Youth's experiences with STI testing in four communities in British Columbia, Canada

Sexually transmissible infections (STI) and HIV testing and diagnosis among Aboriginal and non-Aboriginal adolescents in contact with the Australian justice system: a cross-sectional study

BACKGROUND

It is unclear what factors are associated with sexually transmissible infections (STI) and HIV testing and diagnosis among justice-involved adolescents, and if these differ for Aboriginal or Torres Strait Islander peoples.

METHODS

A cross-sectional survey of 465 justice-involved adolescents (aged 14-17years) from Australia was conducted between 2016 and 2018. Participants were asked about sexual behaviours, STI/HIV knowledge, and prior STI diagnoses and testing.

RESULTS

Approximately 38% (n =130) of those sexually active had ever been screened for STI/HIV and 17.8% (n =23) had been diagnosed with an STI. No participant reported living with HIV. For Aboriginal participants, being male (aOR 3.6, 95% CI 1.3-10.1) and having under three sexual partners in the past 12months (aOR 3.1, 95% CI 1.2-8.0) was associated with never having had an STI/HIV test. For non-Aboriginal participants, being male (aOR 2.7, 95%CI 1.2-5.7), single (aOR 2.4, 95% CI 1.2-4.9), attending school (aOR 2.4, 95% CI 1.1-5.1), not having sought sexual health information (aOR 2.8, 95% CI 1.4-5.8), and having a lower STI/HIV knowledge score (aOR 2.3, 95% CI 1.1-5.0) were associated with never having had an STI/HIV test. Factors associated with STI diagnosis were non-heterosexual sexual orientation (aOR 5.6, 95% CI 1.1-28.2), transactional sex (aOR 11.2, 95% CI 3.0-41.3), and having sought sexual health information (aOR 3.5, 95% CI 1.0-12.5).

CONCLUSIONS

Males, particularly Aboriginal male adolescents, should be engaged with sexual health promotion and testing services as soon as they come into contact with the justice system. Approaches should consider different cultural, gender and sexual orientations.

Encouraging Parental Sexual Communication with Teen Sons: A Social Norms Experiment

Parent-child sexual communication is associated with myriad positive sex-related outcomes for young people, but these conversations tend to be infrequent and limited in scope. Using the Social Norms Approach, we hypothesized that learning that other parents talk with their children about sex-related topics would motivate parents to talk about more sex-related topics with their son. In an online experiment, parents in the United States (N = 378) with a son aged 13-16 were asked how many of 30 sex-related topics they had discussed with their son after exposure to one of the two SNA messages or a control. A 30-day follow-up study repeated these questions. The experiment revealed no significant differences between the three conditions, but all three conditions resulted in greater intentions to discuss more topics with their son in the future. Regardless of condition, parents who identify their sons as gay or bisexual talked about more sex-related topics than parents of sons who identify their sons as straight. The results from this study suggest that social norms messages are not more effective at increasing parents' communication intentions. Parents in all conditions planned to discuss more sex-related topics with their son, suggesting that simply bringing these topics to parents' attention may be enough to increase intentions to have these conversations. Findings are discussed in light of motivating and equipping parents to handle these conversations and tailoring educational materials for parents based on their child's sexual and romantic orientation.

Healthcare professionals discourses on men and masculinities in sexual healthcare: a focus group study

Studies have reported that men's uptake of sexual health services is low, that these services make them feel vulnerable, and that they experience sexual healthcare (SHC) as stressful, heteronormative, potentially sexualised and "tailored for women". They also suggest that healthcare professionals (HCPs) working in SHC view masculinity as problematic, and situated in private relationships. This study aimed to explore how HCPs construct the gendered social location in SHC, specifically in terms of masculinity and a perception that masculinity is situated in relationships. Critical Discourse Analysis was used to analyse transcripts from seven focus group interviews with 35 HCPs working with men's sexual health in Sweden. The study found that gendered social locations were discursively constructed in four ways: (I) by problematising and opposing masculinity in society; (II) through discursive strategies where a professional discourse on men and masculinity is lacking; (III) by constructing SHC as a feminine arena where masculinity is a visible norm violation; (IV) by constructing men as reluctant patients and formulating a mission to change masculinity. The discourses of HCPs constructed the gendered social location of masculinity in society as incompatible with SHC, and saw masculinity in SHC as a violation of feminine norms. Men seeking SHC were constructed as reluctant patients, and HCPs were seen as agents of change with a mission to transform masculinity. The discourses of HCPs risk othering men in SHC, which could prevent care on equal terms. A shared professional discourse on masculinity could create a common foundation for a more consistent, knowledge-based approach to masculinity and men's sexual health in SHC.

Factors Influencing Sexual Health Service Use by South Asian Immigrant Men Living in Ontario, Canada: A Qualitative Study

Introduction: South Asian communities comprise one of the fastest-growing populations in Canada, but there is a paucity of research on if and how immigrant men use sexual health services. Objectives: Our study aimed to understand factors influencing sexual health service use by South Asian immigrant men living in Ontario, Canada. Methods: An interpretive description (ID) research methodology was used, followed by Braun and Clarke’s thematic guidelines to collect and analyze data. Altogether, 18 semi-structured interviews were conducted between May and July 2021 with South Asian immigrant men between 20 and 45 years of age in Ontario. Results: We found that culture shaped the overall perception and use of sexual health services, while the perceived severity of sexual illness also affected the utilization of preventative care. Moreover, there are taboos about sexual health, and while sex positivity and sex negativity exist, sexual health information is shared with trusted sources. We also found South Asian men shared sexual health more openly by following a lifestyle that normalizes sexual health discussions rather than South Asian cultural norms. Conclusions: This study provides a comprehensive understanding of the individual, structural and cultural determinants of health influencing sexual health service use to strengthen existing health communication strategies to improve service utilization for diverse communities in Canada.

Healthcare utilization among persons living with HIV in Manitoba, Canada, prior to HIV diagnosis: A case-control analysis

BACKGROUND

Understanding care patterns of persons living with HIV prior to diagnosis can inform prevention opportunities, earlier diagnosis, and engagement strategies. We examined healthcare utilization among HIV-positive individuals and compared them to HIV-negative controls.

METHODS

Data were from a retrospective cohort from Manitoba, Canada. Participants included individuals living with HIV presenting to care between 2007 and 2011, and HIV-negative controls, matched (1:5) by age, sex, and region. Data from population-based administrative databases included physician visits, hospitalizations, drug dispensation, and chlamydia and gonorrhea testing. Diagnoses associated with physician visits were classified according to International Classification of Diseases chapters. Conditional logistic regression models were used to compare cases/controls, with adjusted odds ratios (AORs) and their 95% confidence intervals (95% CI) reported.

