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Table 1 Barriers and recommendations to improve bacterial STI testing: clinical context

From: Community perspectives on ideal bacterial STI testing services for gay, bisexual, and other men who have sex with men in Toronto, Canada: a qualitative study

Subtheme

Barriers

Recommendations

Supportive Quotations

Geographical Location & Clinic Hours

Too few clinics inclusive to all men, limited hours of operation, and long distance needed to travel to clinics

More sexual health clinic locations inclusive to all men across the city with evening and weekend hours and accessible by transit

“There’s no way you can get tested on a Saturday night, you know, like, and then you’ve gotta make an appointment, go in on the Monday.” (FG1, P6)

“I do [have a good family doctor], I haven’t seen him in a really long time because it’s hard for me to get down here.” (FG3, P3)

“[The drop-in clinic] is not a very inclusive or safe feeling space for me. For trans people. So I don’t want to go to my local drop-in clinic.” (FG3, P3)

“I tend to play the gender fluidity to my advantage […] it’s easier to get away with gender fluidity, identify as a woman, so I would enter a lesbian space for safety. […] any time I call, go to a clinic, I would play up the femininity, I would change, like just, because I was like, I have to fit in somewhere right now so, I’m gonna pretend to be a cis woman for this entire interaction.” (FG3, P2)

“A lot of people I can only imagine like, if they’re working or have a job or are a full-time student, or I don’t know. Lots of things. Yeah. Accessibility. And the hours are like, 5 pm, 6:30. Please note, arrive before 4:30 pm. I don’t know. But like accessibility [of clinic hours] is important.” (FG4, P2)

“I still feel like we’d constantly choose the Village, but gays are all over the city.” (FG1, P7)

“Something close to transit, I would think, close to subway stations, […] and it doesn’t have to be subway stations, it can be like, rapid bus lines.” (FG1, P5 extended)

“This is for testing for people assigned female at birth or something like that instead because like, then you know, it feels more welcoming to trans people because you’re just like, oh well, if they’re saying, assigned female at birth, then they know that, you know, trans, that like, then they must be inclusive of trans people.” (FG3, P1)

Waiting Room

Lack of anonymity

Streamlining testing by limiting time spent time in waiting room with a call back notification system and using numbers instead of names to call people from the waiting room

“Especially cause, as you mentioned too, it’s also a very small community and like being in that room and then like you’re sitting down, and you’re like, hey, I had sex with that guy last week. Or seeing your ex and their new boyfriend there.” (FG2, P1)

“The fact that there’s so many people there, where you check in, and where they possibly will ask you personal questions, people can hear the questions. They can hear them ask. They can hear what your response is.’ (FG4, P6)

“P5: It’s not anonymous

P1: Nobody needs to know my business. It becomes you know what, I’m broadcasting it to whoever’s in that room at the time. And like you said, that room is full.” (FG4)

“The waiting room situation that someone mentioned, like people have to like sit and look at each other as opposed to like, you couldn’t just do one person in a booth or have a set-up time, just like, go in, go out, no one needs to know that you’re getting tested.” (FG1, P7)

“Like I think what they should do is give you a number basically or you know, one of those vibrating, you know, things like you’re in a restaurant.” (P1, FG4)

“I just think like you could always do like, like a leave a number basis […] you literally walk in, you fill out the form, you leave a number, and you walk out, and then they just like ring you, […] rather than you’re just like sitting in a room” (P4, FG2)

“The ideal would be, I walk up to a counter and say hi, I think I have a problem, and they’d say OK, have, have a seat, somebody will be with you right away, somebody taps you on the shoulder or calls your number or whatever, I’d prefer not a name, so that you’re not broadcasting to anybody else.” (FG4, P1)

Waiting Time

Long wait times

Streamline testing by focusing on specimen collection, including self-collecting samples, and proceeding to a lab directly to provide samples to reduce wait times

“Like the fact that the wait times are steeply climbing, like no matter what time you go, at the end of the period clinic, when, at the beginning, the testing period, it’s always like half an hour to two hours wait so I’ve just kind of like, very shied away from that now.” (FG2, P5)

“P6: And just to touch on his point, when you were talking about when you come in and it’s, there are actually people sitting there like, a half hour before they even technically open. That’s how busy it is

P1: Yep. Like when they switch over between, the men’s clinic and the female clinic, if you, if you’re a male and you go in during the female clinic, and you sit down, you register and you sit down. Cause then when it switches over, you’re way ahead of the lineup

P2: It’s like camping for Black Friday discounts.” (FG4)

“My [family] doctor is very booked […] I’m not gonna sit with gonorrhea […] for weeks and weeks, just to see him.” (FG4, P5)

“They [those going to their family doctor] end up getting tested […] closer to once a year or less when they’d be willing to be tested 3 times a year if the services were available.” (FG1, P5 extended)

“And then, Church and Wellesley, [which offers inclusive care to all men] was like, oh you have to be on like a 9-month waiting list” (FG3, P2)

“All they wanted was a urine sample. Just a urine sample! I could’ve easily done that, no. It was sit down, wait, like, and, it was like 50 people ahead of me. Like it’s, you know, and I, and then they give me the, the thing, [urine specimen container], and I was like, they were like washroom’s right there, just leave it in the basket, and I was like, see how easy that could have been? It could have just been like boop, done. Leave.” (FG4, P5)

“At least nowadays with my doctor, if I call him and say I have the following thing, the doctor will pre-do the requisition, and you just go pick it up.” (FG4, P1)

“Why can’t there be something where I walk into a laboratory and say listen, I’d like to do an STI test and they know what to do. And they’ll say to you, well have you done x, y, and z today? Have you done this, you know, or here’s the sheet of paper, come back tomorrow. And, it’s far easier to go to a laboratory nowadays and, and do a test than it is to go to [a clinic]. (FG4, P1)

Clinic Ambience

Uncomfortable, overwhelming and anxiety provoking environment. Less accessible to non-English speakers and ethnoracial minorities

Non-judgmental safe environments with posters that emphasize inclusive spaces and information available in multiple languages

“Because it is fairly identity based, most of the people there are gay, or trans, and most of the volunteers present as such, which is fine, but because there’s not a lot of other resources, when there is like a straight man or, let’s, even better, an MSM who’s on the down-low, showing up there, it’s really, it can be really uncomfortable for them.” (FG1, P5 extended)

“Like that moment when you’re entering and all these gay eyes are like staring at you, I, I can echo that feeling of, super-uncomfortable. […] And I can only imagine for the poor 18-year-old kid, first time, […] he gets through that door and he’ll have these like 50 gays guys like looking at him, or not gay or, whatever, […] people just like look at you, no matter, it doesn’t have to be judging, they just, curious.” (FG2, P5)

“It’s important, that it [information] should be in different languages (FG2, P1)

“That’s why I don’t go there because like, if I sit next to like, all these guys and some of them are not reading me as male, then doing the men’s hours, like, yeah, how will I sit there, right? Cause like, half of them do read me as male, half of them don’t.” (FG3, P2)

“One tip I did hear that was really useful is that, having hospital spaces already have posters of trans folks, in campaigns cause then it just kinda gives like, while you’re in the waiting area, that this is a trans friendly space […]so that kind of makes people feel comfortable” (FG3, P2)