Navigating sexual healthcare: a qualitative study on experiences, STI knowledge, and information sources among migrant men who have sex with men in the Netherlands

Abstract

Background

Migrant men who have sex with men (mMSM) may face barriers in accessing sexual healthcare and information, contributing to health disparities, as they are at increased risk of exposure to sexually transmitted infections (STIs), including HIV, hepatitis B, and hepatitis C. To better understand how healthcare systems can be made more equitable and responsive to mMSM’s needs, this qualitative study explored (1) mMSM’s experiences with sexual healthcare in their countries of origin and in the Netherlands, (2) STI and prevention knowledge, and (3) sources of sexual health information.

Methods

Semi-structured interviews were conducted with 15 mMSM aged 16 years and older from Eastern Europe, South/Central America, Asia, and Africa between December 2023 and April 2024. mMSM were recruited purposively by sexual health nurses at Dutch Public Health Service STI clinics in South Limburg, via snowball sampling and flyers until data saturation was reached. Interviews were transcribed verbatim and thematically analysed in ATLAS.ti using deductive and inductive coding by two independent researchers. Intercoder agreement was reached through consensus.

Results

mMSM reported limited and fragmented access to sexual healthcare in their country of origin, often shaped by stigma, taboos, and limited information, rather than uniformly poor care. Awareness of common STIs, particularly HIV, was high, although depth and accuracy of knowledge varied, while knowledge of hepatitis C was minimal or absent. Most participants were aware of HIV pre-exposure prophylaxis (PrEP) and hepatitis B vaccination, although detailed knowledge of correct use and underlying conditions was often limited or fragmented. In contrast, awareness and knowledge of post-exposure prophylaxis (PEP) were limited. Main sexual health information sources included general internet search engines, sexual health professionals, and the interpersonal social network, with differences in perceived reliability and accessibility between these sources.

Conclusions

Availability of sexual healthcare alone does not ensure equitable access for mMSM; barriers such as language, trust, and information gaps persist, highlighting the need for culturally responsive, stigma-free care and targeted prevention education.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12939-026-02938-4.

Background

By 2024, the global number of international migrants had risen to 304 million, representing 3.7% of the world’s population, almost double the 154 million (2.9%) recorded in 1990. Europe emerged as the principal host region, accommodating approximately 94 million international migrants, equivalent to 12.6% of its total population [1]. International migrants are defined by the International Organization for Migration (IOM) as individuals residing outside their country of nationality (or, for stateless persons, their country of birth or habitual residence), including those who move temporarily or permanently and in both regular and irregular situations [2].

While migration offers numerous social and economic opportunities, it also brings about specific vulnerabilities in health, particularly in the context of sexual health. Migrants generally face a heightened risk of acquiring infectious diseases, including bloodborne infections and sexually transmitted infections (STIs), such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and bacterial STIs, when compared to the general population [3, 4]. This elevated risk often results from exposure to endemic diseases in countries of origin. Migrants’ health vulnerabilities are further influenced by a range of personal, social, and structural factors [5, 6].

A French study found that 62% of HIV-positive migrant men who have sex with men (mMSM) acquired the infection post-migration, with 13% infected within the first year of arrival. Risk was notably elevated among younger men from sub-Saharan Africa or Asia, those experiencing significant social disadvantage, and those reporting high levels of sexual activity [7]. In Europe, access to primary care is shaped by structural determinants, which are broader societal systems and policies, such as immigration and healthcare policies, and social norms. Even where healthcare is formally accessible, migrants may experience missed opportunities for timely STI testing, resulting in delayed diagnoses and treatment [8]. This highlights that sexual health outcomes among migrants are influenced not only by pre-migration experiences but also by the social, legal and healthcare environments of host countries.

Despite historically progressive public health policies in countries such as the Netherlands, inequities persist in the uptake of STI testing and the use of preventive measures such as HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). These disparities are stratified not only by migrant status but also by sexual orientation [9]. mMSM may face additional, layered barriers to accessing sexual health care, such as social vulnerability, stigma rooted in cultural and religious beliefs, and limited knowledge of available services [6, 10]. These disparities, combined with the growing diversity of European societies, illustrate the urgency of developing STI prevention systems that are both inclusive and tailored to the specific needs and circumstances of marginalized groups [5].

