A new study suggests that homophobia may adversely affect the health of gay and bisexual men.

Research led by Yale School of Public Health found that gay men living in European countries with strong policies against homosexual behavior are less likely to use HIV-prevention services and test for HIV.

"Our findings suggest that rather than primarily being the result of personal failure, HIV risk is largely determined by national laws, policies, and attitudes toward homosexuality," John Pachankis, lead author of the study, said in a statement. "This study shows that gay and bisexual men in homophobic countries are denied the resources, including psychological resources like open self-expression, that are necessary to stay healthy."

For the study, researchers collected and analyzed data from the European MSM Internet Survey, which was completed by 174,000 gay and bisexual men. They compared this data to a measure of country-level laws, policies, and social attitudes toward homosexuality.

They found that attitudes about homosexuality varied greatly across the continent, but they noticed that men living in countries with higher levels of homophobia knew less about HIV and were less likely to use condoms. This finding leads the researchers to conclude that homophobia reduces the use of health services and compromises health-service quality.

The findings also suggested that gay and bisexual men had a higher risk of contracting HIV in homophobic countries "where appropriate prevention services are limited but the opportunity for sexual contact is increasing," researchers said.

The researchers concluded that this finding was the result of efforts by gay and bisexual men to conceal their sexual orientation, or stay in "the closet."

The findings are detailed in the journal AIDS.