Table 3 Barriers and recommendations to improve bacterial STI testing: interactions with healthcare providers

Non-stigmatizing, Sensitive Language & Care

Perceived and enacted stigma and use of stigmatizing language

Recognize stigma and discrimination present in health services and creating processes that address them to deliver destigmatizing and trauma informed care

“When my friends have gone to other doctors, this is both gay friends, going to, maybe non-Village doctors, or straight friends, just at their GPs, when they ask for these things, half the time they’re told they don’t have them, or they don’t know how.” (FG1, P5 extended)

“I feel that it’s very, it’s not a sex-positive place. Like they will like, I don’t want to say slut-shame, but they’ll shame you if you have an STI and they have to understand like, it will happen if you’re having sex with condoms or without condoms. Things, skin-to-skin contact, things can transmit as well. If you test positive, they’ll be like you need to use condoms, you can’t do this anymore, and it’s like, we’re having an open, honest conversation like I’m here to get tested. I’m not neglecting my health.” (FG4, P2)

“We also have to recognize intersectionalities when it comes to things like, those who have addictions and mental health issues. Especially when, in the queer scene when party and play is a very big theme, and when you’re on substances, and not to stigmatize substance users at all, but to recognize the reality, that, that might also be a barrier for folks to get proper healthcare or to care, and that leads into addictions, self-esteem, and all of those factors that I think, play a huge part in our community.” (FG2, P1)

“I also know however that for members of the African-Caribbean and Black community, getting tested for anything is really not something that they run out of the door and go do. […] There are difficulties in getting people tested. Methods to get that changed, I haven’t the foggiest idea what to tell you. […] You have to break down so many barriers and homophobia, transphobia, the church, perhaps maybe that’s one way, to talk to members of the church and get them to get active in getting people saying go out and get tested?” (FG4, P3)

“Yeah, they can deny services that happened to me. […] I needed a checkup for HIV and other testing for my immigration, […] and the man was like, I am uncomfortable with knowing that you have a uterus or a vagina. And he asked me to leave.” (FG3, P2)

“It’d be great to be able to go to a place that’s warm and welcoming and you know, […] some place where you feel comfortable that they’re gonna keep your stuff confidential.” (FG4, P3)

“[It was the] rapport, yeah, and it was kind of amazing, when I went in the second time, I didn’t think like she’d recognise me, and she kind of gave me a smile and like I gave her a smile, like said, hello, and went in and we were chatting, and it also makes it a lot more easier to like, be honest and upfront and open about all my sexual experiences and then she has more information to make more sound decisions about the tests she’s giving me.” (FG2, P4)

“So you walk into a clinic and it’s a trans friendly or it’s a trans clinic, and then, you get greeted and you have a form that allows you to put in what name you preferred to be called and pronouns. And then the doctor greets you and asks, what are you here for, and you say, STI check, and instead of asking, oh are you trans and […] they did get that training.” (FG3, P2)

“[…] Even if it’s not like sexual violence, sometimes we just dissociate from those parts of ourselves; […] And so, when, there’s a checkup there, I know that, I get uncomfortable, but it’s probably because like, there is no, like I guess there’s like, that consent like, hey, what do you call your body part? Like, what makes you feel comfortable? You know if there was that check-in.” (FG3, P2)