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Table 3 Illustrative quotations per theme

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

Theme Participant characteristics Quotation
Shame and stigma
Identification sex worker Participant 16
49 years old
“At least I wasn't on it all day, not at all. Far, far from even. So it's not something you need to pay your bills. And with prostitution you have a completely different view of- Prostitution is just something completely different. Are you, there you are just looking for customers who pay continuously. So and that's not how I saw it. It was actually more my pleasure - And that's why I don't see it as sex work."
Identification homosexual Participant 18
48 years old
“I am bisexual, but uh, I could never live with a man. Is purely sexual, yes.”
Shame and stigma
Shame and (self-)stigma sex work Not experiencing shame and (self-)stigma Participant 15
40 years old
“Never, no. I am not ashamed for things I do. And I- Not ashamed, not even what you or other thinks about me because I am a prostitute. I am because I have to be. That's my story, happen like this, was to be like this. I am like this. Shoot me if you don't like it.”
Experiencing shame and (self-)stigma Participant 12
37 years old
“Normally it's a bit embarrassing, in that sense. A little though. That's um, still learning to cope better. 'Cause, yes it's me. So you have to yes, otherwise you will get depression.”
Shame and (self-)stigma MSM Participant 18
48 years old
“That’s what I don’t know. Is this an addiction? Is this an illness? Is this a- are these the genes of my parents?”
Experienced stigmatization MSM Participant 8
35 years old
“Here’s the situation. I’m gay. And I remember, my mother don’t talk to me for three months. Three months. She don’t cook for me. She don’t clean eh, eh, clean my clothes. Anything.”
Sex work Participant 19
35 years old
“Because as sex worker you are like nothing in the face of other people.”
Sexual healthcare services (SHS)
Attitude SHS Participant 7
39 years old
“Always very relaxed and very helpful and when I have questions, it goes really smoothly. I do have a familiar feeling, though. I think if there had to be something, I could ask or say anything or something. Absolutely, I don't have to hide anything."
Awareness available SHS Participant 16
49 years old
“I don't know if there are any costs involved. Now you're saying that it's free ehm, also that eh, that's very ehm-… I think it, I don't know exactly what that test entails. Do you need to draw blood or uh, me, what does that mean?”
Need for sexual health information Participant 6
55 years old
“You see, you don't like to talk about, what is gonorrhoea? What is syphilis? Yes, maybe you could have a little more info on that. Maybe it's on the website? I'm not sure.”
Disclosure sex work Participant 7
39 years old
“You have to tick that box on the list but I have never done that. No I have never. Because I thought, otherwise they might ask questions or this or that. But I would do that now, after this conversation I think. I think so. Actually yes.”
STI and STI testing
Attitude STI test Participant 3
44 years old
“It’s normal, so not a problem. It's for your own health, right?”
Perceived (social) norm STI test Participant 5
46 years old
“I think they're thinking too lightly about it, about the necessity of it. Well, I hardly discuss it, this is just the impression I have.”
Perceived susceptibility STI Participant 7
39 years old
“There is always a risk of course, but I don't think it's that big because I'm always very careful. Okay, sucking may be done without a condom, but the fucking is always with. Well, with one exception.”
Perceived severity STI Participant 20
24 years old
“Well, this might sound stupid, but so to say, most of them can be treated with a shot or with antibiotics, so I don't lose any sleep over that. But if it really were HIV…that’s my biggest fear I guess”
Increasing SHS accessibility and utilisation by MSW-MSM
Suggestions to increase accessibility for MSW-MSM Promotion of SHS and internet fieldwork on online platforms commonly used by MSW-MSM Participant 14
18 years old
“I'm actually just thinking through Grindr or through Bullchat or something. Just through the apps, because otherwise you don't really come into contact with them. … I do think that you should simply address via an account, guys, eh, these are the options, we can offer you this, eh, think about it.”
Provision of STI home-sampling kits Participant 16
49 years old
“I think for a lot of people it would be easier if they could do some kind of home test. I think that will convince a lot of people… I think if someone is in a familiar environment, it's easier.”
Communication towards MSW-MSM Participant 18
48 years old
"No, I just think that the main point should be that it’s anonymous, that a lot of men then will give in."