The barriers To STI testing
Let us start by saying; these barriers are real, if they weren’t the rate of STIs like Chlamydia & Gonorrhoea would not be so high. The numbers speak for themselves, so let’s get into it, why don’t people get STI tests as often as they should or at all?
One great study we want to talk about is, Understanding The Barriers To STI Testing Among Young People, Results From The Online Survey, ‘Getting Down To It’, which was conducted by the National Centre in HIV, Social Research at The University of New South Wales in 2011.
Before we delve into the details, if you’re wondering why we’re talking about a six-year-old study, the fact is the rate of STIs like Chlamydia and Gonorrhoea are particularly serious in those aged 15-29, so this study is far from irrelevant, as we believe that until as many barriers to testing as possible are eliminated the trend won’t change.
Let’s start with where this data came from, “the survey recruited 1,658 eligible, sexually active young participants living in NSW of whom 1,100 provided complete data. Participants were on average aged 20.6 years (range 16–26 years). Among participants 60% were female and 40% were male; 71% reported being heterosexual and 29% non-heterosexual.”
Of those 1,100 participants 52% had ever tested for STIs or HIV, the good news, it’s more than half, the bad news it’s only just more than half. What’s more, only a quarter of participants agreed with statements indicating that testing for STIs was part of their routine, that’s definitely not good.
So who was getting tested? The study showed that routine testing was found to be independently associated with being older (21-26 as opposed 16-20), being female and being non-heterosexual.
Now let’s look at risk, “of the 1,100 sexually active participants, 730 (66%) reported having had unprotected intercourse in the past six months with regular or casual partners.” The positive side of that result is that participants who had had unprotected sex were two and a half more times more likely to have been tested for STIs.
So now we’ve laid the platform, let’s get into those barriers.
When it came to attitudes to STI Testing, unsurprisingly in a univariate analysis of the participants responses, holding positive attitudes towards STI Testing was found to be associated with ever having had an STI Test, which tells us that really it isn’t so bad once you actually get tested. But what about the people that aren’t getting tested…obviously, they didn’t share the same level of comfort about getting tested
Let’s talk about Pros and Cons. According to the Health Belief Model, “individuals evaluate a recommended action by considering the pros and cons of the health behaviour,” which makes sense. Interestingly Participants had a higher level of perceived pros than cons overall, with the perception of cons associated with STI Testing sitting around the mid-point of the scale. But that’s not the end of the story.
Perceived pros were higher in female and non-hetrosexual participants whilst participants aged 16-20 perceived more cons than those aged 21-26, but wait there’s more, once again higher levels of testing were observed amongst participants with higher levels of perceived pros, similarly perceived cons of STI testing were found to be negatively associated with STI testing.
So how do we help people who consider the cons to outweigh the pros overcome them? First, we need to understand what exactly those cons are a little bit more.
Luckily, additional analyses were done to assess the individual association of a selection of pros and cons with testing for STIs. When the perceived cons were evaluated all of them except for one were significantly associated with lower levels of STI testing. The only one that wasn’t was the perception that STI Testing procedures are intrusive and painful, which we’re pleased to hear because they aren’t.
A multivariate analysis showed that two cons, in particular, were even more significantly associated with lower levels of STI testing and they were, ‘Getting tested for STIs is expensive’ and ‘It’s not easy to know where to go to get an STI test.’
We looked very closely at those two cons when we were designing our STI testing process and we made sure our process was affordable, eliminating con 1 for anyone who is not getting tested through a free Sexual Health Clinic or by seeing a bulk-billing GP, which can be time-consuming. Con 2, was easily eliminated by allowing people to go to any Pathology Centre in Australia to get the tests once they have their Pathology Referral from us.
Unfortunately, cons aren’t the only thing that prevents people from getting tested, there are also various fears and worries which many people share including some of the participants in this study.
When it came to fears and worries Participants levels were above the midpoint of the scale and a multivariate analysis of those levels was found to be significantly associated with being younger, being female and reporting a non Anglo-Australian background. We don’t want to sound like a broken record, but the results did also, once again, show a correlation between people’s levels of fear and worry and the uptake in STI testing, with testing rates lower in those with more fears and worries.
So what are people so afraid of?
