A surge in cases of HIV could be on the way to countries that lag behind on gay rights, according to a study.

A team of researchers from a number of universities looked at the behaviours of 175,000 gay or bisexual men across 38 European countries, with varying levels of cultural homophobia.

The study found that men in countries where homophobia is more prevalent are less educated about HIV, and were less likely to use condoms.

This is currently offset as men in such countries tend to have fewer sexual partners – but there are fears a boom in hook-up apps could lead to an upswing in the number of sexual partners, leading to an HIV crisis.

The study was conducted by the Yale School of Public Health, Columbia University, the London School of Hygiene & Tropical Medicine, the Norwegian Knowledge Centre for Health Services, and the German Robert Koch Institute.

Co-author Dr Ford Hickson of the London School of Hygiene & Tropical Medicine said: “Our findings are surprising as it may appear it’s effectively safer for men to stay in the closet in the most homophobic countries because their HIV-risk is lower there. But the closet is a difficult, shameful place which is particularly harmful to mental health and wellbeing.

“It’s also a place where men are kept ignorant, under-resourced and poorly skilled when dealing with sex and HIV. As the way people meet changes with technology, the homophobia that may have appeared to be protecting these men will now be exposing them to huge risk.”

He continued: “Previous research on HIV prevention in Europe has shown there are four key interventions in suppressing HIV: condom distribution, peer-led group education, peer-outreach education projects, and universal access to anti-retrovirals for men with HIV. All health authorities could be commissioning these services as well as working to protect the human rights of sexual minorities.”

The study notes: “Although the high-stigma European countries identified in our country-level index have historically reported lower prevalence of HIV among MSM than low-stigma countries, recent surveillance indicates an increase in new HIV diagnoses among MSM across Europe, especially in high-stigma European countries.

“Our findings, therefore, suggest that stigma might increase the rate of new HIV infections as opportunities for transmission increase with technological advancements.

“Stigma’s impact on the future of the epidemic might be particularly relevant in those countries where technology (e.g. mobile sex seeking applications) is quickly overcoming the relative lack of brick-and-mortar MSM venues (e.g. bars, saunas) to facilitate sexual contact among men.

“Stigma, therefore, can serve to exacerbate other determinants of the epidemic, such as technology and travel that are increasingly relevant to the future epidemic among MSM in high-stigma locales.”