Archives of Sexual Behavior

, Volume 46, Issue 5, pp 1491–1502 | Cite as

The Geography of Sexual Orientation: Structural Stigma and Sexual Attraction, Behavior, and Identity Among Men Who Have Sex with Men Across 38 European Countries

  • John E. Pachankis
  • Mark L. Hatzenbuehler
  • Massimo Mirandola
  • Peter Weatherburn
  • Rigmor C. Berg
  • Ulrich Marcus
  • Axel J. Schmidt
Original Paper

Abstract

While the prevalence of sexual identities and behaviors of men who have sex with men (MSM) varies across countries, no study has examined country-level structural stigma toward sexual minorities as a correlate of this variation. Drawing on emerging support for the context-dependent nature of MSM’s open sexual self-identification cross-nationally, we examined country-level structural stigma as a key correlate of the geographic variation in MSM’s sexual attraction, behavior, and identity, and concordance across these factors. Data come from the European MSM Internet Survey, a multi-national dataset containing a multi-component assessment of sexual orientation administered across 38 European countries (N = 174,209). Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes toward sexual minorities held by the citizens of each country. Results demonstrate that in more stigmatizing countries, MSM were significantly more likely to report bisexual/heterosexual attractions, behaviors, and identities, and significantly less likely to report concordance across these factors, than in less stigmatizing countries. Settlement size moderated associations between country-level structural stigma and odds of bisexual/heterosexual attraction and behavior, such that MSM living in sparsely populated locales within high-structural stigma countries were the most likely to report bisexual or heterosexual behaviors and attractions. While previous research has demonstrated associations between structural stigma and adverse physical and mental health outcomes among sexual minorities, this study was the first to show that structural stigma was also a key correlate not only of sexual orientation identification, but also of MSM’s sexual behavior and even attraction. Findings have implications for understanding the ontology of MSM’s sexuality and suggest that a comprehensive picture of MSM’s sexuality will come from attending to the local contexts surrounding this important segment of the global population.

Keywords

Sexual orientation Stigma Minority stress Men who have sex with men Male bisexuality 

Notes

Acknowledgments

We begin by thanking all of the men who took part in EMIS 2010. We also thank the more than 235 websites who placed the EMIS banner, and particularly to those who sent individual messages to their users: PlanetRomeo, Manhunt, Qruiser, Qguys, and Gaydar. We also thank all NGOs who promoted the survey. This research was made possible by The EMIS Network. EMIS Associated Partners: DE: GTZ, Robert Koch Institute; ES: Centre de Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCat); IT: Regional Centre for Health Promotion Veneto; NL: University College Maastricht; UK: Sigma Research, London School of Hygiene & Tropical Medicine. EMIS Collaborating Partners: AT: Aids-Hilfe Wien; BE: Institute of Tropical Medicine, Facultés Universitaires Saint-Louis, Ex Aequo, Sensoa, Arc-en-ciel Wallonie; BG: National Centre of Infectious and Parasitic Diseases, Queer Bulgaria Foundation; BY: Vstrecha; CH: Institut universitaire de medicine sociale et préventive, Aids-Hilfe Schweiz; CY: Research Unit in Behaviour & Social Issues; CZ: Charles University (Institute of Sexology), Ceska spolecnost AIDS pomoc; DE: Berlin Social Science Research Center (WZB), Deutsche AIDS-Hilfe; Federal Centre for Health Education (BZgA); DK: Statens Serum Institut, Department of Epidemiology, STOP AIDS; ES: National Centre of Epidemiology, stopsida, Ministry of Health, Social Policy and Equality; EE: National Institute for Health Development; FI: University of Tampere (Nursing Science), HIV-saatio/Aids-tukikeskus; FR: Institut de veille sanitaire (InVS), AIDeS, Act Up Paris, Sida Info Service, Le Kiosque, The Warning; GR: Positive Voice; HR: University of Zagreb (Humanities and Social Sciences); HU: Hungarian Civil Liberties Union (TASZ), Háttér; IE: Gay Men’s Health Service, Health Services Executive; IT: University of Bologna, Arcigay, Instituto Superiore di Sanità; LT: Center for Communicable Diseases and AIDS; LV: The Infectiology Center of Latvia; Mozaika; MD: GenderDoc-M; MK: Equality for Gays and Lesbians (EGAL); NL: schorer; NO: Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health; PL: National AIDS Centre, Lambda Warszawa; PT: GAT Portugal, University of Porto (Medical School), Institute of Hygiene and Tropical Medicine; RO: PSI Romania RS: Safe Pulse of Youth; RU: PSI Russia, LaSky; SE: Malmö University, Riksforbundet for homosexuellas, bisexuellas och transpersoners rattigheter (RFSL); SI: National Institute of Public Health, Legebitra, ŠKUC-Magnus, DIH; SK: OZ Odyseus; TR: Turkish Public Health Association, KAOS-GL, Istanbul LGBTT, Siyah Pembe Ucgen Izmir; UA: Gay Alliance, Nash Mir, LiGA Nikolaev; UK: City University, London, CHAPS (Terrence Higgins Trust); EU: ILGA-Europe, Aids Action Europe, European AIDS Treatment Group, PlanetRomeo, Manhunt & Manhunt Cares. EMIS Advisory Partners: Executive Agency for Health and Consumers (EAHC), European Centre for Disease Prevention and Control (ECDC), WHO-Europe.

