TY - JOUR
T1 - Barriers and facilitators to utilisation of public sexual healthcare services for male sex workers who have sex with men (MSW-MSM) in The Netherlands
T2 - a qualitative study
AU - Peters, Charlotte Merel Marije
AU - Dukers-Muijrers, Nicole Helena Theodora Maria
AU - Evers, Ymke Joline
AU - Hoebe, Christian Jean Pierre Antoine
N1 - © 2022. The Author(s).
PY - 2022/7/21
Y1 - 2022/7/21
N2 - BACKGROUND: Male sex workers who have sex with men (MSW-MSM) are a high-risk group for sexually transmitted infections (STI) including human immunodeficiency virus (HIV). Provision of sexual services by MSW-MSM has shifted to the internet. Consequently, MSW-MSM have become hidden to care for providers of sexual healthcare services (SHS). The aim of this study was to 1) assess characteristics of the MSW-MSM population and 2) assess MSW-MSM's perceived barriers and facilitators to utilise SHS provided free and anonymously by the public health STI clinic in The Netherlands.METHODS: For this qualitative study, semi-structured individual in-depth interviews were conducted with 20 MSW-MSM who worked home-based in the Dutch province of Limburg. Participants were recruited from November 2018 to June 2019 by purposive sampling until saturation was reached via 1) five websites and smartphone applications commonly used by MSW-MSM, 2) STI clinic, 3) two gay saunas. A theory-informed interview guide was developed including themes such as sexuality, sex work, SHS and barriers and facilitators to SHS utilisation. The interviews' recordings were transcribed verbatim and thematically analysed by inductive and deductive coding with Atlas.ti 8.RESULTS: The interviewed MSW-MSM were diverse in age (range: 18 - 66; median: 39.5) and mostly western European (85%). Identified barriers to SHS utilisation were lack of self-identification as homosexual and sex worker, perceived stigma on sex work and MSM, the lack of awareness of SHS and a low STI risk perception. Identified facilitators were trust in and positive attitude towards SHS, awareness of SHS's anonymous, confidential and free-of-charge nature, high STI risk perception and knowledgeable about STI/HIV. MSW-MSM-identified implications for SHS-providers were promotion of SHS on online MSW-MSM and general platforms (e.g. Facebook), offering one-on-one online and informal communication with an SHS-provider (e.g. STI clinic nurse) and providing STI (testing) information.CONCLUSION: The MSW-MSM population's diversity and identified barriers, facilitators and implications should be taken into account to optimize accessibility and utilisation of SHS for MSW-MSM in Western Europe. SHS-providers could facilitate sex work disclosure by personally asking patients about sex in exchange for money or goods in a non-judgmental manner and explaining the medical relevance of disclosure.
AB - BACKGROUND: Male sex workers who have sex with men (MSW-MSM) are a high-risk group for sexually transmitted infections (STI) including human immunodeficiency virus (HIV). Provision of sexual services by MSW-MSM has shifted to the internet. Consequently, MSW-MSM have become hidden to care for providers of sexual healthcare services (SHS). The aim of this study was to 1) assess characteristics of the MSW-MSM population and 2) assess MSW-MSM's perceived barriers and facilitators to utilise SHS provided free and anonymously by the public health STI clinic in The Netherlands.METHODS: For this qualitative study, semi-structured individual in-depth interviews were conducted with 20 MSW-MSM who worked home-based in the Dutch province of Limburg. Participants were recruited from November 2018 to June 2019 by purposive sampling until saturation was reached via 1) five websites and smartphone applications commonly used by MSW-MSM, 2) STI clinic, 3) two gay saunas. A theory-informed interview guide was developed including themes such as sexuality, sex work, SHS and barriers and facilitators to SHS utilisation. The interviews' recordings were transcribed verbatim and thematically analysed by inductive and deductive coding with Atlas.ti 8.RESULTS: The interviewed MSW-MSM were diverse in age (range: 18 - 66; median: 39.5) and mostly western European (85%). Identified barriers to SHS utilisation were lack of self-identification as homosexual and sex worker, perceived stigma on sex work and MSM, the lack of awareness of SHS and a low STI risk perception. Identified facilitators were trust in and positive attitude towards SHS, awareness of SHS's anonymous, confidential and free-of-charge nature, high STI risk perception and knowledgeable about STI/HIV. MSW-MSM-identified implications for SHS-providers were promotion of SHS on online MSW-MSM and general platforms (e.g. Facebook), offering one-on-one online and informal communication with an SHS-provider (e.g. STI clinic nurse) and providing STI (testing) information.CONCLUSION: The MSW-MSM population's diversity and identified barriers, facilitators and implications should be taken into account to optimize accessibility and utilisation of SHS for MSW-MSM in Western Europe. SHS-providers could facilitate sex work disclosure by personally asking patients about sex in exchange for money or goods in a non-judgmental manner and explaining the medical relevance of disclosure.
KW - Male sex workers who have sex with men
KW - STI
KW - HIV
KW - Sexual healthcare services
KW - Public health services
KW - Utilisation
KW - STI testing
KW - Sex work stigma
KW - Prevention
KW - Internet fieldwork
KW - Implications for care
KW - RISK BEHAVIOR
U2 - 10.1186/s12889-022-13799-1
DO - 10.1186/s12889-022-13799-1
M3 - Article
C2 - 35864473
SN - 1471-2458
VL - 22
JO - BMC Public Health
JF - BMC Public Health
IS - 1
M1 - 1398
ER -