The COVID-19 pandemic further exacerbated existing health disparities by impacting access and utilization of STI testing among MSM, highlighting systemic fragilities in care provision [11]. A recent Dutch study confirmed that COVID-19 measures worsened existing disparities in STI care, with the greatest impact on vulnerable groups with limited (digital) health literacy [12]. Although the pandemic intensified marginalisation for some, it also accelerated innovation in care delivery, such as increased use of telehealth and other modalities, offering new possibilities for inclusive sexual healthcare [13]. To ensure resilience for future public health crises, sexual health systems must become more integrated, (digitally) inclusive, and culturally competent [10, 14, 15].

However, important gaps remain. Differences in healthcare systems, language, social context, and prior sexual health education may affect STI knowledge and service use among mMSM. Despite this, research on their sexual health knowledge and healthcare experiences in European settings remains limited, partly due to the sensitivity of the topic. Qualitative approaches are particularly well suited to address this gap, as they capture lived experiences and context-specific factors that are not easily assessed through quantitative methods.

This qualitative study explored mMSM’s lived experiences in relation to sexual healthcare in both their country of origin and in the Netherlands. Furthermore, it assessed their knowledge of STIs and prevention and identified their sexual health information sources. By centring the voices of mMSM, this study contributes to a deeper understanding of how healthcare systems can be made more equitable, accessible, and responsive to the needs of marginalized communities. In the context of ongoing national efforts in the Netherlands to reduce health inequalities among migrant populations, these findings will provide actionable insights to move beyond access and promote equitable, culturally responsive care.

Methods

Study design

In this qualitative study, semi-structured interviews were conducted with mMSM. To frame and interpret the qualitative data, we employed thematic analysis, as described by Braun and Clarke [16]. For reporting, the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines were followed (Appendix 1).

Participant recruitment

mMSM were purposively recruited by nurses during consultations at three STI clinics at Public Health Services in South Limburg (southern part of the Netherlands) (hereafter referred to as PHS), as previously reported [9]. Selection was based on predefined eligibility criteria and demographic variation to capture diverse experiences. Inclusion criteria required participants to be at least 16 years old, assigned male at birth and sexually active with other men, currently residing in South Limburg, and of origin from Eastern Europe, Central- or South America, Asia or Africa. These inclusion criteria were selected to focus on migrant MSM in South Limburg who are most relevant to sexual health services, particularly those from regions well represented among regional PHS attendees, where structural barriers, differences in STI epidemiology, and limited access to sexual health information may shape healthcare needs. In addition to recruitment at the PHS, snowball sampling was utilised through bilingual (Dutch-English) flyers provided to both interviewees and professionals to facilitate inclusion of individuals who may not be reached through routine care. These materials were voluntarily distributed within personal networks, at Lesbian, Gay, Bisexual, Transgender, Queer, and other sexual orientations and gender identities (LGBTQ+) events, and in communal settings such as asylum seeker centres (ASC). Once a potential participant was identified in-clinic, they received verbal information and a bilingual pamphlet. If they showed interest and verbally agreed to participate, their contact details were securely transferred to a designated research nurse who arranged the interview. Of 17 recruited mMSM, two later withdrew due to personal reasons. Recruitment continued from December 2023 through April 2024 and concluded upon data saturation, defined as the point at which no new themes or insights emerged from successive interviews during the ongoing analysis.

Interview setting

To ensure comfort and confidentiality, interview locations were determined in collaboration with the participants. Interviews took place at PHS premises, participants’ homes, or virtually via Teams when a face-to-face meeting was not possible. Offering multiple settings allowed participants to choose an environment in which they felt at ease, which may have facilitated openness and the sharing of personal experiences. A professional interpreting service was arranged to support non-native speakers, helping to ensure accurate and inclusive communication.

Two female professionals conducted the interviews: a sexual health nurse with extensive experience with this population through clinical interactions, and researcher CM (MSc) who is part of an experienced research team in this field [17]. This was a deliberate methodological choice, as prior experience within the PHS suggested that mMSM may feel more at ease discussing sensitive topics such as sexual health with female interviewers. The nurse led interviews with mMSM, drawing on her trust-building and conversation skills, and familiarity with the population through clinical interactions. As a result, some mMSM participants had already established a trusting relationship with the research nurse during sexual health consultations. The interviewers had received training in qualitative interviewing, either as part of their academic education or through training in conducting interviews on sensitive topics.

All interviews took place in private, without third-party presence. Prior to beginning, participants were briefed again on the study aims, the interviewer’s professional background, and the interview structure. At the end of the interview, participants received a thank-you gift consisting of €25 in online shopping credit, condoms, and educational materials on sexual health.