Funding

EMIS was funded by grants from the Executive Agency for Health and Consumers (EU Health Programme 2008–2013); Centre dEstudis Epidemiológics sobre les ITS HIV/SIDA de Catalunya (CEEISCat); Terrence Higgins Trust for the CHAPS partnership; Regione de Veneto; Robert Koch Institute; Maastricht University; German Ministry of Health; Finnish Ministry of Health; Norwegian Institute of Public Health; and the Swedish Board of Health and Welfare. Dr. Hatzenbuehler’s contribution to this analysis was partly funded by the National Institute on Drug Abuse (K01 DA032558).

Author’s Contributions

The survey was designed and executed by AJS, UM, and PW in association with The EMIS Network (see Acknowledgements). AJS coordinated the study, PW coordinated the survey promotion, and UM initiated the study. Data were prepared and coded by FH and AJS. JP and MH designed the analysis with suggestions from MM and AJS. JP and MH conducted the statistical analyses. The article was drafted by JP and MH and co-authored by all other authors. All authors approved the final article.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

References

  1. Amirkhanian, Y. A., Kelly, J. A., & Issayev, D. D. (2001). AIDS knowledge, attitudes, behaviour in Russia: Results of a population-based, random-digit telephone survey in St Petersburg. International Journal of STD and AIDS, 12(1), 50–57.CrossRefPubMedGoogle Scholar
  2. Andersen, R., & Fetner, T. (2008). Cohort differences in tolerance of homosexuality attitudinal change in Canada and the United States, 1981–2000. Public Opinion Quarterly, 72(2), 311–330.CrossRefGoogle Scholar
  3. Baumeister, R. F. (2000). Gender differences in erotic plasticity: The female sex drive as socially flexible and responsive. Psychological Bulletin, 126(3), 347–374.CrossRefPubMedGoogle Scholar
  4. Baumeister, R. F. (2004). Gender and erotic plasticity: Sociocultural influences on the sex drive. Sexual and Relationship Therapy, 19(2), 133–139.CrossRefGoogle Scholar
  5. Baumgartner, S. E., Sumter, S. R., Peter, J., Valkenburg, P. M., & Livingstone, S. (2014). Does country context matter? Investigating the predictors of teen sexting across Europe. Computers in Human Behavior, 34, 157–164.CrossRefGoogle Scholar
  6. Berg, R. C., Ross, M. W., Weatherburn, P., & Schmidt, A. J. (2013). Structural and environmental factors are associated with internalised homonegativity in men who have sex with men: Findings from the European MSM Internet Survey (EMIS) in 38 countries. Social Science and Medicine, 78, 61–69.CrossRefPubMedGoogle Scholar
  7. Bränström, R., Pachankis, J. E., Hatzenbuehler, M. L., & Link, B. (2016). Sexual orientation disparities in preventable morbidity: A fundamental cause perspective. Unpublished manuscript. Karolinska Institute, Stockholm, Sweden.Google Scholar
  8. Brown-Saracino, J. (2015). How places shape identity: The origins of distinctive LBQ identities in four small US cities. American Journal of Sociology, 121(1), 1–63.CrossRefGoogle Scholar
  9. Calzo, J. P., Antonucci, T. C., Mays, V. M., & Cochran, S. D. (2011). Retrospective recall of sexual orientation identity development among gay, lesbian, and bisexual adults. Developmental Psychology, 47(6), 1658–1673.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Choi, K. H., Gibson, D. R., Han, L., & Guo, Y. (2004). High levels of unprotected sex with men and women among men who have sex with men: A potential bridge of HIV transmission in Beijing, China. AIDS Education and Prevention, 16(1), 19–30.CrossRefPubMedGoogle Scholar
  11. Colby, D. J. (2003). HIV knowledge and risk factors among men who have sex with men in Ho Chi Minh City, Vietnam. Journal of Acquired Immune Deficiency Syndromes, 32(1), 80–85.CrossRefPubMedGoogle Scholar
  12. DeLamater, J. (1981). The social control of sexuality. Annual Review of Sociology, 7, 263–290.CrossRefPubMedGoogle Scholar
  13. Diamond, L. M. (2008). Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44(1), 5–14.CrossRefPubMedGoogle Scholar
  14. Diez Roux, A. V. (2001). Investigating neighborhood and area effects on health. American Journal of Public Health, 91(11), 1783–1789.CrossRefPubMedPubMedCentralGoogle Scholar
