Reaching Male Sex Workers Who Have Sex With Men (M$M) With Preventive Sexual Healthcare Services In The Netherlands

Background Male sex workers who have sex with men (M$M) are a hidden high-risk group for sexually transmitted infections (STI) including human immunodeficiency virus (HIV). They are neglected in current care-strategies and hard to reach by regional public health service (GGD), who offer free and anonymous preventive sexual healthcare services e.g. STI testing and hepatitis B (HBV) vaccinations. The aim of this study was to assess M$M’s perceived barriers and facilitators to engage in preventive sexual healthcare services provided by the GGD. Methods For this qualitative study semi-structured individual in-depth interviews were conducted with 20 M$M who worked home-based in the Dutch province of Limburg. Respondents were recruited by convenience sampling until saturation was reached via 1) five websites and smartphone applications commonly used by M$M 2) GGD’s STI clinic 3) two gay saunas. An interview guide was developed including themes such as sexuality, sex work, the GGD’s care services, communication and reachability. The interviews’ recordings were transcribed verbatim and inductively coded with Atlas.ti 8. Results The interviewed M$M were diverse in age (range: 18 – 66; median: 39.5) and mostly western European (85%). Several barriers and facilitating factors were identified for M$M to engage in the GGD’s preventive sexual healthcare services. The lack of self-identification as homosexual and as sex worker, self-stigma, the lack of awareness of the GGD’s services and a low STI risk perception are identified as barriers. Online outreach work on websites and smartphone applications commonly used by M$M, promotion of the GGD’s care services and its anonymity, confidentiality and non-judgemental environment and direct online communication between a GGD nurse and M$M are identified as facilitating factors. Conclusion The M$M population’s diversity and identified barriers and facilitating factors should be taken into account in care-strategies in order to optimize future preventive sexual healthcare services for M$M.