Data collection

The interviews were guided by a semi-structured topic list (Appendix 2), covering demographics, STI and prevention knowledge, information sources, sexual healthcare and education experiences in the country of origin and in the Netherlands. The topic list was developed in consultation with sexual health professionals and iteratively adjusted to ensure conceptual clarity and relevance. Interviews commenced only after participants signed an informed consent form. Conversations were audio-recorded and transcribed verbatim by a certified transcription service. Transcripts were not returned for participant validation, nor were second interviews or feedback rounds conducted due to safety concerns. Some mMSM had precarious legal status or had been refused asylum, and could only be contacted by phone, making it challenging to ensure meaningful input from all participants. In addition to thorough discussion with the second coder, the process and data interpretations were reviewed with the project team, including professionals from the Centre for Sexual Health, and senior researchers, to enhance analytic credibility. We recognize that our professional backgrounds and prior engagement with migrant and LGBTQ+ communities may have shaped interaction with participants, data collection, and interpretation. Measures were taken to minimise stigma and distress, including the use of non-judgemental and inclusive language and LGBTQ +- and migrant-sensitive interviewing practices. Participants were assured of confidentiality and informed that they could pause, skip questions, or discontinue the interview at any time. Breaks were offered when needed.

Data analysis

Verbatim transcripts were anonymised and coded using ATLAS.ti (online version), following Braun and Clarke’s approach for thematic analysis [16]. A hybrid coding strategy was applied: deductive codes stemmed from the interview topic guide, while inductive codes emerged from the data during analysis. Coding was carried out independently by CM (MSc) and JB (MSc). Divergences were discussed and reconciled collaboratively. Codes were iteratively refined and organised into themes that largely reflected the predefined topic guide, supported by constant comparison across transcripts and regular team discussions, resulting in a coherent, data-driven set of themes. The codebook is provided in Appendix 3.

Results

Description of the sample

Of the 15 mMSM, six originated from Central and South America, four from Asia, two from Africa, two from Eastern Europe, and one from the Caribbean (Table 1). The majority held university degrees, with an average age of 31.7 years (range: 20–53), and had lived in the Netherlands for an average of 4.1 years (range: 9 months to 8 years). The interviews took approximately 1.5 h. Of these, nine took place at the PHS, three online via Microsoft Teams, and three at the participants’ residences – including one at an ASC. Ten interviews were conducted in English, four in Dutch and one with the assistance of a Spanish-Dutch telephone interpreter.

Table 1.

Characteristics of the participants

Characteristic	N (%)
Sex assigned at birth
Male	15 (100)
Age (in years)
18–30	6 (40)
31–40	8 (53)
40+	1 (7)
Country of origina
Central America	3 (20)
Caribbean	1 (7)
Eastern Asia	1 (7)
Eastern Europe	2 (13)
Northern Africa	1 (7)
South America	3 (20)
Southern Africa	1 (7)
Western Asia	3 (20)
Education level
Secondary vocational education	3 (20)
Higher professional education	2 (13)
University education	10 (67)
Years in the Netherlands
0–5	11 (73)
6–10	4 (27)

^a Following the United Nations Statistics Division geographic regions [18]

Experiences in the country of origin

Stigma, discrimination, and violence

Most mMSM described their country of origin as marked by strong taboos surrounding sex(uality), often reinforced by social, cultural, and religious norms that stigmatised same-sex relationships. As a result, discussions about sexuality and sexual health(care) were often limited, absent, or even forbidden: “That wasn’t allowed, because if you simply claim that [being a man who has sex with men], you could also be sentenced to prison.” (mMSM from Western Asia). This environment contributed not only to non-disclosure of sexual orientation, but also to experiences of discrimination and, in some cases, threats to personal safety, including violence or even forced migration: ‘’I left my country because of my situation [being gay] and my family tried to kill me because of that. And also, because of that I changed my religion because my religion was so strict. So, for both of that, I left my country.’’ (mMSM from Western Asia).

Religion was mentioned by over half of the participants as one of several factors shaping these social norms and reinforcing taboos around sexuality: ‘’Being gay, it’s something that’s really rough, because we have a lot of issues that are against being an LGBT person, as religious issues, political issues, cultural issues. So it’s basically really difficult, because when you’re surrounded by people who think that actually it’s not good being a gay person, it’s really difficult there. I mean, sometimes you can receive physical aggression, but others, that’s the more complicated, psychological aggression, few comments and things that doesn’t make you feel welcome. Those comments or that physical aggression can also come from your family, friends. It’s like, it’s everywhere, you can say in a way.’’ (mMSM from Central America).

