Short summary
Background
Methods
Study design
Participant selection
Data collection
Data analysis
Ethical considerations
Results
Characteristic | N (%) |
---|---|
Biological gender | |
Male | 20 (100) |
Gender identity | |
Male | 18 (90) |
Female | 2 (10) |
Average age (in years) | 39.9 (Range: 18 – 66; Median: 39.5 ) |
Country of birtha | |
The Netherlands | 14 (70) |
Western Europe other | 3 (15) |
Eastern Europe | 2 (10) |
South America | 1 (5) |
Level of educationb | |
Low | 2 (10) |
Medium | 10 (50) |
High | 8 (40) |
Employment besides sex work | |
Employed | 11 (55) |
Unemployed | 9 (45) |
Duration of sex work (range) | 3 months – 32 years |
Relationship status | |
In a relationship | 7 (35) |
Not in a relationship | 13 (65) |
Sexual preference | |
Homosexual | 11 (55) |
Bisexual | 7 (35) |
Heterosexual | 2 (10) |
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 |
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." |
Sex work and sexuality
Identification sex worker
Identification homosexual
Shame and stigma
Shame and (self-)stigma sex work
Shame and (self-)stigma MSM
Experienced stigmatization
Sexual healthcare services
Attitude SHS
Awareness available SHS
Need for sexual health information
Disclosure sex work
STI and STI testing
Attitude STI test
Perceived (social) norm STI test
Perceived susceptibility STI
Perceived severity STI
Perceived barriers STI test
Increasing SHS accessibility and utilisation by MSW-MSM
Suggestions to increase accessibility for MSW-MSM
-
Promotion of the STI clinic’s SHS on all online platforms (websites and apps) commonly used by MSW-MSM for contacting customers. Promotion can be done in the form of a banner or advertisement, an information link about the STI clinic or by doing active and passive internet fieldwork. It was also regularly suggested to use both passive and active internet fieldwork approaches, i.e. promotion in the form of a banner or advertisement, being available for sexual health related questions in chatrooms as well as actively sending messages to possible sex workers. Sex workers can be recognized on online platforms by a money sign, money bag, diamond or “pay” in their name.
-
Promotion of SHS on general (social) media platforms e.g. on Instagram, Facebook, TV, radio and door-to-door promotion. This approach would reach more hetero and bisexually identifying MSW-MSM.
-
Promotion of SHS at gay saunas and other gay meeting locations (i.e. parties, gay cinemas, parking lots). This would mainly be in the form promotional posters or visiting the location for STI testing and counselling.
-
Building trust between the STI clinic and MSW-MSM. Trust could be increased through informal, friendly and clear communication at the MSW-MSM language level. Professional language allegedly increases the distance between the STI clinic and MSW-MSM. Providing an explanation about the STI clinic for non-Dutch MSW-MSM was also mentioned as important to avoid mistrust.
-
Building a personal relationship with an SHS-provider e.g. STI clinic nurse. This could make MSW-MSM feel more at ease and facilitate trust-building.
-
The provision of STI home-sampling kits. Some MSW-MSM would find it convenient, easy and pleasant to obtain the materials for the STI test in their own safe environment. Participants suggested either sending the kit to their home address or being able to pick the kit up at a pick-up point.
-
Providing an accessible appointment system. This includes the option to make an appointment online and to be able to complete the medical questionnaire online.
-
Personal WhatsApp contact with a nurse. Participants mentioned this would remove experienced barriers of having to call for an STI test appointment, a lack of trust and familiarity and disclosure concerns.
-
Receiving a personal reminder to make an appointment for an STI test. This suggestion was said to increase STI testing behaviour, since this strategy worked well for a participant in the past.