articles reviewed, the majority measured stigma toward MSM (over 97%), were conducted in North America, used quantitative methods, and focused on internalized stigma.

Conclusions

With the inclusion of addressing stigma in several domestic and international HIV strategies, there is a need to ensure the use of validated metrics for stigma. The field to date has completed limited measurement of stigma affecting sex workers, and limited measurement of stigma affecting MSM outside of higher income settings. Moving forward requires a concerted effort integrating validated metrics of stigma into health-related surveys and programs for key populations.

Scrutinizing Homophobia: A Model of Perception of Homosexuals in Russia

We aimed to develop and validate a model of associations of perceived threat of homosexuals with lay beliefs about causes of homosexuality, group entitativity of homosexuals, approval of social action strategies targeting homosexuals, and support for their rights using original Russian-language measures. We tested the model in two samples of social network users (n = 1,007) and student respondents (n = 292) using structural equation modeling and path analysis. Attribution of homosexuality to social causes was a positive predictor of perceived threat of homosexuals, whereas biological causes showed an inverse effect. Perceived threat predicted approval of discriminatory strategies targeting homosexuals and lack of support for their rights and fully mediated the effects of causal beliefs on these variables. Group entitativity of homosexuals was a positive predictor of perceived threat and a significant moderator of its effects on support for punishment and medical treatment of homosexuals. We discuss the findings with reference to the Russian social context.

Attitudes Toward Homosexuality in Adolescence: An Italian Study

This study investigates Italian adolescents' attitudes toward gay men and lesbians and same-sex marriage, and their beliefs about the origins of homosexuality. The sample consists of 449 subjects (226 males), aged between 14 and 21 years. The principal instruments used are: the Attitudes Toward Lesbians and Gay men (ATLG), the Modern Homonegativity Scale (MHS), and the Attitudes Toward Same-Sex Marriage (ATSM). Results suggest that males show a more negative attitude than females toward homosexuals. Furthermore data reveal that respondents with a lack of personal direct contact with gay people have less positive attitudes toward homosexual people and same-sex marriage. The data in this study suggest that homophobia could be deeply rooted in a traditional value system that refutes gender equality.

Internalized Homophobia and Perceived Stigma: A Validation Study of Stigma Measures in a Sample of Young Men who Have Sex with Men

Young men who have sex with men (YMSM) experience minority stressors that impact their mental health, substance use, and sexual risk behaviors. Internalized homophobia (IH) and perceived stigma represent two of these minority stressors, and there has been limited research empirically validating measures of these constructs. We validated measures of IH and perceived stigma with a sample of 450 YMSM (mean age=18.9) and a sample of 370 YMSM (mean age=22.9). Results from exploratory and confirmatory factor analyses supported modifications to the IH and perceived stigma scales, ultimately revealing a three factor and one factor structure, respectively. Convergent and discriminant validity were examined utilizing correlations between IH, perceived stigma, and other variables related to minority stress (e.g., victimization). We evaluated predictive validity by examining relations with mental health, substance use, and risky sexual behaviors measured 12-months from baseline. There were mixed findings for IH, with subscales varying in their relations to mental health, drinking, and sexual risk variables. Perceived stigma was not related to mental health or substance use, but was associated with greater prevalence of STIs. Findings supported the use of these modified scales with YMSM and highlight the need for further measurement studies.

[A Brief Homophobia Scale in Medical Students From Two Universities: Results of A Refinement Process]

BACKGROUND

The process of evaluating measurement scales is an ongoing procedure that requires revisions and adaptations according to the characteristics of the participants. The Homophobia Scale of seven items (EHF-7) has showed acceptable performance in medical students attending to two universities in Colombia. However, performance of some items was poor and could be removed, with an improvement in the psychometric findings of items retained.

OBJECTIVE

To review the psychometric functioning and refine the content of EHF-7 among medical students from two Colombian universities.

METHODS

A group of 667 students from the first to tenth semester participated in the research. Theirs ages were between 18 and 34 (mean, 20.9±2.7) years-old, and 60.6% were females. Cronbach alpha (α) and omega of McDonald (Ω) were calculated as indicators of reliability and to refine the scale, an exploratory (EFA) and confirmatory factor analysis (CFA) was performed.

RESULTS

EHF-7 showed α=.793 and Ω=.796 and a main factor that explained 45.2% of the total variance. EFA and CFA suggested the suppression of three items. The four-item version (EHF-4) reached an α=.770 and Ω=.775, with a single factor that accounted for 59.7% of the total variance. CFA showed better indexes (χ²=3.622; df=1; P=.057; Root-mean-square error of approximation (RMSEA)=.063, 90% CI, .000-.130; Comparative Fit Indices (CFI)=.998; Tucker-Lewis Index (TLI)=.991).

CONCLUSIONS

EHF-4 shows high internal consistency and a single dimension that explains more than 50% of the total variance. Further studies are needed to confirm these observations, that can be taken as preliminary.

