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“You can smell the freedom”: a qualitative study on perceptions and experiences of sex among Swedish men who have sex with men in Berlin
  1. Nicklas Dennermalm1,
  2. Kristina Ingemarsdotter Persson1,2,
  3. Sarah Thomsen1,
  4. Birger C Forsberg1
  1. 1 Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
  2. 2 Department of Communicable Disease Control and Health Protection, Unit for Sexual Health and HIV Prevention, Public Health Agency of Sweden, Solna, Sweden
  1. Correspondence to Dr Birger C Forsberg; birger.forsberg{at}


Purpose The purpose of this study was to explore the perceptions and experiences of sex among Swedish Men who have Sex with Men (MSM) in Berlin.

Background MSM are disproportionally affected by HIV.

Berlin is also a key destination when looking into where Swedish MSM sero-convert, while travelling.

Method A qualitative study with semi-structured interviews using open-ended questions with participants recruited through network sampling. Data were analysed with content analysis.

Participants 15 Swedish cis-men (as in non-transgender) who have sex with men aged 25–44 years, who travelled to or were living in Berlin. To be included in the study, the participants had to be cis-MSM, Swedish citizens, spending time in Berlin and having sex in both settings.

Results For a majority of the participants, sex was the main reason for going to Berlin but cultural aspects like art and the techno scene were also important. Berlin was perceived as a sex-oriented city providing venues where respondents did not have to care about reputation and status and where social and sexual spaces co-existed side by side. This in sharp contrast to Sweden, which represented a limiting environment both in culture and what was available culturally and sexually.

Conclusion The men interviewed experienced multiple partners and had a broad sexual repertoire both abroad and at home. However, the behaviour was amplified in Berlin. The men did not alter their safer sex practice depending on if they had sex in Sweden or Berlin. The high mobility and vulnerability for HIV/sexually transmitted infection (STI) among these men highlights the need of increased access to antiretroviral treatment, pre-exposure prophylaxis for HIV and low-threshold HIV/STI testing services in Europe.

  • public health
  • qualitative research
  • men who have sex with men
  • travel medicine

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  • Contributors ND, KIP, ST and BCF conceived and planned the overall study. ND recruited the participants, conducted the interviews and coded the interviews using NVivo. The interview process and coding process were conducted by ND and supervised by ST. ND did the analysis in close collaboration with KIP and with inputs from ST and BCF. KIP reviewed the transcripts and coding in relation to the interviews and provided additional interpretation. KIP prepared the first draft of the manuscript and ND completed it after comments made by KIP, ST and BCF. All coauthors reviewed and commented on drafts and approved the final manuscript. BCF is the corresponding author.

  • Funding The data collection was funded by the Public Health Agency of Sweden.

  • Competing interests None declared.

  • Ethics approval Ethical approval was achieved from Ethical Review Board in Stockholm, reference number 2016/32-31.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The full data supporting the findings of this study are not available in order to protect the integrity of the participants.

  • Patient consent for publication Not required.

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