Young people’s preferences and motivations for STI partner notification: observational findings from the 2024 Sex, Drugs and Rock ‘n’ Roll survey

Introduction

Sexually transmissible infections (STIs) are highly common among young people aged 15 to 29 years. The most common bacterial STIs in this age group include chlamydia, gonorrhoea and syphilis.¹ STIs can lead to adverse consequences for the infected individual, their sexual partners and unborn children, along with perceived feelings of stigma and shame.² Partner notification is the process of informing the sexual partners of a person infected with an STI of a potential STI exposure, suggesting that the partner seek medical care for testing, treatment and prevention advice.³ Also known as ‘contact tracing’, partner notification is a crucial part of STI control, aiming to identify and treat undiagnosed infections, limit disease progression, prevent reinfection and interrupt transmission.³ Current Australian contact tracing guidelines recommend tracing back 6 months for chlamydia, 2 months for gonorrhoea and 3–12 months for syphilis, depending on the stage of infection. For human immunodeficiency virus (HIV), guidelines recommend tracing back either from the onset of risk behaviour (e.g. condomless sex) or last known negative test result.⁴

Partner notification can be patient- or provider-initiated. Providers (e.g. general practioners (GPs), sexual health physicians) have a legal responsibility to discuss partner notification with their patients. The extent of practitioner involvement will often depend on the type of infection. For example, health department contact tracers might provide support in the partner notification process for syphilis and HIV due to the increased risk of morbidity and mortality. Patient-initiated notification is often quicker and easier to perform, and though many patients are willing to notify partners themselves, rates of engagement in this process are often low.⁵ Though there are some resources available to assist patients in notifying partners, including anonymous web-based partner notification tools (e.g. the Australian website ‘Let Them Know’),⁶ few provide tailored information by communication method and partner type.^7,8 Additionally, many patients experience barriers to partner notification, including fear of stigma, embarrassment, partner retaliation and loss of relationship.⁹ Hence, it is vital to best support young people in undertaking this essential, yet at times daunting, sexual health intervention.

Using findings from the 2024 annual Sex, Drugs and Rock ‘n’ Roll (SDRR) survey, this study aimed to understand young people’s preferences and motivations for partner notification, including preferred methods of notifying and being notified by sexual partners. Variation in notification preferences by regular and casual partner type were also explored. Findings are intended to inform the development of practical and tailored resources to assist young people in notifying sexual partners of an STI risk.

Methods

Results

A total of 2720 people commenced the survey of which 1007 were excluded, as they did not provide consent; 246 participants were excluded due to incomplete year of birth or sex responses; and 304 participants were excluded for incomplete responses to the partner notification module. Of the remaining 1163 respondents, 701 (60.3%) identified as women, 467 (40.2%) identified as heterosexual, 956 (82.2%) had visited a health service in the last 12 months and 249 (21.4%) had an STI test in the last 6 months. The median age of the sample was 21.6 years (range 15.1–30.0) (Table 1). Two respondents were aged 30 years to account for birthdays occurring in the month of survey completion, as participants only provided month and year of birth.

Preferences for notifying and being notified

Most (1056, 90.8%) respondents stated that they would notify a sexual partner if they had an STI and recommend their partners get tested, 10 (0.9%) stated they would not notify, and 79 (6.8%) stated it would depend on the situation. Most (1142, 98.2%) respondents also stated they would want to be notified by a sexual partner if their partner had an STI and 13 (1.1%) said they would not want to be notified or that it would depend on the situation. Univariate logistic regression showed no differences in the odds of wanting to notify or be notified by age, gender, sexuality or health seeking behaviours. Multivariate analysis was not undertaken due to univariate analysis confirming that there were no differences in the characteristics of people who would want to notify or be notified. Counts, proportions and logistic regression results are shown in Table 1.

Motivations for notifying and being notified

Participants who selected ‘Yes’, ‘No’ or ‘It depends’ when asked if they would notify or want to be notified were given the option to provide a free-text response as to why they chose that option. The number of responses for each question is provided in Table 2.

Preferred notification methods

When hypothetically asked how they would prefer to notify a regular partner, 941 (80.9%) respondents chose face-to-face, 533 (45.8%) phone call, 531 (45.7%) text message and 176 (15.1%) social media. When notifying casual partners, 785 (67.5%) chose text message, 414 (35.6%) phone call, 361 (27.2%) face-to-face and 280 (24.1%) social media. When hypothetically asked how they would prefer to be notified by a regular partner, 962 (82.7%) chose face-to-face communication, 603 (51.8%) phone call, 573 (49.3%) text message and 181 (15.6%) social media. When being notified by a casual partner, 871 (74.9%) chose text message, 545 (46.9%) phone call, 445 (38.3%) face-to-face communication and 327 (28.1%) social media.

Almost one-third of participants chose only face-to-face communication with regular partners when notifying (349, 30.0%) and being notified (332, 28.5%). One-fifth of participants chose only text message for communicating with casual partners when notifying (236, 20.3%) and being notified (209, 18.0%) . Results for preferred methods to notify (Fig. 1) and be notified (Fig. 2) can be found below.

Fig. 1.

