Internalized Homonegativity: The psychometric structure of the short scale and HIV/SIT associated behaviors

Internalized Homonegativity (IH) is defined as the internalization of negative attitudes and assumptions about homosexual people by homosexuals themselves leading to feelings of guilt, inferiority and lack of self-worth. Among different scales to measure IH, only the revised short internalized homonegativity scale (SIHS) developed by Smolenski et al., 2010 was confirmed to be appropriate across population strata of race/ethnicity and languages in the North America self-identified Latino Men-who-have-sex-with-men (MSM) population and in a Uganda MSM population. In this study, we continued to validate this SIHS in multiple European MSM populations to demonstrate the applicability of this measure in multiple MSM populations across 38 European countries. We also applied the latent variable analysis to assess the associations between IH (mean score and factorial structure) with structure variables and HIV/STI associated factors.^ The employed data in this study was the European MSM internet survey, the largest internet self-completion MSM survey ever conducted with 38 promotion countries and 184, 469 participants. Eight items of the SIHS were measured by a 7-point Likert score. By using Confirmatory Factor Analysis, IH structure was confirmed in both the training and testing data. The SIHS\u27s configural invariance, scalar invariance, residual invariance, and structural invariance were assessed across training and testing data, and across age, education, and country subgroups. The path analysis using IH means score of 8 items and the structural equation modeling (SEM) using confirmed SIHS were also applied to assess the associations between IH and structure variables and HIV/STI associated factors. The invariance measurement was additionally used to identify the appropriateness of the SEM model across population strata.^ We found a good fit of the SIHS in the EMIS data. The measurement invariance tests showed the partly invariance with the inequality of several intercepts and residual variance of items across \u22homosexual discrimination\u22 country clusters, and across age strata. The association of IH and structure variables and risk sexual behavior investigated by Ross et al., 2013 was revised. The associations of IH and HIV/STI associated behaviors were also investigated in path and SEM analyses.^ In conclusion, this study validated the SIHS scale for future research and identified the associations between IH and structural variables, HIV/STIs related behaviors for planning and implementing strategies of HIV/STIs prevention programs.