Background As sexual healthcare moves online, it’s important to understand the needs and preferences of groups with a higher burden of poor sexual health, to ensure equitable services. We explored gay, bisexual, and other men who have sex with men’s [GBMSM] preferences for in-person, telephone, and online provision of sexual healthcare and whether preferences change in the presence of symptoms and/or concerns about STI risk.

Methods Cross-sectional online survey of GBMSM in Scotland recruited from sexual-social media 12/2019–03/2020 (pre-Covid-19 pandemic). Participants were asked their preferences (or no preference) for accessing appointment booking, providing sexual/medical history, and accessing HIV/STI results in two scenarios: routine check-up (no symptoms/concerns); and concerned about new symptoms/possible infection. Data were analysed using Pearson chi-squared, McNemar-Bowker, and post-hoc McNemar tests.

Results 755 GBMSM participated, median age 39, 71.4% completed higher education, 69.9% were White Scottish. When accessing a routine check-up, proportions preferring in person, telephone and online care respectively were: booking appointments [27/755 (3.6%), 113/755 (15.0%), 520/755 (68.9%)]; reporting sexual behaviour [184/748 (24.6%), 39/748 (5.2%), 382/748 (51.1%)]; reporting symptoms [254/747 (34.0%), 46/747 (6.2%), 308/747 (41.2%)]; reporting medication [163/745 (21.9%), 46/745 (6.2%), 358/745 (48.1%)]; receiving HIV results [200/699 (28.6%), 73/699 (10.4%), 304/699 (43.5%)]; receiving STI results [143/746 (19.2%), 96/746 (12.9%), 361/746 (48.4%)]. A significant proportion of participants’ preferences changed across all elements of care measured, when concerned about symptoms or infection (p<0.005). Post-hoc analyses suggest that these changes were mostly attributed to a shift in preference from online to in-person care in the presence of symptoms/STI risk.

Conclusions In this online-recruited sample of highly educated, older GBMSM, online care was highly acceptable but a significant proportion preferred in-person care in the presence of symptoms/STI risk. Choice in sexual healthcare provision is essential as GBMSM’s preferences are not static and appear highly associated with emotional context.