RESULTS

A total of 193 cases and 965 controls were included. Physician visits and hospitalizations were higher for cases, compared to controls. In the 2 years prior to case date, cases were more likely to be diagnosed with "blood disorders" (AOR: 4.2, 95% CI: 2.0-9.0), be treated for mood disorders (AOR: 2.4, 95% CI: 1.6-3.4), and to have 1+ visits to a hospital (AOR: 2.2, 95% CI: 1.4-3.6).

CONCLUSION

Opportunities exist for prevention, screening, and earlier diagnosis. There is a need for better integration of healthcare services with public health.

Reproductive health risks and clinician practices with gender diverse adolescents and young adults

BACKGROUND

Reproductive health counseling is essential for adolescents and young adults (AYAs). Transgender and gender diverse (TGD) AYAs would benefit from tailored counseling given concerns about iatrogenic infertility and sexual dysfunction, and high rates of interpersonal violence, unplanned pregnancies and sexually transmitted infections, yet there are multiple obstacles to providing this care at the patient/family and clinician levels.

OBJECTIVES

This narrative review summarizes the literature on reproductive health considerations for TGD AYAs, current practices, and clinician barriers and facilitators to providing culturally sensitive reproductive care for TGD AYAs. Specific areas of focus include reproductive health goals, risks, and access barriers; clinician knowledge practices and challenges; and strategies for improving counseling practices.

MATERIALS AND METHODS

PubMed, Google Scholar, Medline, Web of Science, and PsycInfo databases were searched using the following terms: transgender, non-binary, gender expansive, gender non-conforming, reproductive health, sexual health, fertility, family planning/building, contraception, sexual dysfunction; gender-affirming hormones/surgery, clinician, physician or provider knowledge and attitudes; counseling.

RESULTS

Many TGD AYAs desire biological children and improved sexual experiences. TGD AYAs may experience infertility and sexual dysfunction associated with transition; have disproportionate HIV/STI risk; experience high rates of interpersonal/sexual violence and trauma; and encounter barriers to accessing competent medical care. Clinicians lack knowledge about reproductive health needs of TGD AYAs; inconsistently discuss family building options; perceive counseling challenges; and desire more training in this area.

DISCUSSION

Enriched communication training for medical/mental health clinicians is necessary to provide a skilled workforce for TGD AYAs. Web-based reproductive health training with other populations (eg oncology) demonstrates efficacy for improving communication skills and confidence in counseling, CONCLUSION: This review highlights barriers to adequate reproductive care encountered by TGD AYAs, exacerbated in underserved minority youth. Dedicated training for providers, and programs increasing access are important goals for improving care. The need for additional research is also emphasized.

Applying a health equity tool to assess a public health nursing guideline for practice in sexually transmitted infection assessment in British Columbia

SETTING

There is a multitude of health equity tools but little guidance on how to effectively use these tools in public health nursing practice. In BC, public health nurses who are certified in sexually transmitted infection care utilize guidelines authorized by the nursing regulatory body.

INTERVENTION

As part of the Equity Lens in Public Health (ELPH) research project, an assessment of the nursing guideline, Sexually Transmitted Infection (STI) Assessment Decision Support Tool, was undertaken using the Assessing Equity in Clinical Practice Guidelines health equity assessment tool. The chosen tool is intended for use by health care providers, is broadly applicable to clinical practice guidelines, can be used retrospectively, and falls within the category of equity checklists and audits.

OUTCOMES

Overall, the tool was useful in assessing the inclusion and omission of an equity focus in the guideline. However, there were several challenges: the identification of an appropriate health equity tool; the absence of an evaluation of the chosen tool; the tool's focus on chronic disease versus communicable disease; and the difficulty of obtaining client perspectives.

IMPLICATIONS

For an improved equity lens in the STI Assessment Decision Support Tool, future revisions should be equity focused and include perspectives from affected populations, an emphasis on the determinants of health that perpetuate inequities for populations who experience a disproportionate burden of STI, information on provincially available resources, and service delivery models that improve timely and equitable access to treatment and care.

From silos to buckets: a qualitative study of how sexual health clinics address their clients' mental health needs

OBJECTIVES

To describe the current constraints, facilitators, and future prospects for addressing mental health and substance use (MHSU) concerns within sexual health clinics in two cities in British Columbia, Canada.

METHODS

We conducted in-depth interviews with 22 providers (14 nurses, 3 physicians, 3 administrators, 2 other health professionals) from six sexual health clinics.

RESULTS

Providers consistently affirmed that MHSU-related concerns co-occur with sexual health concerns among clients presenting to sexual health clinics. Three factors constrained the providers' abilities to effectively address MHSU service needs: (1) clinic mandates or funding models (specific to sexually transmitted infections (STI)/HIV or reproductive health); (2) "siloing" (i.e., physical and administrative separation) of services; and (3) limited familiarity with MHSU service referral pathways. Mental health stigma was an additional provider-perceived barrier for sexual health clinic clients. The low barrier, "safe" nature of sexual health clinics, however, facilitated the ability of clients to open up about MHSU concerns, while the acquired experiences of sexual health nurses in counselling enabled clinicians to address clients' MHSU needs. In response to this context, participants described actionable solutions, specifically co-location of sexual health and MHSU services.

CONCLUSION

Sexual health clinicians in British Columbia generally affirm the results of previous quantitative and client-focused research showing high rates of MHSU-related needs among sexual health clinic clients. Providers prioritized specific short-term (referral-focused) and long-term (healthcare re-organization, co-location of sexual and MHSU services) solutions for improving access to MHSU services for those using sexual health services.

Exploring the Sexually Transmitted Infection Testing Experiences of Young People through Creative Visual Mapping

BACKGROUND

Innovative solution-focused research with youth is needed to improve sexually transmitted infection (STI) testing among adolescents and young adults (AYA). We sought to identify moments that matter to AYA during the STI testing experience.

METHODS

Five social design graduate students and five youth advisory council (YAC) members independently received STI testing and created journey maps documenting their experience. Social design students assisted YAC members in their map creation during group workshops and one-on-one worktime. Participants completed interviews about their experience using their maps to facilitate responses. We used thematic content analysis to synthesize textual interview data.

RESULTS

Participants experienced stress and discomfort throughout the testing process, with three main sources of stress identified: finding a clinic, completing registration forms, and general lack of clarity during the clinical experience. Friendly interactions with providers and staff improved the experience, however. Finally, the physical environment of the clinic space could positively or negatively impact the overall experience.

CONCLUSIONS

Journey mapping may be an important tool for identifying solutions to improve STI testing among AYA.

