Perception of Prostate Screening Services among Men in Trinidad and Tobago

There have been calls for greater involvement of men in Sexual and Reproductive Health (SRH). One of the major SRH issues affecting men is prostate cancer. Prostate cancer represents the leading cause of cancer-related deaths among men in Trinidad and Tobago. A key contributor to this burden of mortality may be low uptake of screening services. This study explored men's perceptions of prostate screening services to identify implications for policy and practice. Data were drawn from 14 focus groups, including 75 men between the ages of 19 and 60 years representing a cross section of socio-demographic groups in Trinidad and Tobago. Data were qualitatively analysed. Across all groups, men were aware of prostrate screening services, and aware of the need for examinations, particularly at older age. Men reported feeling responsible for maintaining their health, but were unwilling to access prostate screening services. Concerns about digital rectal examination (DRE) were universal, and spontaneously raised in discussions. Expressed levels of anxiety were related to fear of the negative implications of being diagnosed with prostate cancer. More significantly, unwillingness to seek screening was related to sensitivity to the associations of the DRE with homosexual activity and an 'assault on manhood'. In a cultural context of extreme homophobia, such cultural meanings were a barrier for most men. The major barriers to accessing services in Trinidad and Tobago are cultural beliefs, not lack of knowledge. Whilst addressing homophobia may be a long-term goal, in the short-term, health promotion which focuses on reducing the associations of digital rectal examinations with a threat to masculinity, and stresses the responsibilities of men to take care of their own health, may be productive in improving outcomes in this important area of men's sexual and reproductive health.