Resumen
In a sample of men who have sex with men (MSM) (N = 3436) in Spain who bear
intrinsic HIV risk, we investigated how internalised homonegativity (IH) is asso-
ciated with the number of non-steady male partners with condomless intercourse
(as a proxy of sexual risk behaviour). Using structural equation modelling (SEM),
we examined the relationship between IH and sexual risk behaviour, and mediat-
ing effects of HIV/PrEP knowledge and substance use during sex on this relation-
ship. We found no direct association between IH and sexual risk behaviour, nor
did IH influence substance use during sex. In line with our hypothesis, association
between IH and sexual risk behaviour was significant when mediated by HIV/PrEP
knowledge. We found that as IH increased, sexual risk behaviour decreased, because
higher IH was associated with lower HIV/PrEP knowledge while higher HIV/PrEP
knowledge was associated with increased non-condom use with non-steady partners.
Substance use during sex was significantly associated with sexual risk behaviour.
Our results emphasize the continuing importance of prevention strategies focused
on behavioural changes and community level interventions, especially targeting sub-
stance use.