  15. EMIS Network. (2013). EMIS 2010: The European Men-Who-Have-Sex-With-Men Internet Survey. Findings from 38 countries. Stockholm: European Centre for Disease Prevention and Control. http://www.emis-project.eu.
  16. Fine, M. (1988). Sexuality, schooling, and adolescent females: The missing discourse of desire. Harvard Educational Review, 58(1), 29–54.CrossRefGoogle Scholar
  17. Gagnon, J. H., & Simon, W. (2011). Sexual conduct: The social sources of human sexuality. New Brunswick, NJ: Transaction Publishers.Google Scholar
  18. Hatzenbuehler, M. L. (2011). The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics, 127(5), 896–903.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Hatzenbuehler, M. L., Bellatorre, A., Lee, Y., Finch, B. K., Muennig, P., & Fiscella, K. (2014). Structural stigma and all-cause mortality in sexual minority populations. Social Science and Medicine, 103, 33–41.CrossRefPubMedGoogle Scholar
  20. Hatzenbuehler, M. L., Keyes, K. M., & Hasin, D. S. (2009). State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. American Journal of Public Health, 99(12), 2275–2281.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Hatzenbuehler, M. L., & Link, B. G. (2014). Introduction to the special issue on structural stigma and health. Social Science and Medicine, 103, 1–6.CrossRefPubMedGoogle Scholar
  22. Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Herdt, G. (1996). Third sex, third gender. Beyond sexual dimorphism in culture and history. New York.Google Scholar
  24. International Lesbian, Gay, Bisexual, Trans, and Intersex Association Europe. (2010). Rainbow Europe Map and Country Index. http://www.ilga-europe.org/homepublications/reports_and_other_materialsrainbow_europe_map_and_country_index_may_2010. Accessed September 7, 2014.
  25. Keene, D. M., Eldahan, A. I., White-Hughto, J. M., & Pachankis, J. E. (2016). Sexual minority stigma, mobility, and health: The experiences of gay and bisexual men in two small cities. Unpublished manuscript. Yale University, New Haven, CT.Google Scholar
  26. Lambevski, S. A. (1999). Suck my nation: Masculinity, ethnicity and the politics of (homo) sex. Sexualities, 2(4), 397–419.CrossRefGoogle Scholar
  27. McClintock, M. K., & Herdt, G. (1996). Rethinking puberty: The development of sexual attraction. Current Directions in Psychological Science, 5, 178–183.CrossRefGoogle Scholar
  28. Michaels, S., & Lhomond, B. (2006). Conceptualization and measurement of homosexuality in sex surveys: A critical review. Cadernos de Saúde Pública, 22(7), 1365–1374.CrossRefPubMedGoogle Scholar
  29. Mock, S. E., & Eibach, R. P. (2012). Stability and change in sexual orientation identity over a 10-year period in adulthood. Archives of Sexual Behavior, 41(3), 641–648.CrossRefPubMedGoogle Scholar
  30. Oldenburg, C., Perez-Brumer, A., Hatzenbuehler, M., Krakower, D., Novak, D., Mimiaga, M., & Mayer, K. (2014). Structural stigma affects access to pre-and post-exposure prophylaxis and HIV risk among men who have sex with men (MSM) in the United States. AIDS Research and Human Retroviruses, 30(S1), A22–A23.CrossRefGoogle Scholar
  31. Oyserman, D., Smith, G. C., & Elmore, K. (2014). Identity-based motivation: Implications for health and health disparities. Journal of Social Issues, 70(2), 206–225.CrossRefGoogle Scholar
  32. Pachankis, J. E., Cochran, S. D., & Mays, V. M. (2015a). The mental health of sexual minority adults in and out of the closet: A population-based study. Journal of Consulting and Clinical Psychology, 83(5), 890–901.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Pachankis, J. E., Hatzenbuehler, M. L., Hickson, F., Weatherburn, P., Berg, R. C., Marcus, U., & Schmidt, A. J. (2015b). Hidden from health: Structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS, 29(10), 1239–1246.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Pachankis, J. E., Hatzenbuehler, M. L., & Starks, T. J. (2014). The influence of structural stigma and rejection sensitivity on young sexual minority men’s daily tobacco and alcohol use. Social Science and Medicine, 103, 67–75.CrossRefPubMedGoogle Scholar
