Comparison of the Influence of Internalized Homonegativity on Sexual Risk Behavior of Men Who Have Sex with Men in Spain and Turkey.

Objectives: This study aimed to understand how the association between internalized homonegativity (IH) and sexual risk behavior differed in Spain ( N  = 3,336) and Turkey ( N  = 550). Methods : We used multigroup structural equation modeling. Results : HIV and pre-exposure prophylaxis (PrEP) knowledge mediated the relationship between IH and sexual risk behavior among MSM in Spain, but not among men in Turkey. Higher HIV/PrEP knowledge was associated with higher sexual risk behavior among MSM in Spain, while among MSM in Turkey the association was in the opposite direction. Conclusions : The meaning of safe-sex may differ across contexts, and this should be taken into consideration when tailoring HIV prevention programs.