Background Men who have sex with men (MSM) are disproportionately overrepresented in the resurgence of sexually transmitted and blood-borne infections (STBBI) indicating a need to understand how access to sexual health services can be adapted for the improvement of the health and well-being of MSM. Our objective was to contextualize the access to and provision of MSM sexual health care with a syndemic lens. Accordingly, this study employs qualitative understanding of access to sexual health care, with particular focus on pre-exposure prophylaxis, for MSM in Vancouver.

Methods We conducted five focus groups from 12/2016-07/2017 with sexual health service providers serving MSM and members from the MSM community who have accessed sexual health care. Focus groups were audio recorded and transcribed verbatim. We iteratively analyzed data through a constant comparative technique to identify the accessibility of sexual health care for MSM in Vancouver with inference to syndemic effect.

Results We identified service provider and MSM community attitudes and the structural concerns impacting access to sexual health care for MSM in Vancouver, Canada. Access to sexual health care assembled into three themes: (1) Perceptions and categorization of underserved; (2) Value of specialized MSM sexual health service; and (3) Capacity: reaching and referring. The first represents syndemics, reaching undiagnosed, representation and intersectionality, and specialized service providers as encouraging PrEP gatekeepers. The second combines MSM friendly environment, separation of sexual from other health care, and fear of association: community stigma and internalized shame. The third includes service promotion, capacity for HIV care, lack of counseling, and referral adequacy.

Conclusion MSM experience many biosocial interactions that negatively impact their access to sexual health care. Therefore, sexual health care would be more likely accessed if conditions were addressed together rather than separately. Findings offer social and structural-level interventions to address stigma and syndemic influence within MSM sexual health care delivery.

Disclosure No significant relationships.