University students' behaviours towards accessing sexual health information and treatment

Globally, it is widely recognised that young people (those under the age of 25 years) are at a higher risk of developing sexually transmitted infections (STIs). The majority of university students studying in the UK fall within this age bracket, and to help prevent such high incidence of STIs in this age group, it is essential that advice and treatment, if required, are obtained from reliable sources. This study sought to explore sources of sexual heath advice and treatment for students at Welsh universities (n = 3007). The main sources of advice were identified as the internet (49.1%) and GP/family doctors (38.9%), whilst local sexual health clinics (24.9%) and GP/family doctor services (20.2%) were the main sources for treatment in students. Males were more likely than females to report never needing advice (AOR 2.74; CI = 2.24-3.35) or requiring treatment (AOR 1.37; CI = 1.17-1.60). The apparent lack of engagement with these services by male students is a cause for concern, although one possible solution could be to further develop online methods to increase uptake of testing. Furthermore, the popularity of the internet for advice provides a timely reminder that regulation of online sexual health information is critical.

A Youth Participatory Project to Address STIs and HIV among Homeless Youth

The purpose of this study was to conduct a youth participatory action research project to address the disparities in sexually transmitted infection (STI) and HIV rates among homeless youth. Four youth served as co-investigators and cultural informants for the project. The team conducted focus groups (N = 22; ages 16-22) and in-depth interviews (N = 20; ages 18-24) with homeless youth to explore decisions about condomless sex, knowledge of STIs and HIV, health-care access for STI-related services, and perceptions about STI testing. Findings revealed that homeless youth have good general knowledge about STIs, are receptive to STI testing for themselves and their sexual partners, and have heightened concerns about being HIV positive and peers knowing their STI status. Results from the current study could contribute to the development of youth-informed tailored interventions to increase protective sexual behavior, reduce health disparities, and improve access to and the quality of health-care services for homeless youth.

Differences in experiences of barriers to STI testing between clients of the internet-based diagnostic testing service GetCheckedOnline.com and an STI clinic in Vancouver, Canada

OBJECTIVES

Internet-based STI testing programmes may overcome barriers posed by in-clinic testing, though uptake could reflect social gradients. The role these services play in comparison to clinical testing services is unknown. We compared experiences of testing barriers between STI clinic clients to clients of GetCheckedOnline.com (GCO; where clients take a printed lab form to a lab).

METHODS

Our 10-month cross-sectional study was conducted after GCO was promoted to STI clinic clients and men who have sex with men (MSM). Clinic and GCO clients completed an online survey assessing testing barriers and facilitators; responses were compared using bivariate analysis (level of significance P<0.01; significant results below).

RESULTS

Compared with 321 clinic clients, the 73 GCO clients were more likely to be older (median 35 vs 30 years), MSM (45% vs 16%), be testing routinely (67% vs 39%), have delayed testing for any reason (76% vs 54%) and due to clinic distance (28% vs 9%), report delays due to wait times (50% vs 17%), embarrassment with testing (16% vs 6%), discomfort discussing sexual health where they usually go for testing (39% vs 22%), as well as discomfort discussing sexual history with (19% vs 5%) and fearing judgement from (30% vs 15%) any healthcare provider. GCO clients were less likely to have found clinic hours convenient (59% vs 77%) and clinic appointments easy to make (49% vs 66%), and more likely to report long wait times (50% vs 17%). We found no differences in technology skills/use.

CONCLUSIONS

In this urban setting, an internet-based testing service effectively engaged individuals experiencing testing barriers, with few social gradients in uptake. While some testing barriers could be addressed through increasing access to clinical services, others require social and structural changes, highlighting the importance of internet-based STI testing services to increasing test uptake.

"They made me feel comfortable": a comparison of methods to measure patient experience in a sexual health clinic

Background

High quality sexual health services are needed to improve both individual and public health outcomes. This study set out to explore what is important to patients who visit a sexual health clinic, and examine their understanding of standard survey questions, in order to inform the collection and interpretation of patient experience data that are used to improve services.

Methods

We conducted a cross-sectional, qualitative study. In the first part of the interview, we used “discovery interviews” to explore patients’ experiences of attending a central London walk-in sexual health clinic. In the second part, we asked patients how they would respond to eight standard patient experience survey questions and to provide an explanation for each of their responses. We conducted a thematic analysis of the interview data.

Results

We interviewed seventeen participants (nine women, eight men) of different ethnicities and backgrounds. All interviewees were positive about their experience. They described how staff had made them feel “comfortable”, and talked about how staff spent time, listened and did not rush them, despite being a very busy clinic.

In response to the survey questions, fourteen patients rated their as care excellent or very good overall. However, survey questions were interpreted in different ways and were not always easily understood.

Conclusions

The open-ended “discovery interviews” provided new insights into aspects of care that were most valued or could improve. Standard patient experience questions provide a rating but little elucidation of the experiences that lie behind patients’ responses. They do not always measure aspects of care valued by patients or identify areas for improvement. They are not uniformly understood and necessarily collapse a wide range of experiences and views into categories that may seem inappropriate. Qualitative methods have a key role in measuring patient experience and involving patients in service improvement.

Use of GetCheckedOnline, a Comprehensive Web-based Testing Service for Sexually Transmitted and Blood-Borne Infections

Background

The British Columbia Centre for Disease Control implemented a comprehensive Web-based testing service GetCheckedOnline (GCO) in September 2014 in Vancouver, Canada. GCO’s objectives are to increase testing for sexually transmitted and blood-borne infections (STBBIs), reach high-prevalence populations facing testing barriers, and increase clinical STI service capacity. GCO was promoted through email invitations to provincial STI clinic clients, access codes to clients unable to access immediate clinic-based testing (deferred testers), and a campaign to gay, bisexual, and other men who have sex with men (MSM).

Objective

The objective of the study was to report on characteristics of GCO users, use and test outcomes (overall and by promotional strategy) during this pilot phase.

Methods

We used GCO program data, website metrics, and provincial STI clinic records to describe temporal trends, progression through the service pathway, and demographic, risk, and testing outcomes for individuals creating GCO accounts during the first 15 months of implementation.

Results

Of 868 clients creating accounts, 318 (36.6%) submitted specimens, of whom 96 (30.2%) tested more than once and 10 (3.1%) had a positive STI diagnosis. The proportion of clients submitting specimens increased steadily over the course of the pilot phase following introduction of deferred tester codes. Clients were diverse with respect to age, gender, and ethnicity, although youth and individuals of nonwhite ethnicity were underrepresented. Of the 506 clients completing risk assessments, 215 (42.5%) were MSM, 89 (17.6%) were symptomatic, 47 (9.3%) were STI contacts, 232 (45.8%) reported condomless sex, 146 (28.9%) reported ≥4 partners in the past 3 months, and 76 (15.0%) reported a recent STI. A total of 63 (12.5%) GCO clients were testing for the first time. For 868 accounts created, 337 (38.8%) were by clinic invitations (0 diagnoses), 298 (34.3%) were by deferred testers (6 diagnoses), 194 (22.4%) were by promotional campaign (3 diagnoses), and 39 (4.5%) were by other means (1 diagnosis).

