Sexual minority stigma and sexual health among gay men in Tunisia: insights from a double-perspective qualitative study

Understanding the social factors contributing to HIV transmission among men who have sex with men (MSM) is a critical public health priority. In North African countries like Tunisia, cultural taboos, legal restrictions, and stigma intensify gay men's vulnerability by fostering risky sexual behaviors and limiting access to sexual health services. This qualitative study explores how stigma intersects with sexual risk-taking by integrating perspectives from gay men and psychiatrists in Tunisia. In-depth interviews were conducted with 17 gay men and 15 psychiatrists, recruited through snowball and convenience sampling, respectively. Reflexive thematic analysis, assisted by MAXQDA, revealed four key themes: (1) Internalized stigma and sexual risk-taking; (2) Concealment, secrecy, and vulnerability; (3) Structural barriers to sexual health knowledge and prevention; and (4) The double burden of being HIV-positive and gay. The findings highlight how stigma influences gay men's sexual health experiences through personal fears, limited knowledge, structural healthcare gaps, and social norms. Addressing these challenges requires more than just access to tools like PrEP or testing. Efforts must also foster safe healthcare environments, reduce stigma, and advocate for inclusive legal reforms to promote health equity for gay men and other MSM.