Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.Social attitudes toward male homosexuality in China so far are still not optimistic.
Third, same-sex marriage is illegal and sexual minorities still experience stigma, prejudice, and the occurrence of negative events due to their sexual orientation .
Even same-sex behaviors may lead to rejection by one’s family and problems in the work setting .
As a result, some gay men choose to conceal their same-sex orientation (especially from their parents)  and choose opposite-sex marriage to ease the stress of being members of this minority (i.e., internalized homophobia).
A study comparing men who have sex with men (MSM) from outside China with MSM in China using a global online survey found that MSM in China reported higher levels of internalized homophobia .
Some studies have found an association between higher levels of internalized homophobia and increased alcohol use , and substance use , such as barbiturates and amphetamines, among male individuals, whereas other studies have reported conflicting findings [22, 23].
Overall, there are differences in cultural and social contexts between Western and Chinese male sexual minorities, especially with respect to the norms and social meanings regarding one’s number of partners (i.e., multiple sex partnerships), which have the potential to affect the expression of individuals’ internalized homophobia.
Additionally, internalized homophobia was found to be associated with practicing HIV at-risk sexual behaviors [1, 20], such as condomless sex, multiple sex partners, and unprotected anal sex among male homosexuals.
In addition, previous reviews of studies have reported inconsistent conclusions regarding the relationship between internalized homophobia and substance/alcohol use.
In addition, internalized homophobia has been found to be associated with sexual compulsivity [20, 26].