‘Fear of parents and partners reactions’ was the most frequently identified one and you know what causes that? A little thing called stigma. That’s why we’re so passionate about trying to get rid of the stigma and creating a more positive conversation about sexual health. We can’t make this fear go away with our testing process, but we can challenge it. So if this particular fear applies to you, then we say don’t worry about what anyone else thinks, the consequences of untreated STIs are much more serious than a potentially awkward conversation with someone. In fact, you should be proud to get tested; being responsible for your good bits is sexy.
In a univariate analyses other fears that cropped up as being detrimental to STI testing were ‘fear of medical procedures’ and ‘fear of negative staff attitudes.’ When it comes to the first one, unfortunately there simply is no way around this one, to get tested you have to give a urine sample and in most cases have a blood test, but at the end of the day, and we’ll say it again, it’s nothing compared to the potential consequences of untreated STIs.
Fear of negative staff attitudes, we get! That’s why our process does not involve a face to face with a doctor, no awkward conversations, and zero judgment. Yes, you still have to go to the Pathology Centre and get tested, but those guys are just carrying out whatever tests our doctors ordered, they’re not there to ask questions. They do Pathology Tests all day long for all kinds of things so there’s no need to worry about them.
Next, let’s talk about shame…
STI related shame was above the mid-point of the scale showing that a substantial proportion of the participants believe they would experience shame if they had an STI. There’s that stigma hard at work again. All we can say about this is, ignorance is not bliss! Not getting tested because you don’t want to know you have an STI and potentially feel ashamed is like cutting off your nose to spite your face. Whilst you’re enjoying your oblivious state that STI is damaging your health and potentially putting your life at stake or endangering your ability to have children one day.
Now, are you ready for the twist? Participants were also asked about their views of other people with an STI and their negative views of people with an STI were found to be lower than the midpoint of the scale meaning they were lower than perceived STI-related shame. What does that tell us? It suggests that only a minority of participants have negative opinions of people with an STI, so why all the self-shaming people? We’re only going to say this once, STIs do not discriminate, they happen to people from ALL walks of life. So stop supporting the stigma, don’t be ashamed if you’ve had one, don’t be ashamed if you have one, don’t be ashamed if you find out you have one, because this study proves that other people really don’t care all that much, but you know what, they’ll probably care a whole lot more if you give them something so nip it in the bud, get tested, get treated if you need to and be proud of it, you’re doing the right thing.
We’re going to wrap it up soon…
Let us just touch on the Subjective Norms of STIs, this evaluated whether or not participants thought that the people in their lives would be supportive of them being tested i.e do they think it’s an acceptable normal behaviour in the eyes of others. The results were around the midpoint of the scale, which might seem like a pretty positive thing, but actually, that’s not great, we want everyone to think of it as the norm and to think their peers think of STI testing as acceptable behaviour. How do we make that happen? Step 1 – get more people to get STI tests by eliminating as many of the barriers as possible. Step 2 – the more people get tested the more they’ll start talking about it with friends and then voila, perceived normal behaviour. Sounds simple right? So let’s do it!
The bottom line is the decision to get an STI test is not always an easy one, as we’ve shown there are some serious barriers in the way and it’s impossible to eliminate them all completely. We’ve done our best to eliminate some of the key ones and we’re doing our best to help to break down the stigma that strengthens so many of the others, but we can’t do it alone. We need you to get tested and then we need your voices to help create a more positive conversation.
So what do you say, let’s try to take down some barriers together?
A few other interesting takeaways (yes we were really fascinated by this study)
- On average perceived vulnerability to STIs was low, but the perceived severity of STIs was high. What does this tell us? People aren’t aware of how prevalent STIs like Chlamydia and Gonorrhoea are and they also aren’t aware how easily treated these two STIs in particular are.
- Participants who had ever experienced symptoms of an STI were three times more likely to have been tested than those who had never experienced symptoms. But here’s the thing a lot of people don’t experience symptoms from STIs like Chlamydia or Gonorrhoea at all, so just waiting for the symptoms to appear is not an accurate way to decide whether you need an STI test. You should be having an STI test every time you change sexual partner, regardless of whether you’ve tried to be safe, the fact is condoms aren’t fool proof and it’s always better to be safe than sorry! You can’t argue with that logic.
Adam, P., de Wit, J., Hermans, J., Story, L., Edwards, B., Murray. C., & Bourne C. (2011). Understanding barriers to STI testing among young people: results from the online survey ‘Getting Down To it’ (Monograph 2/2011). Sydney: National Centre in HIV Social Research, The University of New South Wales
This blog originally posted on HYPHEN.HEALTH subsidary www.stigmahealth.com/blog on 25 May 2020