Conclusions

Our evaluation suggests that GCO is an acceptable and feasible approach to engage individuals in testing. Use by first-time testers, repeated use, and STI diagnosis of individuals unable to access immediate clinic-based testing suggest GCO may facilitate uptake of STBBI testing and earlier diagnosis. Use by MSM and individuals reporting sexual risk suggests GCO may reach populations with a higher risk of STI. Motivation to test (eg, unable to access clinical services immediately) appears a key factor underlying GCO use. These findings identify areas for refinement of the testing model, further promotion, and future research (including understanding reasons for drop-off through the service pathway and more comprehensive evaluation of effectiveness). Increased uptake and diagnosis corresponding with expansion of the service within British Columbia will permit future evaluation of this service across varying populations and settings.

Bridging the silos in HIV and Hepatitis C prevention: a cross-provincial qualitative study

Objectives

The Our Youth Our Response (OYOR) study explored the scope and accessibility of existing youth-oriented human immunodeficiency virus (HIV) and Hepatitis C (HCV) prevention in Atlantic Canada.

Methods

A cross-provincial, qualitative population health and gender-based analytic approach was used in this study. Four hundred and twenty-five documents were part of the initial scoping review, while 47 in-depth interviews across youth-relevant sectors were undertaken to explore the perceptions related to current approaches to youth-oriented HIV/HCV prevention policies and programs. The study also conducted focus group discussions with 21 key informants aimed at identifying strategies to address the challenges identified from the interview data.

Results

Five overarching themes emerged from our triangulated data in relation to the present state of youth-related HIV/HCV prevention. These included: inter-organizational and intersectoral collaboration; youth engagement; access to testing; harm reduction; and education.

Conclusions

Our findings will assist in informing the next generation for HIV/HCV prevention aimed at youth. Specifically, the results indicate that future prevention initiatives should support the use of intersectoral collaboration, gender-based approaches, and HIV/HCV testing innovation to help de-stigmatize prevention efforts.

HIV Knowledge, Attitudes, and Practices of Young People in Iran: Findings of a National Population-Based Survey in 2013

Introduction

The evidence is mixed on the HIV knowledge, attitude, and practices of youth in Iran. The aim of the current study was to assess knowledge, attitudes, and practices of Iranian youth towards HIV through a national survey.

Materials and Methods

Through a cross-sectional study with multistage cluster sampling, we administered a pilot-tested standard questionnaire to assess the levels of HIV knowledge, attitudes and practices of individuals aged 15–29 years old. Participants were recruited from 13 provinces in Iran and consisted of 2456 men and 2412 women.

Results

Only 37.3% of the participants had a high knowledge score. Most participants knew the main routes of HIV transmission; however, misconceptions existed about the transmission of HIV through mosquito bites across all age groups (31.7% correct response). Positive levels of attitude wereobserved among 20.7% of the participants. Most participants believed that people living with HIV (PLHIV) should be supported (88.3%) while only 46.3% were ready to share a table with them. Among those aged 19–29 years old, the main source of HIV information was mass media (69.1%), only 13.1% had ever tested for HIV, around 20.8% had ever had extramarital sex (31.7% male vs. 9.6% female),1.8% ever injected drugs (2.9% male vs. and 0.7% female). Among sexually active subjects in this age group, only 21.8% (26.1% male vs. 7.1% female) were consistent condom users.

Conclusions

The findings showed that Iranian youth and young adults have relatively insufficient overall knowledge and negative attitudes about HIV and PLHIV. Novel strategies involving schools and youth’s networks could be employed to deliver a culturally sensitive sexual health program.

Integrating gender and sex to unpack trends in sexually transmitted infection surveillance data in British Columbia, Canada: an ethno-epidemiological study

OBJECTIVES

Surveillance data frequently indicate that young men and women experience high-yet considerably different-reported rates of sexually transmitted infections (STIs), including bacterial infections such as chlamydia. We examined how several sex-based (eg, biological) and gender-based (eg, sociocultural) factors may interact to influence STI surveillance data trends.

METHODS

Employing ethno-epidemiological techniques, we analysed cross-sectional qualitative data collected between 2006 and 2013 about young people's experiences accessing STI testing services in five communities in British Columbia, Canada. These data included 250 semistructured interviews with young men and women aged 15-24 years, as well as 39 clinicians who provided STI testing services.

RESULTS

The findings highlight how young women are socially and medically encouraged to regularly test, while young men are rarely offered similar opportunities. Instead, young men tend to seek out testing services: (1) at the beginning or end of a sexual relationship; (2) after a high-risk sexual encounter; (3) after experiencing symptoms; or (4) based on concerns about 'abnormal' sexual anatomy. Our results illustrate how institutions and individuals align with stereotypical gender norms regarding sexual health responsibilities, STI testing and STI treatments. While these patterns reflect social phenomena, they also appear to intersect with sex-based, biological experiences of symptomatology in ways that might help to further explain systematic differences between young men's and women's patterns of testing for STIs.

CONCLUSIONS

The results point to the importance of taking a social and biological view to understanding the factors that contribute to the gap between young men's and women's routine engagement in STI care.

Sexually transmitted infection testing among heterosexual Maritime Canadian university students engaging in different levels of sexual risk taking

OBJECTIVES

Individuals aged 15-29 years have the highest rates of diagnosed sexually transmitted infection (STI), and in Canada routine STI testing is recommended for sexually active individuals under 25 years of age. Despite its being readily available to most Canadian university students, testing is not accessed by all sexually active students. This study examines correlates of STI testing among sexually active heterosexual university students. Specifically, we sought to determine: i) the lifetime incidence of STI testing overall and stratified by biological sex; ii) whether those most at risk of STI are being tested; and iii) which other characteristics are associated with ever having been tested for STI.

METHODS

A cross-sectional survey of undergraduate students at eight universities in Maritime Canada was carried out in 2012, gathering information on student demographic characteristics, sexual behaviours and use of sexual health services. We conducted a sex-stratified descriptive analysis of each covariate and of STI testing at three levels of STI risk. We then performed multiple logistic regressions to determine the factors associated with lifetime STI testing.

RESULTS

Only 34% of the study population and 51% of those at higher risk of STI acquisition had ever been tested for STI. Individuals at moderate or higher risk of STI were more likely to be tested than those at lower risk. In both sexes, older students, those who reported experiencing non-consensual sex while enrolled at university and those with more sexual health knowledge were more likely to be tested. Higher perceived risk was associated with STI testing only among females.

CONCLUSIONS

Individuals at higher risk of STI acquisition are more likely to be tested; however, STI testing rates are low in this sample. Health promotion with campaigns designed to increase general sexual health knowledge may be more effective in increasing testing when targeting younger students.