Percentage of respondents who chose at least each communication method (acceptable) and only each communication method (preferred) for notifying a regular and casual sexual partner that they are at risk of having an STI, N = 1163. *Anonymous methods include text or email via a notification website, through a friend or third person, with support from a health professional, or using an anonymous social media account or dating app.

Fig. 2.

Percentage of respondents who chose at least each communication method (acceptable) and only each communication method (preferred) for being notified by a regular and casual sexual partner that they are at risk of having an STI, N = 1163. *Anonymous methods include text or email via a notification website, through a friend or third person, with support from a health professional, or using an anonymous social media account or dating app.

Discussion

Our study found that, overwhelmingly, young people want to notify and be notified by sexual partners that they are at risk of having an STI, regardless of their age, gender and sexual identity. Young people want to notify and be notified by partners because they feel it is the responsible thing to do, to look after their own and their partner’s health and protect others by reducing transmission. Few stated that embarrassment and fear of repercussion may make them less likely to notify, and often a choice to notify would depend on the type of relationship shared. When notifying or being notified by a regular partner, face-to-face was the preferred method of communication, whereas for casual partners, respondents preferred to notify or be notified via text message. Around a quarter of respondents felt that notifying or being notified by a casual partner via social media was an acceptable method of communication, although few would like to use a dating app for notification. These relevant and practical findings can directly inform sexual health strategies designed to assist young people in undertaking what can be a daunting but crucial step in STI control.

Partner notification rates, in practice, are slightly lower than our findings of hypothetical intention to notify at around 74–92%,^13–16 highlighting differences between intention and reality and the presence of known barriers discussed below. Our results also show that notification intention is influenced by relationship type, as has been found in previous studies.¹⁷ The reasons for wanting to notify and be notified by sexual partners of an STI risk are consistent across the literature. These reasons include wanting to reduce transmission, care for their partner and feeling that it was the right thing to do, along with barriers, including fear of embarrassment, social stigma, retaliation or loss of relationship.^5,9,16–18 Previous studies looking at notification methods also showed face-to-face and phone call were preferred options.^9,16,19 Our findings show an increase in text message favourability compared to that found by Hopkins et al.¹⁹, likely reflecting the increased use of smartphone technology.²⁰ Few studies have looked at the use of social media. Contesse et al. found that men who have sex with men were generally comfortable with use of geo-spatial networking apps for HIV and STI partner notification, either by partner services staff using a health department profile or by a hypothetical built-in anonymous messaging system.²¹ Similar to Tomnay et al.²², we found that young people preferred to use anonymous communication methods for notifying and being notified by casual partners compared to regular partners, which may reflect the ways in which they met their casual partners, such as online and through dating apps.

There are several strategies that can be used to support young people’s engagement in partner notification. In their recent recommendations to improve digital partner notification, Kocur et al. highlight that interventions need to empower and support the index patient, be convenient and integrate with other systems, and normalise partner notification as a social responsibility and an act of caring.⁵ Some strategies likely to assist young Australians with partner notification uptake include providing resources (such as a comparison table or interactive decision tool) that help the index patient choose their preferred method of notification, including tailoring by different partner types,²³ pre-recorded demonstrations and adaptable scripts for face-to-face or telephone notification, example text message templates (such as that provided on the Management of Chlamydia Cases in Australia²⁴ and Better To Know²⁵ websites) and providing STI information and local testing options.⁵ Partner notification messaging should also reinforce positive aspects, such as collective responsibility, including looking after one’s own and their partner’s health, which were key motivators found in our study. Such resources could be made available on general practice, state-based public health unit, state and federal government, and sexual health organisation websites (including in different languages). Workforce training and resources that can be implemented into existing workflows to support clinicians in discussing and undertaking partner notification can also strengthen the crucial role that primary care providers play in STI control. Supporting the uptake of patient-initiated partner notification is particularly pertinent, as the work of GPs and health department contact tracers continues to be resource limited, particularly for common STIs such as chlamydia and gonorrhoea.

This study has several strengths. First, recruitment was conducted online via social media, a platform in which young people are highly engaged. Second, a large sample size was used and with a composition that reflected the general Victorian population, not just people diagnosed with an STI. Third, the inclusion of free-text responses added richness and complexity to the quantitative findings.

Study limitations include the use of convenience sampling during recruitment that may have led to possible selection bias.

Those who completed the survey are likely to have been more engaged in their health, which is reflected by more than 80% of our sample having visited a health service in the last 12 months. This may lead to an overrepresentation of people who may be more likely to notify their partners. Additionally, the use of hypothetical scenarios was chosen to maximise the number of responses but may have led to a disparity between intended and actual partner notification actions. For example, some participants might have intended to notify in the survey, when in reality they might not. Though not included in this survey, the type of STI may also influence notification intentions, as different STIs carry differing levels of stigma, transmission risk and management pathways. Finally, as the survey was only advertised in Victoria and recruited more women and other gender groups than the average Australian population, the sample may not be representative of all young people in Australia.

STIs are continuing to rise, particularly among young people, and emerging threats, such as antimicrobial resistance and novel diseases (e.g. Mpox), present new challenges to STI control. Empowering young people to engage in partner notification by providing tailored and practically relevant partner notification resources can help to reduce transmission and reproductive complications associated with STIs, benefiting not only the individual and their partner but also the wider community.

Supplementary material

Supplementary material is available online.