Table 3.

Barriers and Facilitators to Anal Cancer Prevention.

Theme	Subtheme	Supporting Quote
HPV-related Knowledge	Knowledge about HPV	Personally, I’m 30 years old and I had never heard about it until my friend told me and that’s when I did some research. It would be great if people were informed. (Participant 4, Colombia, Age 30)
	Does not affect men	Well, I had heard about it when I was in high school. I didn’t know how it was with gay men, particularly in terms of how common it was, and now I know it’s really common and that it’s—there’s really no vaccine for it. I mean, there is for women but it’s until a certain age, from what I understand, and, yeah. I mean, you’re basically treated (Participant 21, Colombia, Age 25)
	Anal warts	Well, I have heard that it develops over the years and your body also produces it. I had a boyfriend once, he was positive and three years later he got some warts. The doctor told him he had a problem, I freaked out because I said—not only does he have HIV but he also has this. I thought it was contagious. But now I actually think that it’s a skin condition that is more or less normal. (Participant 8, Venezuela, Age 43)
Facilitators to HPV vaccine	Provider recommendation	Out here, the primary care is always speaking to them, and they [the Hispanic patients] really listen. Even though you think they’re not listening, they’re listening. I’m a peer educator, and I ask patients to consult with the doctor. After health care visits they tell me “Oh, I’m scared because the doctor just told me about such-and-such. (Participant 20, Honduras, Age 26)
Barriers to HPV vaccine	Lack of knowledge	People don’t have the least idea [about anal cancer], just like me. (Participant 2, Mexico, Age 44)
	Health insurance	Sometimes it’s the health insurance and also because they don’t go to the doctor. Because I know a lot of people that want to come and get a checkup but they can’t because they don’t have insurance, others are busy with work. But more than anything because they don’t have insurance. (Participant 10, Chile, Age 68)
	Side effects	That they tell you that it has effects—that it’s going to cause fevers or that you’re going to feel bad (Participant 20, Honduras, Age 26)
Barriers to screening for anal dysplasia	Stigma associated with sexual orientation	I’ve lived here 30 some years and it’s so closeted. I believe the culture, the Latin culture just has it so—they want to be open and out, there’s so much on the down low in this county. I dated a man for ten years who was married with kids. (Participant 31, Dominican Republic, Age 53)
	How sexual orientation is defined	There is a taboo about men having sex with men. A lot of men do not consider themselves as homosexuals, but they have sex with other men. (Participant 9, Cuba, Age 46)
	Intersectionality of sexual orientation and HIV stigma	I am from Venezuela is not much approved of, it is not accepted. This is the reason that the homosexuals begin have the habit of hiding. That world—it’s an underground world. Everything is hidden. As a homosexual, you are not accepted and not respected. Now, imagine how it would be to have HIV. (Participant 11, Venezuela, Age 45)
	Embarrassment of testing procedure	Mostly embarrassment. Yeah. You don’t want anybody playing with your butt. Right? I mean, let’s be honest. (Participant 20, Honduras, Age 26)
		I was embarrassed the first time. I was forty-three years old. The doctor put his finger inside me and I pushed it out. I was like, “No, no”, but after that I was like, “I have to do this because otherwise I will never know if I am well”. (Participant 1, Cuba, Age 56)
	Perceptions of how the test will impact masculinity	I think we believe that performing this test will make you less of a man. (Participant 4, Colombia, Age 30)
	Fear of anal dysplasia testing results	I would be scared to have a positive result. I wouldn’t know how to react about that but not as bad as with HIV. (Participant 5, Cuba, Age 59)
Self-screening for anal dysplasia	Prefers self-screening	It would be easier because there’s no fear of going to a doctor and explain everything for example nowadays there’s a test called Orasure test or Oraquick, and you can find it in pharmacies and it’s easier for people to take the test and then to go to the doctor. (Participant 5, Cuba, Age 59)
	Prefers health care providers conduct screening	I’d prefer the clinic because in case I don’t consider something and I infect the exam and the results would be wrong. I’d prefer this is done by the right person and in the right place. That’s something important because they’re detecting a cancer, and for people like us with a weak immune system will be better to go to the right place. (Participant 27, Cuba, Age 37)

Abbreviations: HIV, human immunodeficiency virus; HPV, human papillomavirus.