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The paper studies internalized homonegativity (IH) and its predictors among men who have sex with men (MSM) in 12 countries of Eastern Europe and Central Asia (EECA). Internalized homonegativity (sometimes called internal homophobia) is a negative attitude to own same-sex attractions. It arises when gays and other people with homosexual attractions interiorize predominant negative attitudes and assumptions about homosexuals and homosexuality. Internalized homonegativity is a significant factor of poorer health (including vulnerability to HIV infection), and lower inclusion in the community in Western countries. It remains highly understudied in post-Soviet countries, although there is a sufficient ground to suppose its higher prevalence here. Cross-sectional online survey of MSM was conducted in August–October, 2017. Convenience sample was recruited via dating apps and websites, other partner sites, and MSM-service organizations. Analytical sample size was 8239 respondents from Russia, Ukraine, Belarus, Kazakhstan, Kyrgyzstan, Estonia and Lithuania (which were merged), Armenia, Georgia, Azerbaijan, Macedonia, and Moldova. IH was measured by the 8-item Short Internalized Homonegativity Scale (SIHS) in all main languages of the countries. According to results of Cronbach's a test and multi-group confirmatory factor analysis, adaptation of SIHS showed satisfactory to good reliability, and partial scalar invariance across EECA. IH was not predominant in all countries' samples. However, average IH was significantly different by countries. That could be attributed to both sampling design and differences in societal homophobia. Results of structural equation modeling of SIHS predictors also varied between countries. However, in most countries IH was lower among self-identified gays, those who were more open about own homosexual attractions, and was less religious. The unexpected findings included negative associations between IH and higher education, and contradictory associations with age in some countries. Results showed that internalized homonegativity is a common and comparable phenomenon among MSM in Eastern Europe and Central Asia. Its prevalence is presumably different across the countries. IH relates, first of all, to own sexual orientation (gay, bi- etc.), and acknowledgement of own same-sex attractions. Also, the SIHS measure is good enough for use in further studies of male health and possibilities for LGBTIQ mobilization in the region.

AbstractIntroductionGay social networking apps have grown in popularity among men who have sex with men offering opportunities for rapid and confidential collection of vital data as well as social connection. The goal of our study was to explore factors associated with utilization of pre‐exposure prophylaxis (PrEP) and antiretroviral treatment (ART), and self‐reported undetectable viral load (UVL) using data collected by the gay social networking app Hornet.MethodsIn 2016, the Global Forum on MSM & HIV (MSMGF) partnered with Hornet, to support an educational initiative called Blue‐Ribbon Boys. One aspect of the initiative prompts Hornet users to answer a short series of yes‐no questions about their sexual health. Using survey responses, we evaluated factors associated with PrEP and ART use as well as self‐reported UVL by fitting separate multivariable generalized estimating equation models.ResultsIn total, 16,008 unique Hornet users started the survey, of which 12,126 (76%) provided sufficient data for analyses. Of the 10,774 HIV‐negative men, 13% reported PrEP use in the past year. PrEP use was associated with a recent sexually transmitted infection (STI) test or treatment (aOR = 2.19, CI = 1.49 to 3.21); and taking steps to protect oneself from HIV (aOR = 1.41, CI = 1.13 to 1.76). Among HIV‐positive Hornet users (n = 1243), ART use was associated with older age (each year increase aOR = 1.02, CI = 1.01 to 1.04), a recent STI test or treatment (aOR = 4.54, CI = 2.65 to 7.78); and awareness of unlikely HIV transmission with UVL (aOR = 1.53, CI = 1.03 to 2.26). UVL was associated with older age (each year increase aOR = 1.03, CI = 1.01 to 1.04), a recent STI test or treatment (aOR = 4.84, CI = 2.74 to 8.55), and awareness of unlikely HIV transmission with UVL (aOR = 1.98, CI = 1.37 to 2.85).ConclusionsStudy findings underscore the importance of STI testing and treatment as well as information about HIV transmissibility for encouraging PrEP and ART use. Our findings also reveal age disparities, which can undermine incidence reduction among gay men. Gay social networking apps can be effectively used for rapid data collection and sexual health promotion with men who have sex with men. STI testing and treatment programmes offer important opportunities for encouraging PrEP and ART use. Information about HIV transmissibility with consistent ART use should be incorporated into prevention messaging tailored to various age groups.

BACKGROUND: The coronavirus pandemic has necessitated a range of population-based measures in order to stem the spread of infection. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 control measures and interruptions to HIV prevention and treatment services for MSM. SETTING: Data for this study were collected between 16-Apr-2020 and 24-May-2020 as part of a COVID-19 Disparities Survey implemented by the gay social networking app, Hornet. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index: each country received a score (0–100) based on the number and strictness of nine indicators related to restrictions, closures, and travel bans. METHODS: We used a multilevel mixed-effects generalized linear model with Poisson distribution to assess the association between stringency of pandemic control measures and access to HIV services. RESULTS: A total of 10,654 MSM across 20 countries were included. 38% (3992/10396) reported perceived interruptions to in-person testing, 55% (5178/9335) interruptions to HIV self-testing, 56% (5171/9173) interruptions to PrEP, and 10% (990/9542) interruptions to condom access. For every ten-point increase in stringency, there was a 3% reduction in the prevalence of perceived access to in-person testing (aPR: 0·97, 95%CI: [0·96, 0·98]), a 6% reduction in access to self-testing (aPR: 0·94, 95%CI: [0·93, 0·95]), and a 5% reduction in access to PrEP (aPR: 0·95, 95% CI: [0·95, 0·97]). Among those living with HIV, 20% (218/1105) were unable to access their provider; 65% (820/1254) reported being unable to refill their treatment prescription remotely. CONCLUSION: More stringent responses were associated with decreased perceived access to services. To minimize increases in HIV-related morbidity and mortality, innovative strategies are needed to minimize ...