Table 2 Identified barriers and facilitators to SHS utilization by MSW-MSM and implications for SHS
Barriers | Facilitators | Implications SHS |
|---|---|---|
Sex work and sexuality | ||
 Lack of identification as sex worker | - Identifying as sex worker - Willingness to disclose sex work | - Promotion of MSW-MSM SHS and IFW1 on online platforms commonly used by MSW-MSM - Using more neutral, non-stigmatizing terms of sex work in communication messages - Informing on the relevance of disclosure for the provision of tailored SHS |
 Lack of social support regarding sex work |  | - Providing social support in consultations - Permanent contact person - Linking MSW-MSM, organizing peer group meetings |
 Lack of identification as homosexual |  | - Promotion of MSW-MSM SHS on more general platforms, e.g. social media, TV - Communication not specifically focused on LGBTQIA+ community, both in communication message and visualization |
Shame and stigma | ||
 Experiencing shame and (self-)stigma MSM | Not experiencing shame and (self-)stigma MSM | - Communication message: stressing anonymous and confidential nature of SHS for MSW-MSM and using non-stigmatizing language - Providing home self-sampling STI kits |
 Experiencing shame and (self-)stigma sex work | Not experiencing shame and stigma sex work | - Communication message: stressing anonymous and confidential nature of SHS for MSW-MSM and using non-stigmatizing language - Providing home self-sampling STI kits |
 Perceived negative social norm towards MSM and sex work |  | - Personal contact with a nurse - Informal and positive communication style - Communication message: stressing anonymous and confidential nature of SHS for MSW-MSM, non-judgmental environment of STI clinic and professional experience in MSM and sex work field - Providing home self-sampling STI kits |
 Fear of stigmatization towards MSM and sex work |  | - Personal contact with a nurse - Informal and positive communication style - Communication message: stressing anonymous and confidential nature of SHS for MSW-MSM, non-judgmental environment of STI clinic and professional experience in MSM and sex work field - Providing home self-sampling STI kits |
Sexual healthcare services (SHS) | ||
 Negative attitude STI clinic | Positive attitude STI clinic | - IFW to promote MSW-MSM SHS and counsel MSW-MSM on online platforms commonly used by MSW-MSM - Personal contact with a nurse - Informal and positive communication style - Communication message: stressing anonymous, free and confidential nature of SHS for MSW-MSM |
 Low awareness of SHS STI clinic | High awareness of SHS STI clinic | - Promotion of MSW-MSM SHS through active and passive IFW on online platforms commonly used by MSW-MSM - Promotion of MSW-MSM SHS on more general platforms, e.g. social media, TV - Promotion of MSW-MSM SHS in gay saunas and other popular gay meeting places - Communication message: stressing anonymous, free and confidential nature of SHS for MSW-MSM |
 Lack of trust in STI clinic | Trust in STI clinic | - Personal contact with a nurse - Informal and positive communication style - Communication message: stressing anonymous, free and confidential nature of SHS for MSW-MSM and explaining term STI clinic |
 Lack of awareness of anonymity and confidentiality of the STI test and -clinic | Awareness of anonymity and confidentiality of the STI test and -clinic | - Promotion of MSW-MSM SHS through active and passive IFW on online platforms commonly used by MSW-MSM - Promotion of MSW-MSM SHS on more general platforms, e.g. social media, TV - Promotion of MSW-MSM SHS in gay saunas and other popular gay meeting places - Communication message: stressing anonymous and confidential nature of SHS for MSW-MSM |
Disclosure concerns: - having to disclose sex work to an unknown healthcare professional - fear of judgement - lack of understanding of (medical) relevance of disclosure | - Willingness to disclose sex work - Explicitly and personally being asked for sex work status in a non-judgmental manner - Aware of the medical relevance of disclosing sex work | - Personal contact with a nurse - Informal and positive communication style - Communication message: stressing anonymous and confidential nature of SHS for MSW-MSM, non-judgmental environment of STI clinic and professional experience in sex work field - Informing on the relevance of disclosure for the provision of tailored SHS - Providing home self-sampling STI kits |
Practical aspects of getting tested: - calling to make an appointment - freeing up time to get tested - distance and transportation to the STI-clinic | Â | - Providing home self-sampling STI kits - Providing user-friendly appointment system including possibility to make appointments online - Personal reminders |
STI and STI testing | ||
| Â | Positive attitude STI test | - Providing general STI test procedure information through online platforms commonly used by MSW-MSM |
Positive perceived norm STI test - Social support STI test - Modelling STI test | Negative perceived norm STI test | Normalizing STI testing by promotion of STI testing on both general platforms and online platforms commonly used by MSW-MSM |
Low STI risk perception: - Low perceived susceptibility STI - Low perceived severity STI | High STI risk perception - High perceived susceptibility STI - High perceived severity STI | - Providing STI risk information through online platforms commonly used by MSW-MSM - IFW to promote MSW-MSM SHS and counsel MSW-MSM to provide personal risk information on online platforms commonly used by MSW-MSM - Communication message: Stressing own health benefits, responsibility towards sexual partners and preventing infecting them with STI (gain frame) |
Fear of results STI test | - Understanding of health benefits STI test - Feeling sense of social responsibility to not transmit STI to sex partners | - Providing general STI information through online platforms commonly used by MSW-MSM - IFW to promote MSW-MSM SHS and counsel MSW-MSM to provide tailored information on online platforms commonly used by MSW-MSM |
Fear of possible costs associated with the STI test | Awareness of available free SHS at STI clinic | - Promotion of MSW-MSM SHS and active and passive IFW on online platforms commonly used by MSW-MSM - Promotion of MSW-MSM SHS on more general platforms, e.g. social media, TV - Promotion of MSW-MSM SHS in gay saunas and other popular gay meeting places - Communication message: stressing free nature of SHS for MSW-MSM |
Fear of needles | Â | - Providing general STI test procedure information through online platforms commonly used by MSW-MSM - IFW to promote MSW-MSM SHS and counsel MSW-MSM to provide tailored information regarding the STI test procedure on platforms commonly used by MSW-MSM |
Perceived stigma on STI test | Â | - Normalizing STI testing by promotion of STI testing on both general platforms and online platforms commonly used by MSW-MSM - Providing home self-sampling STI kits |
Lack of STI knowledge - Lack of understanding of STI and STI test - Not feeling a sense urgency to get tested for STI due absence of symptoms | Knowledgeable about STI - Understanding health benefits of getting tested for STI - Understanding of STI and their (absence of) symptoms | - Providing general STI and STI test information through online platforms commonly used by MSW-MSM - IFW to promote MSW-MSM SHS and counsel MSW-MSM to provide tailored information regarding the STI and STI test on platforms commonly used by MSW-MSM |