Multilevel Barriers to Perianal Condyloma Care Among Men Who Have Sex With Men in Northeast China.

Abstract

Men who have sex with men (MSM) with perianal condyloma face compounded health care challenges within structural inequities. Current research poorly characterizes their medical experiences, including barriers to care, psychosocial stressors, and policy-driven exclusion. Human papillomavirus (HPV)-related perianal condyloma in MSM is associated with high recurrence, diagnostic delays, and limited preventive access, underscoring the need to address systemic disparities. To explore health care experiences of MSM with perianal condyloma, identify multilevel care barriers, and characterize structural oppression affecting clinical outcomes. This qualitative study used semistructured interviews and qualitative analysis. Twenty MSM with confirmed perianal condyloma acuminatum were purposively sampled via clinician referrals. Inclusion criteria included age of 18 years or older and the capacity to provide informed consent. The study was conducted at a tertiary hospital (First Affiliated Hospital of China Medical University, Northeast China). Data were collected from January 1 to March 31, 2025, and analyzed from March 31 to June 30, 2025. Thematic analysis and grounded theory were used to identify barriers across 4 levels (individual, clinical, societal, and policy) and reflect how multiple barriers contribute to structural oppression. Twenty MSM (mean [SD] age, 23.95 [4.36] years) participated in the study. Of the 20 MSM, 10 (50%) were students, 17 (85%) had a bachelor's degree or higher, 13 (65%) identified as gay, and 9 (45%) engaged in exclusive anal-receptive intercourse. The mean (SD) monthly income was ¥4725 (¥2573). Regarding health care visits, 8 (40%) visited for active disease, 5 (25%) used private health care, and 1 (5%) had HIV coinfection. Participants faced synergistic barriers: (1) gaps in HPV knowledge, reliance on unverified online information, and risky sexual behaviors (individual level); (2) fragmented care pathways, privacy violations, and postoperative trauma (clinical level); (3) stigma-driven identity concealment, social isolation, and relationship strain (societal level); and (4) exclusion from HPV vaccination, lack of male-adapted screening tools, and inadequate sexual health education (policy level). Together, these barriers reflect how clinical neglect and structural oppression emerge and how their intersection perpetuates health care disparities among MSM with perianal condyloma. In this qualitative study of MSM with perianal condyloma, the findings suggest that privacy-protected care, standardized protocols, inclusive prevention strategies, and practitioner cultural competency training are required. These findings also emphasize the urgent need for equity-focused sexual health policies to address the needs of marginalized populations.