Sexually Transmitted Infection Services for Adolescents and Youth in Low- and Middle-Income Countries: Perceived and Experienced Barriers to Accessing Care

PURPOSE

Access to sexual and reproductive health (SRH) services is vital for sexually active adolescents; yet, their SRH care needs are often unmet.

METHODS

We conducted a qualitative systematic review of mixed methods studies to assess adolescent and provider views of barriers to seeking appropriate medical care for sexually transmitted infection (STI) services for adolescents. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (aged 10-24 years) and/or health service providers. Nineteen studies were identified for inclusion from 15 countries. Thematic analyses identified key themes across the studies.

RESULTS

Findings suggest that youth lacked knowledge about STIs and services. In addition, youth experienced barriers related to service availability and a lack of integration of services. The most reported barriers were related to acceptability of services. Youth reported avoiding services or having confidentiality concerns based on provider demographics and some behaviors. Finally, experiences of shame and stigma were common barriers to seeking care.

CONCLUSIONS

Adolescents in low- and middle-income countries experience significant barriers in obtaining STI and SRH services. Improving uptake may require efforts to address clinic systems and provider attitudes, including confidentiality issues. Moreover, addressing barriers to STI services may require addressing cultural norms related to adolescent sexuality.

Low HIV testing rate and its correlates among men who inject drugs in Iran

BACKGROUND

Iran has a concentrated HIV epidemic among people who inject drugs (PWID). Low HIV testing uptake could contribute to the significant number HIV-infected PWID, who go undiagnosed. This study aims to assess HIV testing uptake and its correlates among PWID in Iran.

METHODS

Data were collected through a national cross-sectional bio-behavioral study in 2010. Adult male HIV-negative PWID were included in the current analysis. All estimates were adjusted for the clustering effect of the sampling sites. Multivariable logistic regression was used to examine the correlates of recent HIV testing and adjusted odds ratios (AOR) were reported.

RESULTS

Out of the 2146 eligible PWID for this study, 49.8% reported having ever tested for HIV. However, only 24.9% had tested in the previous year and received their test results. Around 65.2% of PWID knew an HIV testing site. In the multivariable analysis, knowing an HIV testing site (AOR=13.9; P-value<0.001), ≥24 years of age (AOR=3.30; P-value=0.027), and multiple incarcerations (AOR=1.71; P-value<0.001) were positively, and a monthly income of ≥65 US dollar (AOR=0.23; P-value=0.009) was negatively associated with having been tested and received the results.

CONCLUSION

Despite the availability of free HIV counselling and testing for PWID in Iran, only one-fourth of adult male PWID had been tested for HIV and received their results. Implementing policies and strategies to normalize routine HIV testing among PWID are crucial steps to help curb the epidemic among Iranian PWID.

Colonial legacy and the experience of First Nations women in cervical cancer screening: a Canadian multi-community study

Regular Papanicolaou (Pap) screening has dramatically reduced cervical cancer incidence in Canada since the 1950s. However, Indigenous women's rates of cervical cancer remain disproportionately high, a factor which is not acknowledged in national media or in educational materials reporting Canada's new cervical cancer screening guidelines. Here, we present findings from a cervical cancer screening initiative in Northwestern Ontario. Based on participatory action research, we worked with 10 First Nations communities in the Robinson Superior Treaty area to increase awareness of cervical cancer risk, develop culturally sensitive tools for screening and education and test the efficacy of human papillomavirus (HPV) self-sampling as an alternative to Pap cytology. We conducted 16 interviews with health care professionals and 9 focus groups with 69 women from the communities. A central theme for both health care providers (HCPs) and community members was the colonial legacy and its influence on women's experiences of cervical cancer screening. This was evidenced by a strong sense of body shyness, including shame related to sexuality and sexually transmitted infections, concerns about confidentiality in clinical encounters and distrust or caution around HCPs. Reaffirming women's traditional caregiving and educational roles, enhancing mother and daughter communication, improving cultural sensitivity in health care and education and adoption of HPV self-sampling to increase women's privacy and control of the cervical cancer screening experience were endorsed. We argue that education and screening initiatives must reflect the cultural preferences of Indigenous women, empowering them to take control of their experiences of health and body in cervical cancer screening.

How do 'Public' Values Influence Individual Health Behaviour? An Empirical-Normative Analysis of Young Men's Discourse Regarding HIV Testing Practices

Philosophical arguments stemming from the public health ethics arena suggest that public health interventions ought to be subject to normative inquiry that considers relational values, including concepts such as solidarity, reciprocity and health equity. As yet, however, the extent to which 'public' values influence the 'autonomous' decisions of the public remains largely unexplored. Drawing on interviews with 50 men in Vancouver, Canada, this study employs a critical discourse analysis to examine participants' decisions and motivations to voluntarily access HIV testing and/or to accept a routine HIV test offer. Within a sub-set of interviews, a transactional discourse emerged in which the decision to test features an arrangement of 'giving and receiving'. Discourses related to notions of solidarity emphasize considerations of justice and positions testing as a 'public' act. Lastly, 'individualistic' discourses focused on individual-level considerations, with less concern for the broader public 'good'. These findings underscore how normative dimensions pertaining to men's decisions to test are dialectically interrelated with the broader social and structural influences on individual and collective health-related behaviour, thereby suggesting a need to advance an explicit empirical-normative research agenda related to population and public health intervention research.

Being diagnosed with a sexually transmitted infection (STI): sources of support for young women

BACKGROUND

Sexually transmitted infections (STIs) are prevalent throughout the world with the rate of these infections increasing on a daily basis. STI acquisition has the ability to cause personal adversity and elicit feelings of stigma and shame.

AIM

The aim of this paper is to report on the sources of support young women who acquired STIs drew on to overcome their associated adversity.

METHODS

This study utilised a feminist qualitative methodology.

FINDINGS

Findings revealed that the women drew on both personal and anonymous sources of support.

CONCLUSION

Nurses and other health-care professionals need to be equipped with knowledge and strategies to promote personal wellbeing and minimise the adversity felt among people having acquired these infections.

A validation study of a clinical prediction rule for screening asymptomatic chlamydia and gonorrhoea infections among heterosexuals in British Columbia

BACKGROUND

One component of effective sexually transmitted infections (STIs) control is ensuring those at highest risk of STIs have access to clinical services because terminating transmission in this group will prevent most future cases. Here, we describe the results of a validation study of a clinical prediction rule for identifying individuals at increased risk for chlamydia and gonorrhoea infection derived in Vancouver, British Columbia (BC), against a population of asymptomatic patients attending sexual health clinics in other geographical settings in BC.

METHODS

We examined electronic records (2000-2012) from clinic visits at seven sexual health clinics in geographical locations outside Vancouver. The model's calibration and discrimination were examined by the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow (H-L) statistic, respectively. We also examined the sensitivity and proportion of patients that would need to be screened at different cut-offs of the risk score.

