Internalized Heterosexism Among HIV-Positive, Gay-Identified Men: Implications for HIV Prevention and Care

Mallory O. Johnson, Adam W. Carrico, Margaret A. Chesney, Stephen F. Morin

Research output: Contribution to journalArticlepeer-review

70 Scopus citations


Internalized heterosexism (IH), or the internalization of societal antihomosexual attitudes, has been consistently linked to depression and low self-esteem among gay men, and it has been inconclusively associated with substance use and sexual risk in gay and bisexual men. Using structural equation modeling, the authors tested a model framed in social action theory (C. K. Ewart, 1991, 2004) in which IH is associated with HIV transmission risk and poor adherence to HIV antiretroviral therapy (ART) through the mechanisms of negative affect and stimulant use. Data from a sample of 465 gay-identified men interviewed as part of an HIV risk reduction behavioral trial were used to test the fit of the model. Results support the hypothesized model in which IH was associated with unprotected receptive (but not insertive) anal intercourse with HIV-negative or unknown HIV status partners, and with ART nonadherence indirectly via increased negative affect and more regular stimulant use. The model accounted for 15% of the variance in unprotected receptive anal intercourse and 17% of the variance in ART nonadherence. Findings support the potential utility of addressing IH in HIV prevention and treatment with HIV-positive gay men.

Original languageEnglish (US)
Pages (from-to)829-839
Number of pages11
JournalJournal of consulting and clinical psychology
Issue number5
StatePublished - Oct 2008
Externally publishedYes


  • adherence
  • depression
  • homophobia
  • methamphetamine

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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