"So Much Is at Stake": Professional Views on Engaging Heterosexually Identified Men who Have Sex with Men with Sexual Health Care in Australia

Australian HIV prevention, testing, and treatment services are well-established for men who have sex with men (MSM) who identify as gay or bisexual. However, the sexual health needs of heterosexually identified MSM (hereafter called "straight MSM" as a shorthand) and opportunities to engage this sub-group with services and information are less clear. Semi-structured interviews were conducted in 2015-2016 with 30 professionals working in the sexual health sector in the state of New South Wales, Australia. Participants viewed straight MSM as comprising multiple, intersecting sub-groups, but sharing a common preference for services which promise "discretion" and "confidentiality", and information which does not presume an alignment between gay identity and sex between men. Participants described these men as typically very concerned about keeping this aspect of their sexual lives secret and separate from their family, work, and community lives. Participants were keenly aware of both the benefits and the challenges of providing respectful and non-judgmental care. This exploratory study provides initial evidence of the complexities of engaging straight MSM with sexual health care and suggests a range of strategies for increasing cultural understanding of the diverse sexual practices that can be present in the lives of some heterosexually identified men.