Other reasons for poor access to health care and decreased help seeking behavior from the patient point of view are: shame, guilt, low self-esteem, and fear of disapproval upon self-disclosure.
4
From the clinicians point of view, the access to care for MSM can be hindered by: discomfort with male-male sex, homophobia, judgmental and moralistic approach, irrational fear for contamination, ignorance about specific conditions associated with male-male sex, and not obtaining swabs from correct body orifices.