with partners outside of one's household. We tried to elucidate motives and barriers for complying with sexual distancing among men who have sex with men (MSM) and the relation with social distancing. Methods In this exploratory qualitative study we interviewed STI clinic visiting MSM during the first COVID-19 lock down using a semi-qualitative questionnaire from March-May 2020. We interviewed both men who complied and did not comply with the sexual distancing measures. The interviews were

more »

... cribed using verbatim transcription and analyzed using MAXQDA. Results We included 18 non-compliers and 4 compliers. Motivations mentioned to comply with sexual distancing measures were: perceiving COVID-19 as a serious health threat, experiencing critically ill COVID-19 patients first hand, protecting someone dear from COVID-19, and being satisfied with social and/or sexual distancing measures. Barriers mentioned to comply with sexual distancing measures were: not being aware of the need for sexual distancing, being single, previously having had an active sex life, importance of the social aspect of sex, a strong urge for sex, having sex to reduce stress, being under the influence of alcohol or drugs, and not perceiving COVID-19 is a serious health threat. Conclusion Our findings suggest that the information on sexual distancing needs to be made more explicit, accessible, understandable, customized and relatable to the key populations. This will improve effective measures and health advises for the current COVID-19 pandemic and future droplet borne outbreaks.