In addition to sexuality-related stigma, discrimination, and violence, participants also described experiences of HIV-related stigma, which appeared to be driven primarily by misinformation and institutional practices, rather than religious beliefs: ‘’Like, no one wants to be in contact, especially in my country, with one [person living with HIV], even though if they are in treatment. I think education like, [in] a big part of Europe, most people or a big part of the population are aware of these kinds of treatments and they are more, more open about this. But eh, outside of here [Europe], I don’t know, I think it’s still a taboo and people are just afraid of that or being in contact with people with HIV.’’ (mMSM from Central America). One participant referred to perceived formal registration or monitoring of people living with HIV: ‘’And up until now, it has always remained a taboo in (country of birth). Because, as I’ve heard from certain doctors in [country of birth], every HIV-positive person is basically placed on [country of birth’s] blacklist. Yes, labelled as a high-risk profile, and told to be extremely careful with people like that.” (mMSM from Northern Africa).

Sexual education

Sexual education at school in the country of origin, which was explicitly explored during the interviews, was largely absent or minimal; nearly two-thirds of mMSM participants reported no formal sexual education or only limited biological information on reproductive organs: ‘’No, we don’t have that kind of education in [country of birth]. And I must say that sexual health education is very poor in there, or non-existent at all.’’ (mMSM from Central America). However, some reported having received sex education and a non-judgemental environment, suggesting that access to sexual education may also be influenced by school type and socioeconomic context, rather than solely by country of origin: ‘‘I was in an American school in [country of birth], so it was more of a private school and we got like sex education stuff as well. So I have always been aware, my family has always been really open about it also and protection is important and stuff like that.’’ (mMSM from South America).

Sexual healthcare services

Approximately one-quarter of the participants reported never having received information about where to access STI testing in their country of origin: ‘’In my country don’t, it’s not good to talk about that [STI testing]. [It is] also forbidden.’’ (mMSM from Western Asia). Among those who had accessed sexual healthcare, pathways to care varied considerably, reflecting differences across countries, healthcare systems, and social contexts. The most cited providers were non-governmental organizations (NGOs) offering STI testing specifically for the LGBTQ community, often through outreach initiatives such as mobile rapid testing units, HIV campaigns, or university-based programs. These findings suggest that access to sexual healthcare was often fragmented and reliant on targeted initiatives rather than integrated within formal healthcare systems, and was shaped by social taboos, stigma, and limited availability of information. At the same time, some participants reported accessing care through general practitioners or specialized infectious disease departments within hospitals, indicating variability in service availability. Less frequently mentioned venues included community centres, family planning clinics, PHS, and the use of over-the-counter self-testing kits purchased from pharmacies.

Sexual healthcare in the Netherlands

Most participants, who were recruited through and had experience with PHS sexual health clinics, described these services positively when compared with sexual healthcare in their country of origin. In particular, they valued the free and accessible STI testing, comprehensive information provision, and the non-judgemental approach of PHS staff for MSM. Additionally, participants highlighted the importance of clear guidance and support in navigating the healthcare process, which facilitated understanding of available services and next steps. Participants also expressed a preference for specialized sexual health services over general practitioners and asylum seeker healthcare (GZA) in this context, emphasizing the importance of expertise, appropriate communication, and a setting where they did not need to explain their sexual identity or health concerns: ‘’The fact that there is a set company in this country for this, is wonderful.’’ (mMSM from Southern Africa). However, some participants were hesitant to access care because they were not used to talking openly about sex and sexuality ‘’Yes, in the beginning I found it a bit more difficult [accessing sexual healthcare in the Netherlands], because I was raised in a Christian family, where religion was important and where all of that [being a MSM] was somewhat controversial.” (mMSM from the Caribbean).

Participants frequently expressed satisfaction with the absence of taboo surrounding sexual health: ‘’It [sexual healthcare] is not a taboo at all. For example, I notice that everyone is open to get tested. Everyone knows what HIV means. Everyone knows what sexual diseases like gonorrhoea or chlamydia are. Also, younger guys in their 20s-24s are also very well informed about what to do; that they should use condoms and so on. And that you [the PHS] are always available for people to get tested and inform people. […] Everyone here is very alert.‘’ (mMSM from Northern Africa). However, some participants, while generally satisfied, identified areas for improvement, particularly regarding language accessibility and navigating the Dutch healthcare system, especially for newcomers or when moving between regions: ‘’At the beginning I got confused a lot, because I don’t know about the names of the stuff in here. I don’t know ‘GGD’ [PHS], what does it stand for, like, sexual health or something? So [information] being in Dutch most of the time, I think it’s not that friendly for a new incomer.’’ (mMSM from Central America). These findings suggest that, although PHS services were often perceived as accessible and supportive, barriers related to language and system navigation may still affect equitable access to care. One participant did not know anything about Dutch sexual healthcare because of the long and turbulent migration admission process.