RESULTS

The prevalence of infection was 5.3% (n=10 425) in the geographical validation population. The prediction rule showed good performance in this population (AUC, 0.69; H-L p=0.26). Possible risk scores ranged from -2 to 27. We identified a risk score cut-off point of ≥8 that detected cases with a sensitivity of 86% by screening 63% of the geographical validation population.

CONCLUSIONS

The prediction rule showed good generalisability in STI clinics outside of Vancouver with improved discriminative performance compared with temporal validation. The prediction rule has the potential for augmenting triaging services in STI clinics and enhancing targeted testing in population-based screening programmes.

Examining clinicians' experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice

Although barriers related to lesbian, gay, bisexual, transgender and queer (LGBTQ) youth's experiences accessing sexual health services have been examined in detail, research into the experiences and perceptions of clinicians providing these services has been conspicuously absent. The aim of this article is to explore the perceptions and experiences of clinicians providing sexual health services for LGBTQ youth. Drawing on in-depth, semi-structured interviews, this study examines 24 clinicians' experiences providing sexual health services to LGBTQ youth in five communities in British Columbia, Canada. Our findings reveal how many clinicians provide services to LGBTQ youth with a lack of cultural competency-either implicitly (e.g., by describing heteronormative practices) or explicitly (e.g., by expressing frustration that they had not been sufficiently provided with appropriate training related to LGBTQ youth sexual health). Institutional norms and values were identified as the dominant barriers in the effective provision of LGBTQ-tailored services. Many clinicians find themselves unprepared to provide culturally competent sexual health services that have both the capacity to address individual-level issues (e.g. promoting condom use) while considering (and adapting services to) the broader socio-cultural and structural conditions that can render LGBTQ youth socially vulnerable.

Examining the scope of public health nursing practice in sexually transmitted infection prevention and management: what do nurses do?

AIMS AND OBJECTIVES

To develop a more comprehensive understanding of the scope of public health nursing practice in the prevention and management of sexually transmitted infections and also to examine the public health nursing workforce in sexually transmitted infection care and the range of patient populations served.

BACKGROUND

Sexually transmitted infections are increasing, widespread and remain a significant public health problem throughout the world. Although nurses are taking on expanded roles in sexually transmitted infection care, little is known about the scope of this practice.

DESIGN

A cross-sectional descriptive study took place over 18 months (2009-2010).

METHODS

Three hundred and fourteen eligible nurses completed a 62-item questionnaire.

RESULTS

93·6% of participants were women; 77·5% were baccalaureate prepared and 87·9% underwent continuing education in sexually transmitted infection care. Most spent 50% of their time in direct patient care. Women were the main care recipients (72·9%). Sexually transmitted infection care was one aspect of nurses' multifaceted public health roles accounting for 28% of overall work activities. Not all nurses were working to the full scope of their practice; 77·9% undertook health history assessment, and 79% conducted testing.

CONCLUSION

This study is a comprehensive description of the scope of sexually transmitted infection nursing practice activities. It expands our understanding of sexually transmitted infection nursing practice among nurses working within an expanded scope and provides a baseline for future investigations. This description is situated within nursing competencies and best practices that may be used to develop, implement and evaluate models of sexually transmitted infection service delivery in other locales.

CLINICAL PRACTICE RELEVANCE

Sexually transmitted infection nursing practice needs to be understood and investigated beyond health education and testing practices. The scope of practice is comprehensive and incorporates a full spectrum of care. Public health nurses are a critical entry point into the healthcare system and provide primary and preventative care and healthcare referrals. Models of nursing care need to support nurses working to their full scope, and associated barriers warrant further investigation.

Self-collected versus clinician-collected sampling for sexually transmitted infections: a systematic review and meta-analysis protocol

BACKGROUND

Three meta-analyses and one systematic review have been conducted on the question of whether self-collected specimens are as accurate as clinician-collected specimens for STI screening. However, these reviews predate 2007 and did not analyze rectal or pharyngeal collection sites. Currently, there is no consensus on which sampling method is the most effective for the diagnosis of genital chlamydia (CT), gonorrhea (GC) or human papillomavirus (HPV) infection. Our meta-analysis aims to be comprehensive in that it will examine the evidence of whether self-collected vaginal, urine, pharyngeal and rectal specimens provide as accurate a clinical diagnosis as clinician-collected samples (reference standard).

INCLUSION AND EXCLUSION CRITERIA

Eligible studies include both randomized and non-randomized controlled trials, pre- and post-test designs, and controlled observational studies.

SEARCH STRATEGY

The databases that will be searched include the Cochrane Database of Systematic Reviews, Web of Science, Database of Abstracts of Reviews of Effects (DARE), EMBASE and PubMed/Medline.

DATA COLLECTION AND ANALYSIS

Data will be abstracted independently by two reviewers using a standardized pre-tested data abstraction form. Heterogeneity will be assessed using the Q2 test. Sensitivity and specificity estimates with 95% confidence intervals as well as negative and positive likelihood ratios will be pooled and weighted using random effects meta-analysis, if appropriate. A hierarchical summary receiver operating characteristics curve for self-collected specimens will be generated.

DISCUSSION

This synthesis involves a meta-analysis of self-collected samples (urine, vaginal, pharyngeal and rectal swabs) versus clinician-collected samples for the diagnosis of CT, GC and HPV, the most prevalent STIs. Our systematic review will allow patients, clinicians and researchers to determine the diagnostic accuracy of specimens collected by patients compared to those collected by clinicians in the detection of chlamydia, gonorrhea and HPV.

Nurse leaders' experiences of implementing regulatory changes in sexual health nursing practice in British Columbia, Canada

Most research about regulatory policy change concerning expanded nursing activities has emphasized advanced practice roles and acute care settings. This study is a contribution to the small pool of research concerned with regulatory policy implementation for nurses undertaking expanded nursing practice activities in a public health context. Using the regulatory changes in certified nursing practice in one Canadian province as our starting point, we investigated the experiences of nurse leaders in implementing this change. Using a qualitative interpretive descriptive approach informed by tenets of complexity theory, we examined the experiences of 16 nurse leaders as situated within the larger public health care system in which nurses practice. Two interrelated themes, (a) preparing for certification and (b) the certification process, were identified to illustrate how competing and contrasting demands between health care and regulatory organizations created substantial barriers to policy change. Implications for health service delivery and future research are discussed.

