Skip to main content

Table 2 Identified barriers and facilitators to SHS utilization by MSW-MSM and implications for SHS

From: Barriers and facilitators to utilisation of public sexual healthcare services for male sex workers who have sex with men (MSW-MSM) in The Netherlands: a qualitative study

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
  - Providing home self-sampling STI kits
- Providing user-friendly appointment system including possibility to make appointments online
- Personal reminders
STI and STI testing
  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   - 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   - 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
  1. 1IFW: internet fieldwork