Knowledge and information sources

STI and prevention

Participants demonstrated uneven STI and prevention knowledge, with clear differences between awareness, general knowledge, and accurate understanding. Most participants were aware of common STIs, such as HIV, gonorrhoea, chlamydia, syphilis, and human papillomavirus (HPV). While half of the participants mentioned transmission routes and distinguished between curable and chronic infections, still a third presented only limited or inaccurate information and knowledge. In exceptional cases, STI rates, STI-specific symptoms, and STI testing methods were mentioned.

Compared to other infections, HIV was more consistently recognised and understood, although gaps in accurate knowledge remained. Many participants demonstrated a relatively good understanding of HIV transmission, treatment, and the distinction between HIV and AIDS. Knowledge was often shaped by personal experiences, such as contact with someone living with HIV or perceived exposure, rather than structured education. At the same time, participants reflected on a shift from viewing HIV as a fatal condition to understanding it as a manageable chronic illness, although stigma-related perceptions persisted.

Awareness of HIV PrEP was high, as almost all participants had heard of it and understood its primary function in preventing HIV. However, detailed knowledge of its correct use (daily versus on-demand use) varied, indicating a gap between general awareness and detailed knowledge. In contrast, knowledge of PEP was considerably more limited, with many participants unfamiliar with its purpose or availability: ‘’I have heard about it before and I knew there was some sort of relation between the two, but I don’t know what it is.’’ (mMSM from Southern Africa). Knowledge of both PrEP and PEP was often acquired through interaction with healthcare services or following perceived risk situations, rather than through proactive education. Additionally, some participants reported structural barriers, such as waiting lists or changes in cost, which limited access despite awareness: ‘’The first time [I went to the PHS I] just got a lot of information from you guys just like that. I had done something stupid; I had just thought eh, just now [it’s] just too much information [for me] at the PHS, I just want to take it easy. And then [when] I was ready to take PrEP, the list was just full and they couldn’t put me on the list.‘’ (mMSM from Western Asia).

Similarly, knowledge of viral hepatitis varied. Some participants reported awareness of HBV, often linked to vaccination programmes in their countries of origin or information received in the Netherlands: ‘’Because they [PHS staff] asked me do you have the vaccine, I said yes. They asked me, are you sure, because I know it is not a [mandatory] thing here, I said yes, I am sure. But let’s just run a test, because I understand that you may have to get another one [vaccination], right, if you are still not protected. But everything was okay. And in my country, it is a big disease, so you just get the vaccines when you are a kid, it is like a mandatory vaccine.’’ (mMSM from South America). Some had a family member or a friend who experienced acute HBV infection and therefore knew the symptoms. Furthermore, a few participants knew it affected an organ. Notably, several participants reported being vaccinated against HBV without having a clear understanding of the infection itself, sometimes confusing it with other STIs such as HPV. This suggests that vaccination and exposure to care do not necessarily translate into comprehensive knowledge, and that understanding was often fragmentary or experience-driven rather than based on structured education.

In contrast to HBV, which was often recognised in relation to vaccination, HCV was largely unfamiliar to participants. Knowledge of HCV was minimal, with many participants having little to no prior awareness of the infection or confusing it with other types of hepatitis. This suggests that HCV is not well integrated into participants’ risk perceptions, and that knowledge, where present, was often fragmented or influenced by language and contextual understanding.

Overall, these findings indicate that while participants were often aware of key infections and prevention methods, their understanding was incomplete and uneven, with stronger knowledge in areas that are more publicly visible or actively promoted (e.g., HIV and PrEP), and more limited knowledge of less visible infections and prevention strategies.

Information sources

Participants reported using multiple sources to obtain sexual health information, most commonly general internet search engines such as Google, healthcare professionals in the Netherlands, and social networks. However, these sources differed markedly in terms of accessibility, trustworthiness and relevance, which shaped how participants accessed and interpreted information. General internet searches were the most frequently used source, reflecting their ease of access. However, reliance on search engines often indicated uncertainty about where to find reliable or official information.

In contrast, healthcare professionals, especially sexual health nurses at the PHS, were cited by approximately half of the participants. Participants emphasized the importance of receiving clear, reliable, and personalised information from professionals. This highlights the role of trusted, face-to-face interactions in translating general awareness into accurate understanding.

