Engaging hard‐to‐reach men‐who‐have‐sex‐with‐men with sexual health screening: Qualitative interviews in an Australian sex‐on‐premises‐venue and sexual health service

Abstract

Context Compared with the general population in Australia, men‐who‐have‐sex‐with‐men (MSM) have higher rates of HIV and sexually transmissible infections (STIs). Despite widespread advice to test regularly, a minority of these men remain “hard to reach.” We undertook qualitative interviews with a group of such men in Sydney to better understand their views and experiences in relation to sexual health screening. Methods We conducted semi‐structured interviews with men engaging with HIV/STI screening services at a sex‐on‐premises‐venue and the local Sexual Health Service in Greater Western Sydney. We analyzed these data for content and themes. Results Sexual behaviors and identities were diverse, often discordant and compartmentalized from everyday lives. Overall, reported HIV/STI knowledge was poor and men did not see themselves at risk of HIV/STIs regardless of sexual behavior. Men took calculated risks and balanced with pleasure and escapism. Reasons for avoidance of testing included fear, unwillingness to disclose behavior, privacy concerns, and perceived low risk. Men viewed sexual health care as distinct from general health care. Service delivery preferences varied by service venue. Participants highlighted convenience, confidentiality, and trust as critical factors for a testing service. Conclusion A variety of testing options are needed to engage hard‐to‐reach MSM. Opportunities to enhance testing may include expanding health messaging, demystifying testing, and delinking sexual identity from sexual behavior and risk, thus promoting advantages of testing and establishing testing as standard of care.

Knowledge of Australia’s My Health Record and factors associated with opting out: Results from a national survey of the Australian general population and communities affected by HIV and sexually transmissible infections

“…HIV remains a stigmatised condition, and people living with HIV may have understandable fears about their status being disclosed without their consent [26,58,59]. Lesbian, gay, bisexual and other non-heterosexual people may actively compartmentalise aspects of their health care, selectively disclosing details about their sexuality and sexual practices to some providers and not others to avoid judgmental treatment and discrimination [60][61][62]. Sex work remains subject to regulation and criminalisation in some Australian jurisdictions, and people may actively avoid disclosing sex work to health providers for that reason [34,63,64].…”