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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12939-017-0530-1) contains supplementary material, which is available to authorized users.