One-third referred to their social networks, their interpersonal relationships, for example friends or sexual partners, as sources of information: ‘’Ehm, I think a part of it [STI knowledge] is Googling, a part of it is experience, a part of it is being around people who organized themselves when it comes to these topics, especially when I was younger, so I heard something here and there.’’ (mMSM from Eastern Europe). While these networks facilitated information sharing and normalisation of sexual health topics, the information obtained was not always perceived as reliable, and participants often expressed a preference for confirming such information with professionals. Less frequently cited sources included social media platforms, physicians in countries of origin, school-based sexual education, and television. Overall, these findings suggest that access to sexual health information among mMSM is shaped by a combination of readily accessible but variable-quality sources, and more trusted but less immediately accessible sources such as health professionals.

Discussion

mMSM are an important underserved group for sexual healthcare, who were included in the current qualitative study to gain insight into their experiences and to better understand how healthcare systems can serve mMSM more equitably. Our findings highlight that, although sexual healthcare services are formally available, equitable access for mMSM depends on language, system navigation, trust in care, stigma-free interactions, and the availability of tailored and understandable information. Many mMSM in this study experienced sexuality-related stigma, and in some cases discrimination or threats to safety, in their countries of origin. These experiences varied across individuals and contexts and should not be viewed as uniform. This stigmatisation was often compounded by limited access to sexual healthcare services and a lack of comprehensive sexual health education. In contrast, participants, who almost all had experience with the PHS, expressed a high level of satisfaction with the PHS sexual healthcare services, particularly valuing the non-stigmatising and comprehensive care provided. However, several participants reported difficulty navigating the Dutch healthcare system, especially because information was primarily available in Dutch. A lack of multilingual information and clear navigation highlights the distinction between the formal availability of sexual health practices and the extent to which these services are equitably accessible in practice. Although participants demonstrated awareness and general knowledge of STIs, their accurate and detailed understanding was considerably more extensive regarding HIV, PrEP, and HBV(-vaccination), than for HCV and PEP. Internet search engines were identified as the primary source of sexual health information, followed by professionals of the PHS and social networks. While widely used, these sources differed in trustworthiness and (language) accessibility. Participants relied on professionals as the most trusted source, suggesting that familiarity with the healthcare system may influence how information is sought, understood, and applied, particularly among migrants navigating a new healthcare context.

MSM continue to be misunderstood, stigmatised, and subject to discrimination across many settings [19]. The stigmatisation of LGBTQ + sex and sexuality in the countries of birth in this study was described in relation to social norms, taboo, misinformation, and in some cases religious or cultural influences. For some participants, the primary motivation for migrating to the Netherlands was the non-acceptance or, in some cases, experiences of violence or persecution related to their sexual orientation. Despite a global trend toward decriminalising same-sex sexuality, a parallel counter-movement of intensified criminalisation is also emerging [20]. The European MSM Internet Survey (EMIS study) showed that structural stigma directed at sexual minorities—both in countries of origin and destination—as well as stigma targeting immigrants within host countries, was found to be significantly associated with diminished HIV prevention knowledge, restricted access to relevant health services, and reduced engagement in protective behaviours among mMSM [21]. These findings indicate that the presence of services alone does not guarantee access, as anticipated stigma may impede individuals from seeking care and from effectively accessing available care, thereby restricting access to information and preventive interventions. The EMIS study also found that knowing the local language and living longer in the new country reduced some of the negative effects of stigma, showing that settling in can soften its impact. Because stigma can be prevented and changed, tackling it is a key part of global HIV prevention efforts, especially to close gaps for mMSM [21].

Beyond stigma-related experiences, our study revealed that comprehensive sexual education was generally lacking, often limited to biologically oriented learning material. These findings reflect participants’ retrospective experiences, which varied across countries, time periods, and educational contexts, and may not represent current educational provision. Comprehensive school-based sex education has been shown to decrease HIV-related risk by improving knowledge, self-efficacy regarding sex-refusal, condom use, and fewer sexual partners [22]. Our results suggest that access to such education was uneven and context-dependent. In addition, we found that access to sexual health services in the participants’ country of origin was generally poor, due to a lack of information on services and prevailing LGBTQ+ stigma. Providing information on local sexual healthcare services during sexual education can play a vital role in connecting young people to care and address barriers such as confidentiality concerns [23].

