The Relationship Between Homosexual Discrimination And Outness Among Men Who Have Sex With Men

Objective:The purpose of this study was to understand the status of homosexual discrimination,Internalized homophobia and coming out of the closet among MSM(Men who have sex with Men)in China.To analyzes the influence of homosexualy discrimination and Internalized homophobia on the coming-out behavior,and to explore the mediating mechanism on the coming-out behavior,so as to provide targeted theoretical basis for the improvement of various coming out behaviors among MSM.Methods:During the period from August 2017 to January 2018,using the combination of opportunity sampling and peer recommendation in different places(testing institutions,bars,parks,KTV.)of 4 cities(Wuhan,Yichang,Changsha,Nanchang.)to recruit respondents and questionnaire investigation.Finally the study recruited 810 respondents and recovered 749 valid questionnaires,33 of which were removed because they did not meet the standard of this study.The questionnaire collected socio-demographics(date of birth,household registration type,education level,occupation,monthly incoming,living status,etc.),status of coming out and psychosocial status(sexual orientation-related stigma,internalization discrimination).The software of Excel,SPSS22.0 and AMOS7.0 were used to data collation,descriptive analysis,univariate analysis,correlation analysis,path analysis and mediating effect analysis.The test level P < 0.05.Results:1.The general demographic status of respondents: The total of 716 MSM were included in this study.For all respondents,the range of age was 17-62 years old,with an average age of 27.4 ± 8.4 years old.Most of them were not students(72.6%),college degree and above(72.6%),and their parents’ education level was below college level(82.7%,88.5%),unmarried(84.4%),monthly income level of 1001-6000 yuan,62.7% reported drinking,31% reported smoking.2.The status of homosexual discrimination,internalized discrimination and outness:In this study,the ranged of homosexual discrimination score between 10 to 40,with an average score of 15.97±4.94;The ranged of internalized discrimination score between 8 to 32,with an average score of 13.93±5.69.58.1% of MSM self-reported outness,and the top three choices of outness were friends(49.3%),family(22.9%)and health care workers(13.1%).3.Analysis of influencing factors of outness: Multiple logistic regression analysis showed that occupation(non-student vs.student,overall OR=0.38,95%CI= 0.23-0.64,P<0.001;friend OR=0.39,95%CI=0.24-0.64,P<0.001)was related with overall(outness)and friends(outness),marriage history(Yes vs.No,overall OR=0.26,95%CI=0.15-0.47,P<0.001;friends OR = 0.17,95% CI = 0.08-0.35,P<0.001;family OR=0.25,95%CI=0.12-0.54,P<0.001)was related with overall(outness),friends(outness)and family(outness).After adjusting the general demographic characteristics,homosexual discrimination(overall AOR=0.96,95%CI=0.93-0.99,P<0.05;friend AOR=0.94,95%CI=0.91-0.98,P<0.01)was a risk factors of outness(overall,friends).Internalized discrimination(overall,AOR=0.88,95%CI=0.85-0.91;friends,AOR=0.89,95%CI=0.86-0.92;family,AOR=0.89,95%CI=0.86-0.93;medical staff,AOR=0.93,95%CI=0.88-0.97)was a risk factors of outness(overall,friend,family and health care workers).4.The mediating effect of homosexual discrimination on outness: For outness(overall),homosexual discrimination(β=-0.005,P=0.206)did not directly affect the outness behavior,but homosexual discrimination(β=0.245,P<0.001)could increase the internalized discrimination status,and higher internalized discrimination(β=-0.028,P<0.001)may reduce the possibility of outness(overall).The result shown that internalized discrimination could fully mediated the effects of homosexual discrimination and outness(overall).For outness(friend),homosexual discrimination(β=-0.010,P=0.008)could directly affect the outness behavior,homosexual discrimination(β= 0.245,P<0.001)could also increase the internalized discrimination status,and higher internalized discrimination(β=-0.025,P<0.001)may reduce the possibility of outness(friend).The result shown that internalized discrimination could partial mediated the effects of homosexual discrimination and outness(friend).For outness(family),homosexual discrimination(β=0.004,P=0.203)did not directly affect the outness behavior,but homosexual discrimination(β=0.245,P<0.001)could increase the internalized discrimination status,and higher internalized discrimination(β=-0.016,P<0.001)may reduce the possibility of outness(family).The result shown that internalized discrimination could fully mediated the effects of homosexual discrimination and outness(family).For outness(health care workers),homosexual discrimination(β=-0.016,P=0.462)did not directly affect the outness behavior,but homosexual discrimination(β=0.245,P<0.001)could increase the internalized discrimination status,and higher internalized discrimination(β=-0.007,P=0.002)may reduce the possibility of outness(health care workers).The result shown that internalized discrimination could fully mediated the effects of homosexual discrimination and outness(health care workers).Conclusions:1.Homophobic discrimination and internalized discrimination are common among the respondents,the older and marital history will aggravate the degree of discrimination.2.Nearly 60% of MSM had the experience of outness,but there was a huge difference in the proportion of outness.The percentage of outness is the highest among friends,while the percentage of outness is the lowest among medical staff.We needed to improve their outness among families and medical staff.3.We find that internalized discrimination has mediating effect and is different among different objects.Homosexual discrimination can reduce the occurrence of various outness behaviors by increasing the individual’s own internalization discrimination,but only when outness to friends,homosexual discrimination can directly affect the outness behavior.4.Among the discriminatory intervention measures for outness behavior,the older and married people should increase the intensity of intervention.In addition to maintaining the intervention measures for homosexual discrimination,the intervention for internalizing discrimination can also be used to improve the situation of outness behavior.