Cross-cultural and socio-demographic correlates of homophobic attitude among university students in three European countries

PURPOSE

The aim of this study was to investigate homophobic attitudes in three European countries: Italy, Albania, and Ukraine. One thousand and forty-eight students were recruited in Italian (n = 766), Albanian (n = 180), and Ukrainian (n = 102) university centers.

METHODS

A socio-demographic questionnaire and Homophobia Scale (HS) were administered by our staff.

RESULTS

Cross-cultural and significant differences among Italian, Albanian, and Ukrainian students were found on the Homophobia Scale (HS; Italy: mean = 22.26 ± 16.73; Albania: mean = 38.15 ± 17.28; Ukraine: mean = 59.18 ± 16.23). The analysis of socio-demographic characteristics revealed that the male gender emerged as main predictor of homophobic attitude in all the three countries, although also a conservative political orientation and the religious belief predict higher homophobia levels in Italy and Albania, particularly.

CONCLUSIONS

This study revealed that in these European countries assessed, attitudes toward homosexuality are different. Ukrainians display higher levels of homophobia than Albanians and Italians, confirming the central role of cultural differences in homophobic attitudes. Nevertheless, some socio-demographic aspects such as identification as male have a similar influence on homophobic attitudes in all assessed populations.

Validation Study of the Revised Version of the Scale of Prejudice Against Sexual and Gender Diversity in Brazil

In Brazil, there is a deficit of culturally adapted tools to assess prejudice against sexual and gender diversity with empirically demonstrable validity and reliability. Prejudice against non-heterosexual orientations is a strong problem within Brazilian culture and is particularly related to nonnormative expressions of gender. To address these issues, a scale was created. The objective of this article is to validate the revised version of this instrument developed for the specificities of Brazilian culture and establish its reliability. The revised version of Scale of Prejudice Against Sexual and Gender Diversity (PASGD) was completed by 8,184 undergraduate students from southern Brazil. Analysis was conducted using the item response theory (IRT) model for rating scale data, criterion validity, and confirmatory factor analysis (CFA). The scale showed good validity and reliability. The results indicate that the PASGD is a useful tool for assessing prejudice in the Brazilian context, adapted for the local Brazilian reality.

The Impact of Victimization and Neuroticism on Mental Health in Young Men who have Sex with Men: Internalized Homophobia as an Underlying Mechanism

Sexual minorities experience greater mental health issues compared to heterosexuals due to minority stressors. This study focused on the impact of victimization and neuroticism on mental health in young men who have sex with men (YMSM), and the mediating role of internalized homophobia (IH). IH refers to when a sexual minority person internalizes social bias and develops a negative view of themselves, which is a likely process through which victimization and neuroticism impact mental health. Data were collected over three time points across 12 months, with 450 YMSM (mean age = 18.9) and an 80.7% retention rate. Two mediation analyses with bias-corrected bootstrapping using 1000 samples were conducted, controlling for age, race, and sexual orientation. Results revealed that victimization [F (9, 440) = 4.83, p < .001, R² = .09] and neuroticism [F (9, 440) = 12.23, p < .001, R² = .20] had a significant indirect effect on mental health via increased levels of IH. These findings show how external experiences of stigma and personality level characteristics may impact YMSM in terms of their sense of self. Furthermore, these results support addressing social conditions that marginalize YMSM in order to promote better mental health through decreasing IH.

Italian Validation of Homophobia Scale (HS)

Introduction

The Homophobia Scale (HS) is a valid tool to assess homophobia. This test is self-reporting, composed of 25 items, which assesses a total score and three factors linked to homophobia: behavior/negative affect, affect/behavioral aggression, and negative cognition.

Aim

The aim of this study was to validate the HS in the Italian context.

Methods

An Italian translation of the HS was carried out by two bilingual people, after which an English native translated the test back into the English language. A psychologist and sexologist checked the translated items from a clinical point of view. We recruited 100 subjects aged18–65 for the Italian validation of the HS. The Pearson coefficient and Cronbach's α coefficient were performed to test the test–retest reliability and internal consistency.

Main Outcome Measures

A sociodemographic questionnaire including the main information as age, geographic distribution, partnership status, education, religious orientation, and sex orientation was administrated together with the translated version of HS.

Results

The analysis of the internal consistency showed an overall Cronbach's α coefficient of 0.92. In the four domains, the Cronbach's α coefficient was 0.90 in behavior/negative affect, 0.94 in affect/behavioral aggression, and 0.92 in negative cognition, whereas in the total score was 0.86. The test–retest reliability showed the following results: the HS total score was r = 0.93 (P < 0.0001), behavior/negative affect was r = 0.79 (P < 0.0001), affect/behavioral aggression was r = 0.81 (P < 0.0001), and negative cognition was r = 0.75 (P < 0.0001).

Conclusions

The Italian validation of the HS revealed the use of this self-report test to have good psychometric properties. This study offers a new tool to assess homophobia. In this regard, the HS can be introduced into the clinical praxis and into programs for the prevention of homophobic behavior.