You have full access to this open access article. We found no direct association between IH and sexual risk behaviour, nor did IH influence substance use during sex. Substance use during sex was significantly associated with sexual risk behaviour. Our results emphasize the continuing importance of prevention strategies focused on behavioural changes and community level interventions, especially targeting substance use.
Forty years into the epidemic, sex between men remains the predominant mode of HIV transmission in the countries of the European Economic Area, accounting for In Spain, new HIV diagnoses were reported in , with more than half These factors not only influence risk behaviours, but also directly limit options for accessing prevention services for HIV and other STIs and jeopardise prevention efforts Andrinopoulos et al.
Internalised Homonegativity IH , defined as negative feelings about one's homosexuality Herek, , is the product of social and political stigma and bias instead of a response which stems from within individuals. This has also been shown for European Berg et al.
Similar inconsistent research results exist regarding the relation between IH and drug use. Some researchers found that IH was associated with higher levels of drug use, whereas others found either no significant relation with drug use or negative associations Puckett et al. The effect of sexualized drug use on SRB has also been studied extensively.
Men with high level of IH are less likely to be involved in the gay community and likewise more isolated from getting informed about HIV prevention and risk reduction programs. Among gay and bisexual men Huebner et al. Huebner et al. Further, of the MSM who had heard about at least one service, IH was not a significant predictor for participation in these services, when controlled for education levels.