Women on men's sexual health and sexually transmitted infection testing: a gender relations analysis

Sexual health and sexually transmitted infection (STI) testing is typically portrayed as a women's issue amid men's estrangement from healthcare services. While the underreporting of men's STIs has been linked to masculinities, little is known about how women interpret and respond to heterosexual men's sexual health practices. The findings drawn from this qualitative study of 34 young women reveal how femininities can be complicit in sustaining, as well as being critical of and disrupting masculine discourses that affirm sexual pleasure and resistance to health help-seeking as men's patriarchal privileges. Our analysis revealed three patterns: looking after the man's libido refers to women's emphasised femininity whereby the man's preference for unprotected sex and reticence to be tested for STIs was accommodated. Negotiating the stronger sex refers to ambivalent femininities, in which participants strategically resist, cooperate and comply with men's sexual health practices. Rejecting the patriarchal double standard that celebrates men as 'studs' and subordinates women as 'sluts' for embodying similar sexual practices reflects protest femininities. Overall, the findings reveal that conventional heterosexual gender relations, in which hegemonic masculinity is accommodated by women who align to emphasised femininity, continues to direct many participants' expectations around men's sexual health and STI testing.

Masculinities, 'guy talk' and 'manning up': a discourse analysis of how young men talk about sexual health

Sexually transmitted infection testing rates among young men remain low, and their disengagement from sexual health services has been linked to enactments of masculinity that prohibit or truncate discussions of sexual health. Understanding how men align with multiple masculinities is therefore important for tailoring interventions that appropriately respond to their needs. We draw on 32 in-depth interviews with 15-24-year-old men to explore the discourses that facilitate or shut down sexual health communication with peers and sex partners. We employ a critical discourse analysis to explore how men's conversations about sexual health are constituted by masculine hierarchies (such as the ways in which masculinities influence men's ability to construct or challenge and contest dominant discourses about sexual health). Men's conversations about sexual health focused primarily around their sexual encounters - something frequently referred to as 'guy talk'. Also described were situations whereby participants employed a discourse of 'manning up' to (i) exert power over others with disregard for potential repercussions and (ii) deploy power to affirm and reify their own hyper-masculine identities, while using their personal (masculine) power to help others (who are subordinate in the social ordering of men). By better understanding how masculine discourses are employed by men, their sexual health needs can be advanced.

Heteronormativity hurts everyone: experiences of young men and clinicians with sexually transmitted infection/HIV testing in British Columbia, Canada

Heteronormative assumptions can negatively influence the lives of young gay and bisexual men, and recent sociological analyses have identified the negative impacts of heteronormativity on heterosexual men (e.g. 'fag discourse' targeted at heterosexual adolescents). However, insights into how heteronormative discourses may be (re)produced in clinical settings and how they contribute to health outcomes for gay, bisexual and heterosexual men are poorly understood. This analysis draws on in-depth interviews with 45 men (15-25 years old) and 25 clinicians in British Columbia, Canada, to examine how heteronormative discourses affect sexually transmitted infection testing. The sexually transmitted infection/HIV testing experience emerged as a unique situation, whereby men's (hetero)sexuality was explicitly 'interrogated'. Risk assessments discursively linked sexual identity to risk in ways that reinforced gay men as the risky 'other' and heterosexual men as the (hetero)normal and, therefore, relatively low-risk patient. This, in turn, alleviated concern for sexually transmitted infection/HIV exposure in heterosexual men by virtue of their sexual identity (rather than their sexual practices), which muted discussions around their sexual health. The clinicians also positioned sexual identities and practices as important 'clues' for determining their patients' social contexts and supports while concurrently informing particular tailored clinical communication strategies. These findings highlight how men's experiences with sexually transmitted infection/HIV testing can (re)produce heteronormative assumptions and expectations or create opportunities for more equitable gendered relations and discourses.

Young people's perspectives on the use of reverse discourse in web-based sexual-health interventions

Web-based sexual-health promotion efforts often utilise reverse discourse - the acknowledgement and rejection of shame associated with stigmatised terms - both to challenge judgments about 'risky' behaviours (e.g., casual sex) and to appeal to young people. This study examines the use of reverse discourse in Internet-based sexual-health promotion and analyses young people's perspectives on this approach. During in-depth interviews and focus groups with young people (aged 15-24), participants shared their perspectives on written (e.g., clinical language; colloquial language) and visual (e.g., generic, stock images; sexualised images) depictions of sexual-health topics on the websites. More explicit styles elicited negative responses from young people in terms of perceived appeal, trust and quality of websites. Negative social mores were associated with some of the more explicit portrayals of young people's sexual lives on the websites, revealing how reverse discourse re-stigmatises young people by re-emphasising young people's sexual activity as inherently risky or immoral. Reverse discourse was perceived to have negative effects on the saliency and credibility of online sexual-health information. We discuss the theoretical basis for the operationalisation of reverse discourse in this context, and discuss the importance of considering sociotechnical aspects of Internet-based sexual-health interventions.

STI service delivery in British Columbia, Canada; providers' views of their services to youth

Background

Little is known about service providers’ knowledge, attitudes, and experiences in relation to the assessment, diagnosis, and treatment of individuals seeking care for sexually transmitted infections (STIs), and how they influence the delivery of services. The purpose of this study was to explore the perceptions of STI care providers and the ways they approached their practice.

Methods

We used a qualitative approach drawing on methods used in thematic analysis. Individual semi-structured in-depth interviews were conducted with 21 service providers delivering STI services in youth clinics, STI clinics, reproductive health clinics, and community public health units in British Columbia (BC), Canada.

Results

Service providers’ descriptions of their activities and roles were shaped by a number of themes including specialization, scarcity, and maintaining the status quo. The analysis suggests that service providers perceive, at times, the delivery of STI care to be inefficient and inadequate.

Conclusion

Findings from this study identify deficits in the delivery of STI services in BC. To understand these deficits, more research is needed to examine the larger health care structure within which service providers work, and how this structure not only informs and influences the delivery of services, but also how particular structural barriers impinge on and/or restrict practice.

Cognitive-behavioral therapy versus other PTSD psychotherapies as treatment for women victims of war-related violence: a systematic review

Although war-trauma victims are at a higher risk of developing PTSD, there is no consensus on the effective treatments for this condition among civilians who experienced war/conflict-related trauma. This paper assessed the effectiveness of the various forms of cognitive-behavioral therapy (CBT) at lowering PTSD and depression severity. All published and unpublished randomized controlled trials studying the effectiveness of CBT at reducing PTSD and/or depression severity in the population of interest were searched. Out of 738 trials identified, 33 analysed a form of CBTs effectiveness, and ten were included in the paper. The subgroup analysis shows that cognitive processing therapy (CPT), culturally adapted CPT, and narrative exposure therapy (NET) contribute to the reduction of PTSD and depression severity in the population of interest. The effect size was also significant at a level of 0.01 with the exception of the effect of NET on depression score. The test of subgroup differences was also significant, suggesting CPT is more effective than NET in our population of interest. CPT as well as its culturallyadapted form and NET seem effective in helping war/conflict traumatised civilians cope with their PTSD symptoms. However, more studies are required if one wishes to recommend one of these therapies above the other.

