Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Sten Vermund

Second Advisor

Inci Yildirim


Human Immunodeficiency Virus (HIV) is highly preventable with the right resources. Nonetheless, young men who have sex with men (YMSM) face disproportionately high rates of HIV acquisition, indicating barriers to effective implementation of prevention strategies. To better understand these implementation barriers, this research explores the relationship between internalized homonegativity and HIV prevention outcomes with a focus on the mediating effect of sexual orientation disclosure to healthcare professionals among YMSM. The data used in this research were collected in a previous prospective cross-sectional study that enrolled YMSM seeking HIV prevention care in two U.S. cities ( Nashville, TN and Buffalo, NY) from 2019-2020. In this retrospective secondary analysis, data was analyzed to evaluate the differential relationship between Internalized Homonegativity(IH) and numerous HIV prevention outcomes (PrEP awareness, PrEP willingness, PrEP use, HIV testing in the past 3,6,12,24 months, drug use before sex, alcohol use before sex, condomless receptive anal sex with men, condomless insertive anal sex with men, and condomless sex with an HIV+ partner) by sexual orientation disclosure status. Among YMSM who disclosed, there was a negative association between IH and PrEP awareness. Among YMSM who did not disclose, a positive association was observed between IH and both condomless receptive anal sex (CRAS) and condomless insertive anal sex (CIAS) . There was no significant relationship between IH and Sexual Orientation Disclosure status. Findings provide insufficient evidence to suggest disclosure status has a differential impact on the relationship between IH and HIV prevention outcomes. Further research is needed to understand the impact of disclosure status


This is an Open Access Thesis.

Open Access

This Article is Open Access