Between 0.6% and 22.2% of the global adult male population has a sexual interest in children (SIIC), depending on evaluation methods [1]. SIIC constitutes a major risk factor for child sexual abuse (CSA) and viewing of child sexual abuse material (CSAM). The true rates of CSA offences cannot be estimated, but self-report studies find 30 times higher rates of child-reported CSA compared to reports from child protection services or police.

Engagement in therapy is a protective factor against the risk of child sexual abuse and can lead to reductions in CSAM consumption and severity. Anticipated negative therapist behaviour is associated with less willingness to seek treatment. The fear of being reported by the therapist discourages participation in therapy, a concern complicated by mandatory reporting laws in some countries. Negative attitudes towards ISIC are high, and SIIC may be the most stigmatised trait globally.

Identifying barriers to treatment for ISIC, and of measures to overcome them, is important to increase therapy engagement, with the goal to improve wellbeing, reduce CSAM consumption, and reduce the risk of CSA offences. Patient anonymity during therapy may play an important role in increasing disclosure of stigmatised traits. It remains unclear whether anonymous therapy addresses patient treatment anxieties and therefore increases the comfort or willingness to engage in therapy. To address this research gap, we conduct an anonymous online survey with ISIC to answer the following questions:

RQ1. Can online therapy preferences be identified for minor-attacted individuals and for their therapists?

RQ2. Are there individual factors that predict stigmatized individuals' online therapy preferences? (E.g. Trust, Self-Stigma)

RQ3. Are there differences between the different stigmatized groups', therapists, and general populations' online therapy preferences?

Participants will receive a study information that describes the aim of the project and a brief overview of data anonymization procedures. This study information is in simple English for comprehesability. Participants will have the option to access more detailed study information, explaining that privacy protections are implemented; tracking technologies are disabled; data will be encrypted and stored on Charité - Universitätsmedizin Berlin servers in compliance with the EU General Data Protection Regulation; and that anonymized data might be shared with academic research institutes within the project consortium. It is also stated that data could be stored for up to three years and that access will be restricted to project members only. To ensure accessibility and comprehensibility for diverse populations, the study information was additionally provided in an easy-to-understand language version. Participants are required to provide informed consent (collected via checkbox without personally-linkable ID) before participation. The questionnaire is available in both German and English.

Pilot testing was conducted prior to the main data collection, involving researchers and general members of the public who are not experts in the topic of the study. The pilot study evaluated the comprehensibility, sensitivity, clarity, and overall acceptability of the questionnaire items. In addition, technical functionality and user experience were informally tested across different individuals and devices.

This study was approved by the Institutional Ethics Committee of Charité - Universitätsmedizin Berlin (ID EA4_187_24).

The Charité data protection officewas consulted prior to the start of this study to ensure compliance with applicable data protection regulations, and their advise was implemented.

An instance of the survey tool SoSci Survey was hosted on Charité servers. Server-side IP logging disabled are disabled. Within SoSci Survey, cookies and IP-tracking are disabled, and a "Leave and delete my data" button is available for participants prior to final submission of their data. Participants are instructed not to provide any identifiable information either within the Survey or by email to the study team.

For preservation of anonymity, consent will be collected only via checkbox, and no records of individual identity were stored. To limit the identifiability of the data through data linkage, demographic information is limited to high-level information rather than specific information, such as country of residence rather than nationality, and age range rather than precise age. We also provide guidelines to participants about how to increase their privacy on the project website (https://project-veranda.github.io/VERANDA/news/How\_to\_protect\_your\_identity/) online. To the best of our efforts, this survey will be conducted anonymously.

Inclusion Criteria:

• Belonging to one of the target groups.
• Otherwise, for general members of the public, none.

Exclusion Criteria:

• Younger than 18

The investigators do not assign participants to conditions, instead the investigators have different target groups:

Groups that experience stigmatization:

Individuals with a sexual interest in children

Transgender and gender-diverse people

Sex workers

Healthcare workers

Individuals who have experienced child sexual abuse

Groups that provide services to stigmatized groups:

Therapists for individuals with a sexual interest in children

Therapists of transgender and gender-diverse individuals

Therapists of sex workers

Control/comparison group:

General public