Background Men who have sex with men (MSM) and transgender persons are disproportionately affected by sexually transmitted infections (STIs), including HIV, in Guatemala. Access to integrated sexual health prevention and treatment services is limited. The purpose of this study was to identify barriers to accessing sexual health services among gay, bisexual, and non-gay identified MSM and male-to-female transgender persons in Guatemala City to inform the development of high quality and population-friendly services that are sensitive to the needs of this population.

Methods Semi-structured in-depth interviews were conducted with 27 purposively sampled participants, including 7 transgender, 11 gay, 5 bisexual, and 4 non-gay-identified participants, in Guatemala City. Interview topics included experiences with sexual health services, perceived barriers to access, social and sexual network characteristics, and HIV risk behaviours. Topical codes were developed based on readings of interview transcripts and codes were applied to the data using the qualitative software Atlas.ti. Data were compared between study sub-groups using thematic matrices and analytic memos.

Results Across all participants, public clinics were the most commonly used sexual health services due to their lower cost and greater accessibility, but many participants provided examples of discrimination, violation of confidentiality, and distrust in the quality of services offered. Transgender and gay participants preferred clinics where they felt a sense of belonging while non-gay identified participants preferred clinics that were not associated with the MSM community. The most prominent barriers to sexual health services described by participants included fear of discrimination related to sexual identity and/or behaviour, fear of having HIV and the associated stigmatisation, cost, and lack of social support.

Conclusions Findings highlight the need to strengthen and expand existing public STI clinics to improve access to services among MSM and transgender populations in Guatemala City. These services must address the multiple layers of stigma and discrimination that MSM and transgender persons experience related to identity, behaviour, and STI/HIV. Insights from this study are currently being applied to the implementation of two public clinics in Guatemala City that seek to provide a discrete, non-judgemental environment where individuals can seek affordable services without fear.