  35. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (Vol. 1). Beverly Hills, CA: Sage.Google Scholar
  36. Risman, B., & Schwartz, P. (1988). Sociological research on male and female homosexuality. Annual Review of Sociology, 14, 125–147.CrossRefGoogle Scholar
  37. Rosenbluth, S. (1997). Is sexual orientation a matter of choice? Psychology of Women Quarterly, 21(4), 595–610.CrossRefGoogle Scholar
  38. Ross, M. W., Berg, R. C., Schmidt, A. J., Hospers, H. J., Breveglieri, M., Furegato, M., & Weatherburn, P. (2013). Internalised homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country cross-sectional study: Some public health implications of homophobia. BMJ Open, 3(2), e001928.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Savin-Williams, R. C. (1990). Gay and lesbian youth: Expressions of identity. New York: Hemisphere Publishing Corp.Google Scholar
  40. Savin-Williams, R. C. (2006). Who’s gay? Does it matter? Current Directions in Psychological Science, 15(1), 40–44.CrossRefGoogle Scholar
  41. Savin-Williams, R. C., & Diamond, L. M. (2000). Sexual identity trajectories among sexual minority youths: Gender comparisons. Archives of Sexual Behavior, 29(6), 607–627.CrossRefPubMedGoogle Scholar
  42. Savin-Williams, R. C., & Ream, G. L. (2007). Prevalence and stability of sexual orientation components during adolescence and young adulthood. Archives of Sexual Behavior, 36(3), 385–394.CrossRefPubMedGoogle Scholar
  43. Schmitt, D. P. (2005). Sociosexuality from Argentina to Zimbabwe: A 48-nation study of sex, culture, and strategies of human mating. Behavioral and Brain Sciences, 28(2), 247–275.PubMedGoogle Scholar
  44. Stein, E. (2001). The mismeasure of desire: The science, theory, and ethics of sexual orientation. New York, NY: Oxford University Press.Google Scholar
  45. Stephens-Davidowitz, S. (2014). Estimating the closeted gay male population. Future Perfect? Social Sciences in Public Health conference. Columbia University, New York, NY.Google Scholar
  46. Tolman, D. L., & Diamond, L. M. (2001). Desegregating sexuality research: Cultural and biological perspectives on gender and desire. Annual Review of Sex Research, 12, 33–74.PubMedGoogle Scholar
  47. Troiden, R. R. (1988). Gay and lesbian identity: A sociological analysis. Lanham, MD: Rowman & Littlefield.Google Scholar
  48. Twenge, J. M., Sherman, R. A., & Wells, B. E. (2015). Changes in American adults’ sexual behavior and attitudes, 1972–2012. Archives of Sexual Behavior, 44, 2273–2285.CrossRefPubMedGoogle Scholar
  49. Udry, J. R. (1988). Biological predispositions and social control in adolescent sexual behavior. American Sociological Review, 53, 709–722.CrossRefGoogle Scholar
  50. Udry, J. R., & Billy, J. O. (1987). Initiation of coitus in early adolescence. American Sociological Review, 52, 841–855.CrossRefGoogle Scholar
  51. Wade, A. S., Kane, C. T., Diallo, P. A. N., Diop, A. K., Gueye, K., Mboup, S., … Lagarde, E. (2005). HIV infection and sexually transmitted infections among men who have sex with men in Senegal. AIDS, 19(18), 2133–2140.Google Scholar
  52. Weatherburn, P., Schmidt, A. J., Hickson, F., Reid, D., Berg, R. C., Hospers, H. J., & Marcus, U. (2013). The European Men-Who-Have-Sex-with-Men Internet Survey (EMIS): Design and methods. Sexuality Research and Social Policy, 10(4), 243–257.CrossRefGoogle Scholar
  53. Weeks, J. (1985). Sexuality and its discontents: Myths, meanings, and modern sexualities. London: Routledge & Kegan Paul.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Chronic Disease Epidemiology, Social and Behavioral Sciences Division, Yale School of Public HealthYale UniversityNew HavenUSA
  2. 2.Department of Sociomedical Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  3. 3.Department of Pathology, Infectious Diseases SectionVerona University HospitalVeronaItaly
  4. 4.Department of Social and Environmental Health ResearchLondon School of Hygiene and Tropical MedicineLondonUK
  5. 5.Department of Community MedicineUniversity of TromsoTromsoNorway
  6. 6.Department of Infectious Disease EpidemiologyRobert Koch InstituteBerlinGermany

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