Online sexual health services: examining youth's perspectives

OBJECTIVES

Sexually transmitted infections (STIs) are high and rising in British Columbia, Canada, and youth ages 15-24 account for a disproportionate amount of the infections. As a result, new public health interventions have increasingly turned towards media such as the internet to reach youth populations at risk for STIs/HIV. We describe youth's perceptions about online sexual health services.

METHODS

We used data from in-depth, semi-structured interviews with 38 men and 14 women between the ages of 15 and 24 who discussed: online STI/HIV testing services and online counselling and education services.

RESULTS

In general, youth are familiar with, receptive to and have an affinity for online sexual health services. Youth in the current study suggested that online STI/HIV risk assessment and testing as well as online counselling and education could enhance opportunities for low-threshold service provision. Online services appealed to youth's needs for convenience, privacy, as well as expedient access to testing and/or counselling; however, youth also appear to have relatively low tolerance for technologies that they perceive to be antiquated (e.g., printing lab requisition forms), revealing the challenges of designing online approaches that will not quickly become outdated.

CONCLUSION

Globally, pilot programs for Internet-based sexual health services such as online testing and partner notification have shown promising results. As Canadian interventions of this type emerge, research with youth populations can provide relevant insights to help program planners launch effective interventions.

Internet-based HIV and sexually transmitted infection testing in British Columbia, Canada: opinions and expectations of prospective clients

BACKGROUND

The feasibility and acceptability of Internet-based sexually transmitted infection (STI) testing have been demonstrated; however, few programs have included testing for human immunodeficiency virus (HIV). In British Columbia, Canada, a new initiative will offer online access to chlamydia, gonorrhea, syphilis, and HIV testing, integrated with existing clinic-based services. We presented the model to gay men and other men who have sex with men (MSM) and existing clinic clients through a series of focus groups.

OBJECTIVE

To identify perceived benefits, concerns, and expectations of a new model for Internet-based STI and HIV testing among potential end users.

METHODS

Participants were recruited through email invitations, online classifieds, and flyers in STI clinics. A structured interview guide was used. Focus groups were audio recorded, and an observer took detailed field notes. Analysts then listened to audio recordings to validate field notes. Data were coded and analyzed using a scissor-and-sort technique.

RESULTS

In total, 39 people participated in six focus groups. Most were MSM, and all were active Internet users and experienced with STI/HIV testing. Perceived benefits of Internet-based STI testing included anonymity, convenience, and client-centered control. Salient concerns were reluctance to provide personal information online, distrust of security of data provided online, and the need for comprehensive pretest information and support for those receiving positive results, particularly for HIV. Suggestions emerged for mitigation of these concerns: provide up-front and detailed information about the model, ask only the minimal information required for testing, give positive results only by phone or in person, and ensure that those testing positive are referred for counseling and support. End users expected Internet testing to offer continuous online service delivery, from booking appointments, to transmitting information to the laboratory, to getting prescriptions. Most participants said they would use the service or recommend it to others. Those who indicated they would be unlikely to use it generally either lived near an STI clinic or routinely saw a family doctor with whom they were comfortable testing. Participants expected that the service would provide the greatest benefit to individuals who do not already have access to sensitive sexual health services, are reluctant to test due to stigma, or want to take immediate action (eg, because of a recent potential STI/HIV exposure).

CONCLUSIONS

Internet-based STI/HIV testing has the potential to reduce barriers to testing, as a complement to existing clinic-based services. Trust in the new online service, however, is a prerequisite to client uptake and may be engendered by transparency of information about the model, and by accounting for concerns related to confidentiality, data usage, and provision of positive (especially HIV) results. Ongoing evaluation of this new model will be essential to its success and to the confidence of its users.

STD and HIV testing behaviors among black and Puerto Rican young adults

CONTEXT

Given the high rates of infection among urban young adults, STD and HIV testing promotion is a public health priority. To inform future testing efforts, lifetime and recent testing behaviors of this population within casual and serious relationships should be better understood.

METHODS

Data from a 2007-2008 study conducted in select neighborhoods in Hartford and Philadelphia were used to examine self-reported STD and HIV testing behaviors and attitudes among 483 sexually active black and Puerto Rican young adults aged 18-25. Multivariate ordered logit regression analyses were conducted to assess characteristics associated with lifetime number of STD tests.

RESULTS

More than eight in 10 participants reported having been tested for STDs, and a similar proportion for HIV, most of them multiple times. Nineteen percent had ever had an STD diagnosis. A majority-86%-perceived their risk of STD infection in the next year as "not at all likely." Sixty-one percent of those in serious relationships reported that both partners had been tested, compared with 25% of those in casual relationships. Characteristics associated with higher lifetime number of STD tests were being female (odds ratio, 2.2), being from Philadelphia (2.5), being black (1.5), having lived with two or more serious partners (1.7) and having ever received an STD diagnosis (2.3).

DISCUSSION

Despite their risks, participants did not perceive themselves to be at risk of STDs. However, they did report testing repeatedly. Testing was highly acceptable, particularly within serious relationships. Questions about the timing of testing initiation and repeat testing merit attention for the benefits of widespread testing to be fully realized.

Reproductive health screening disparities and sexual orientation in a cohort study of U.S. adolescent and young adult females

PURPOSE

To examine sexual orientation group disparities in the Papanicolaou (Pap) and sexually transmitted infection (STI)/human papillomavirus (HPV) tests among adolescents and young adult females.

METHODS

Survey data from 4,224 adolescents and young adults aged 17-25 years who responded to the 2005 wave questionnaire of the Growing Up Today Study were cross-sectionally examined with multivariate generalized estimating equations regression. We examined associations between sexual orientation and reproductive healthcare utilization as well as abnormal results with completely heterosexual as the referent group, controlling for age, race/ethnicity, geographic region, and sexual history.

RESULTS

After accounting for sociodemographics and sexual history, mostly heterosexual/bisexual females had 30% lower odds of having a Pap test within the last year and almost 40% higher odds of being diagnosed with an STI, as compared with the completely heterosexual group. Additionally, lesbians had very low odds of having a Pap test in their lifetime (odds ratio = .13, p ≤ .0001) and having a Pap test within the last year (odds ratio = .25, p = .0002), as compared with completely heterosexuals.

CONCLUSIONS

Our study demonstrates that sexual minority adolescent and young adult women underutilize routine reproductive health screenings, including Pap smears and STI tests. Providers and health educators should be aware of these disparities so that they can provide appropriate care to young women and their families and ensure that all young women receive reproductive health screening. Further research is needed to explore reasons sexual minority females are not accessing care as recommended because this may suggest opportunities to improve reproductive health screenings as well as broader healthcare access issues.