‘Put me off getting tested for years and years’: a qualitative study of gay, bisexual and other men who have sex with men’s experiences of homophobia in primary healthcare in Aotearoa New Zealand

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBM) are disproportionately impacted by HIV and other sexually transmitted infections (STIs). Recent biomedical innovations such as HIV pre-exposure prophylaxis, STI vaccines and testing offer new prevention tools. However, realising these benefits hinges on GBM disclosing their sexuality and receiving appropriate support from healthcare providers (HCPs). We aimed to understand GBM's experiences of sexual healthcare in Aotearoa New Zealand. METHODS: We conducted an inductive thematic analysis of free-text responses to the Sex and Prevention of Transmission Study, a large and diverse national cross-sectional behavioural surveillance survey of GBM in 2022. Data from 422 participants reporting negative experiences when discussing their sexuality and sexual health with HCPs were examined. RESULTS: Overall, 19.1% reported a negative experience discussing their sexuality with an HCP. Six themes were derived from participants' experiences. Negative reactions to GBM's sexuality and sexual health needs centred around four themes: (1) judgement and prejudice, (2) disrespect, (3) discrimination, and (4) inexperience and skill deficits. Additionally, two themes related to: (5) participants' views about how their HCP's demographic characteristics (e.g. age, gender, religion, sexual orientation) might underpin their behaviour, and (6) consequences of GBM's negative experiences (changing HCPs, forgoing sexual health services, suffering poor mental and physical health). CONCLUSION: In the era of biomedical HIV/STI prevention, GBM's ability to communicate about their sexuality and sexual health will be a key antecedent to eliminating HIV and STI transmission. Strategies spanning health workforce training and targeted service expansion are needed to improve experiences of sexual healthcare services for GBM. Heterosexist environments that underpin judgement and prejudice, disrespect, discrimination and lack of skill must be addressed; cultural competence and safety must support diverse HCPs to improve delivery; and the consequences for those whose care is compromised by negative healthcare experiences must be mitigated.