In contrast to the often-limited access described in countries of origin, participants, who almost all had experiences with the PHS, expressed strong appreciation for PHS sexual health services in the Netherlands. These findings indicate that specialised, low-threshold and non-judgemental services can effectively support engagement in care. Nevertheless, our findings suggest that equitable access depends not only on formal service availability, but also on the findability of comprehensible information on healthcare services, and trust that care can be accessed safely and confidentially. This study forms part of a broader project in which, besides the fifteen mMSM, ten professionals were interviewed on access to sexual healthcare and outreach strategies. The findings underscore the importance of designing accessible healthcare services with clear, user-friendly care pathways that reduce personal, social, and structural barriers. Practical measures include providing multilingual, culturally relevant and easy to understand information and ensuring LGBTQ + and migrant-sensitivity of staff [10].

While general knowledge of STIs was common, this often reflected awareness rather than comprehensive understanding and varied by individual and by type of infection. HIV was the most well-known, and mMSM expressed widespread awareness of PrEP, though familiarity with PEP was more limited. This highlights a gradient in prevention knowledge, with more visible interventions as PrEP being better understood than less familiar strategies, such as PEP. This was also found in another Dutch study, in which all migrant groups were less likely to be familiar with PEP in comparison with non-migrant MSM [9]. Knowledge of HBV was moderate, often linked to information provided by the PHS on vaccinations, whereas understanding of HCV was minimal. Findings from the EMIS study indicate that in the Netherlands, knowledge of hepatitis (A and B) in MSM is notably higher than the European average; namely 80% vs. 68% [24]. Furthermore, sexual orientation disclosure during the last STI test was significantly associated with more basic hepatitis knowledge in the EMIS study, underscoring the need for safe and welcoming medical services for all to convey targeted (vaccination) information and other (pharmaceutical and non-pharmaceutical) STI prevention measures [24]. Although sexual healthcare is generally well-organised in the Netherlands, there remains significant room for improvement in effectively reaching mMSM populations. Our findings indicate the need to increase knowledge of lesser-known STIs and prevention strategies, particularly PEP.

In this study, general internet search engines emerged as the principal source of sexual health information, followed by interactions with PHS professionals and discussions within individuals’ (sexual) networks. The predominant reliance on technology as the primary source for accessing sexual health information among MSM is consistent with findings from previous research [25–28]. This reliance also highlights potential inequities related to digital literacy and language proficiency, which may shape access to care despite service availability. While digital sources were commonly used, participants distinguished between use and trust, with professional sources considered trusted. This is echoed by a study conducted among MSM in Georgia, which identified healthcare providers and sexual partners as the most trusted and commonly consulted sources of information [29]. This offers diverse opportunities for improving outreach to mMSM who are not engaged in the care system.

Implications for practice

Across Europe and in the Netherlands, the implementation of migrant-sensitive healthcare, including the broad provision of culturally appropriate and accessible mMSM (online and in person) information, remains limited and inconsistent [30]. A recent Dutch study also reinforced this, revealing that individuals with intersecting vulnerabilities, such as a practical (vocational) education background, a migration background, and limited financial resources, are often inadequately reached by sexual healthcare services [15].

To reduce disparities in sexual health among mMSM, we propose three practical recommendations. First, sexual health services should be culturally responsive and stigma-free, with explicit attention to migration-related and intersectional vulnerabilities. This requires creating safe, non-judgemental environments in which mMSM feel comfortable to discuss their experiences and concerns openly, and where healthcare providers actively explore the impact of migration and their social context on sexuality and health during consultations. Stigma reduction should be supported by normalising routine STI testing and biomedical prevention, such as HIV PrEP and PEP, for example through neutral and inclusive language and by framing these interventions as comparable to other routine preventive measures (e.g. vaccinations).

Second, although participants reported greater openness around sexual health and prevention compared with their countries of origin, important knowledge gaps persist. Sexual health services should therefore offer tailored, culturally appropriate education that addresses misconceptions and strengthens understanding, particularly regarding lesser-known infections such as HCV and prevention options such as PEP.

Third, as most participants relied on general internet search engines for sexual health information, sexual health service websites should be optimised for commonly used search queries (search engine optimization; SEO). Moreover, the websites should provide clear, multilingual information on sexual health, available services, and confidentiality protection. This can support mMSM in navigating the Dutch sexual healthcare system and accessing appropriate care.

