‘A tale of two seaside cities’ Identifying the barriers and enablers of access to sexually transmitted infection (STI) prevention methods for heterosexual-identifying men who have sex with men in two English coastal communities.

Research question: What are the barriers and enablers of access to sexually transmitted infection (STI) prevention services for heterosexually identifying men who have sex with men (HIMSM) living in coastal communities? Objective: This study aims to investigate the sources of sexual health information utilized by HIMSM and identify factors that may enhance their uptake of interventions to prevent STIs. The research will focus on two seaside towns: Brighton, Sussex, and Skegness, Lincolnshire. Background: The UK has seen a recent rise in incident syphilis and HIV diagnosis among people who identify as heterosexual, against the backdrop of rising diagnosis of STIs in all groups. A contributing factor is thought to be transmission networks involving men who have sex with both women and men. Many sexual health interventions focus on gay, bisexual and other men who have sex with men as a homogenous group, however some identify as heterosexual and so may miss out on health promotion messages aimed at the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) community. This can lead to later diagnosis and poorer health outcomes for this group. People living in coastal communities also face poorer sexual health outcomes, further highlighting the need for targeted prevention efforts. Identifying barriers and enablers to accessing STI prevention for HIMSM can improve sexual health outcomes and help meet the government's goal of zero new HIV transmissions by 2030. Aims and objectives: 1. To appraise the existing evidence surrounding the sexual health needs and behaviours of HIMSM. 2. To quantify the size of the population of HIMSM and identify what, if any, characteristics of this group are currently known. 3. To identify and explore factors which may motivate or prevent HIMSM from accessing sexual health care. 4. To explore geographical variation in the barriers and enablers to HIMSM accessing sexual health care. 5. To identify commissioning priorities to inform sexual health services and targeted health promotion interventions. Methods: The project will use a mixed methods design following 4 stages: A review of current data and research to assess existing knowledge on the behaviour and sexual health needs of HIMSM. A community-informed survey designed to evaluate current STI prevention knowledge and healthcare preferences among HIMSM. Qualitative interviews with HIMSM to capture their experiences of STI prevention and accessing sexual health services. Comparative analysis of findings from Brighton and Skegness to identify commonalities and divergences in needs and preferences. Public Involvement: Community engagement is pivotal to the research design. An advisory group with lived experience will be consulted during all stages of the research, including survey design, recruitment strategies, interview guides and dissemination. Dissemination: The findings will be published in scientific journals and presented at conferences to contribute to the broader understanding of STI prevention. Additionally, results will be reported to local authority public health teams to inform service provision and will be shared with health promotion agencies to tailor messaging for HIMSM. This research seeks to bridge gaps in knowledge and services, ultimately improving sexual health outcomes for the population.