Dr Hayley Denison - Centre for Public Health Research, Massey University
The early detection of sexually transmitted infections (STIs) is crucial. Timely treatment not only reduces the risk of long-term health complications for the individual, it also reduces the likelihood the infection will be passed on to new people. Therefore, increasing the number of people testing and the speed at which people test after potential STI exposure could bring down STI rates in New Zealand over time. To make this a reality, we need to find out what factors are preventing or delaying people from seeking an STI test.
As part of my PhD, I conducted interviews with 24 young people to identify barriers to STI testing. The interviews were transcribed and analysed using qualitative analysis techniques. The data showed that there are many barriers to seeking an STI test, and individuals may experience any number of these.
Underestimating the personal risk of contracting an STI was common. This led people to erroneously believe that they do not need to have a test. Some people, especially males, were afraid of the STI test procedure itself, imagining it to be very invasive and painful. Other individual beliefs or thought-patterns which prevented or delayed testing included the misconception that most STIs are not serious, embarrassment about having a physical examination, or being too busy to go for a test.
Structural barriers to testing were also apparent, including the financial cost for the individual of getting a test. Some people were worried that the consultation would be “awkward”, but once having attended, they found they were generally comfortable discussing sexual health with the healthcare professional. A few participants did report a negative attitude during an STI test consultation but this hadn’t seemed to have put them off seeking an STI test subsequently. Rather, they said they would simply visit a different clinician next time. Although many participants in our study expressed a preference for a same-sex health professional when going for an STI test, most said they would not be deterred from having an STI test if a health professional of their preferred gender was not available.
Finally, a powerful barrier to STI testing is STI stigma. Being diagnosed with an STI suggests a violation of social norms and values, perhaps that an individual has had unprotected sex with multiple partners, or sex with disreputable partners. Some participants reported avoiding going for an STI test because they were afraid that if they were seen doing so, people would assume that they either had an STI or had been engaging in “bad” behaviour.
The findings of this research provide New Zealand-specific information for clinicians, service-providers, educators, and policy makers, which can be used to find ways to improve testing and subsequently reduce STI transmission in New Zealand. The study results suggest that making people aware of their own risk may be one way to encourage STI testing. In addition, getting the message out that routine STI testing is a simple, fast and pain-free experience would be a positive step. Making STI tests free for everyone would also remove a barrier to STI testing for some people. More difficult, however, will be challenging the social stigma that is associated with STIs and STI testing. Normalising STIs by talking about them more openly with our friends and whānau, as well as highlighting the importance of STI testing as part of looking after our overall health and wellbeing, is a good place to start.
This research has been published in the Australian and New Zealand Journal of Public Health and is freely available as an open-access article from the journal website http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12680/abstract
This research took place while Hayley was a PhD student at Victoria University of Wellington, and was partly funded by a Wellington Medical Research Foundation grant.