Strengths and limitations

A strong feature of this study is the in-depth qualitative analysis of lived experiences of mMSM, which is often lacking in quantitative surveys. Furthermore, the study included mMSM from diverse countries of origin, reflecting a broad range of cultural backgrounds and experiences. We want to emphasize that these findings reflect individual experiences, which may vary depending on personal, cultural, and structural factors. Additionally, selection bias cannot be excluded, as participants recruited at the PHS who agreed to participate may have been more likely to have good experiences with sexual healthcare and to report them, potentially resulting in an overrepresentation of positive service experiences. As recruitment was primarily clinic-based, most participants were already engaged in sexual healthcare and relatively highly educated, which may have influenced their knowledge, health literacy, and ability to navigate services.

Besides, the sample likely is not fully representative of the broader mMSM population in the Netherlands, particularly those less engaged with healthcare services, with no or practical education, with lower literacy levels, living in more precarious circumstances, or originating from countries not included in this study. The predominance of interviews conducted in English and Dutch may have underrepresented mMSM with lower language proficiency. These groups may experience additional barriers to care, such as limited health literacy and competing survival priorities. Social desirability bias cannot be excluded, and prior contact between some participants and the interview nurse may have influenced responses. Finally, the diversity of countries of origin combined with small subgroup sizes limited interpretation of differences across contexts and affects transferability. Consequently, our findings may underestimate barriers and overestimate the accessibility of sexual healthcare for the wider mMSM population, highlighting the need for research targeting mMSM who have not yet accessed such services.

Conclusions

In conclusion, this study shows that the formal availability of sexual healthcare does not automatically ensure equitable access for mMSM. Among participants with experience of Dutch PHS sexual health services, care was generally perceived as accessible and non-judgemental. However, access depended on factors such as language, navigability of the system, trust in services, and the availability of tailored and comprehensible information. Persistent gaps in practical prevention knowledge, particularly regarding PEP and HCV, highlight the need for targeted education. Reliance on general internet sources underscores the importance of improving the findability, reliability, and linguistic accessibility of sexual health information. Together, these findings emphasise that strengthening equitable access requires not only the provision of services, but also attention to how these services are communicated, navigated, and experienced by mMSM.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

mMSM

Migrant men who have sex with men

STIs

Sexually transmitted Infections

PrEP

Pre-exposure prophylaxis

PEP

Post-exposure prophylaxis

HIV

Human immunodeficiency virus

HBV

Hepatitis B virus

HCV

Hepatitis C virus

COREQ

COnsolidated criteria for REporting Qualitative research

PHS

Public Health Service

LGBTQ+

Lesbian, Gay, Bisexual, Transgender, Queer, and other sexual orientations and gender identities

ASC

Asylum seeker centres

NGOs

Non-governmental organizations

HPV

Human papillomavirus

EMIS study

The European MSM Internet Survey

FHML-rec

Faculty of Health Medicine and Life Sciences of Maastricht University

CAPI

Dutch Collaborative Academic practice for Public health Infectious diseases

IOM

International Organization for Migration

Author contributions

CM: Conceptualisation, Formal analysis, Funding acquisition, Investigation, Project administration, Writing – original draft. CH: Conceptualisation, Funding acquisition, Supervision, Writing – review & editing. CdH: Conceptualisation, Funding acquisition, Project administration, Supervision, Writing – review & editing. JB: Formal analysis, Writing – review & editing. MW: Conceptualisation, Project administration, Writing – review & editing. YE: Writing – review & editing. NDM: Conceptualsation, Funding acquisition, Supervision, Writing – review & editing.

Funding

This work was supported by the National Institute for Public Health and the Environment [no funding number]. The funder had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Data availability

The data of this study contain potentially identifying and sensitive participant information. Due to the General Data Protection Regulation, it is not allowed to distribute or share any personal data that can be traced back (direct or indirect) to an individual. In addition, publicly sharing the data would not be in accordance with participants’ consent obtained for this study. Therefore, data used and/or analysed during the study are available from the head of the data-archiving of the PHS South Limburg on reasonable request. Interested researchers should contact the head of the data-archiving of the PHS South Limburg (Tamara Kleine: [tamara.kleine@ggdzl.nl]) when they would like to re-use data.

Declarations

Ethical approval and consent to participate

The study, including the protocol, participant information form and written informed consent form, was approved by the medical ethical committee of the Faculty of Health Medicine and Life Sciences of Maastricht University (FHML-REC) (reference number FHML-REC/2023/096). Written informed consent was obtained from all individual participants included in the study.

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this work, the authors used ChatGPT (OpenAI Inc) version 3.5 to improve the readability and language of the manuscript. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article.

Competing interests

The authors declare no competing interests.