Stigma associated with sexually transmissible infection testing in an online testing environment: examining the perspectives of youth in Vancouver, Canada
Mohammad Karamouzian A B C , Rod Knight A B D , Wendy M. Davis E , Mark Gilbert A F and Jean Shoveller A B G
+ Author Affiliations
- Author Affiliations
A School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
B British Columbia Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
C HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-Bagh Highway, Kerman 7616913555, Iran.
D Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
E Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
F Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
G Corresponding author. Email: jean.shoveller@ubc.ca
Sexual Health 15(1) 46-53 https://doi.org/10.1071/SH17089
Submitted: 29 April 2017 Accepted: 28 June 2017 Published: 1 September 2017
Abstract
Background: Online sexually transmissible infection (STI) testing is increasingly available and has shown promising results across different settings. However, evidence on how stigma associated with STI testing may be experienced by youth in the context of these online services is limited. Methods: A convenience sample of 71 youth (aged 15–24 years) both male and female was engaged through online and offline recruitment strategies in Vancouver, Canada. Through semistructured and exploratory interviews, participants were asked about their perceptions of stigma associated with STI testing in an online testing environment. Data were analysed using a thematic analysis approach. Results: Youth came from a diverse set of sociodemographic backgrounds and most (n = 46, 65%) had previously accessed STI testing in clinic-based settings. Participants’ perceptions pointed to the benefits of online testing for reducing the external stigma despite the potential persistence of internalised stigma. Notions of hegemonic masculinity and emphasised femininity were also present in the participants’ descriptions of the role of gender in accessing online STI testing. Conclusions: Online STI testing could potentially ameliorate the experiences of participants in regards to the stigma associated with STI testing; however, participants’ internalised feelings of shame and stigma around testing for STI may continue to persist. Our findings underscore the need to revisit and re-evaluate existing STI testing services to provide less anxiety-inducing testing environments for youth.
Additional keywords: Stigma, urban youth.
References
[1] Knight R, Shoveller J, Oliffe J, Gilbert M, Goldenberg S. Heteronormativity hurts everyone: experiences of young men and clinicians with STI/HIV testing in British Columbia, Canada. Health 2013; 17 441–59.| Heteronormativity hurts everyone: experiences of young men and clinicians with STI/HIV testing in British Columbia, Canada.Crossref | GoogleScholarGoogle Scholar |
[2] Shoveller J, Knight R, Johnson J, Oliffe JL, Goldenberg S. ‘Not the swab!’Young men’s experiences with STI testing. Sociol Health Illn 2010; 32 57–73.
| ‘Not the swab!’Young men’s experiences with STI testing.Crossref | GoogleScholarGoogle Scholar |
[3] Oliver de Visser R, O’Neill N. Identifying and understanding barriers to sexually transmissible infection testing among young people. Sex Health 2013; 10 553–8.
| Identifying and understanding barriers to sexually transmissible infection testing among young people.Crossref | GoogleScholarGoogle Scholar |
[4] Shoveller J, Johnson J, Rosenberg M, Greaves L, Patrick DM, Oliffe JL, Knight R. Youth’s experiences with STI testing in four communities in British Columbia, Canada. Sex Transm Infect 2009; 85 397–401.
| Youth’s experiences with STI testing in four communities in British Columbia, Canada.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MnjvFOmsQ%3D%3D&md5=2a6520075f867769d26991154c0d640eCAS |
[5] Wolitski RJ, Pals SL, Kidder DP, Courtenay-Quirk C, Holtgrave DR. The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS Behav 2009; 13 1222–32.
| The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV.Crossref | GoogleScholarGoogle Scholar |
[6] Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol 2001; 27 363–85.
| Conceptualizing stigma.Crossref | GoogleScholarGoogle Scholar |
[7] Tomnay JE, Bourke L, Fairley CK. Exploring the acceptability of online sexually transmissible infection testing for rural young people in Victoria. Aust J Rural Health 2014; 22 40–4.
| Exploring the acceptability of online sexually transmissible infection testing for rural young people in Victoria.Crossref | GoogleScholarGoogle Scholar |
[8] Kapphahn CJ, Wilson KM, Klein JD. Adolescent girls’ and boys’ preferences for provider gender and confidentiality in their health care. J Adolesc Health 1999; 25 131–42.
| Adolescent girls’ and boys’ preferences for provider gender and confidentiality in their health care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MznsVOjtA%3D%3D&md5=30fc1012d32c547b6a76fa5416d94562CAS |
[9] Oliffe JL, Chabot C, Knight R, Davis W, Bungay V, Shoveller JA. Women on men’s sexual health and sexually transmitted infection testing: a gender relations analysis. Sociol Health Illn 2013; 35 1–16.
| Women on men’s sexual health and sexually transmitted infection testing: a gender relations analysis.Crossref | GoogleScholarGoogle Scholar |
[10] Davis WM, Shoveller JA, Oliffe JL, Gilbert M. Young people’s perspectives on the use of reverse discourse in web-based sexual-health interventions. Cult Health Sex 2012; 14 1065–79.
| Young people’s perspectives on the use of reverse discourse in web-based sexual-health interventions.Crossref | GoogleScholarGoogle Scholar |
[11] Goldenberg S, Shoveller J, Ostry A, Koehoorn M. Youth sexual behaviour in a boomtown: implications for the control of sexually transmitted infections. Sex Transm Infect 2008; 84 220–3.
| Youth sexual behaviour in a boomtown: implications for the control of sexually transmitted infections.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1czkt12isA%3D%3D&md5=db0c28e68d5d244ff8f6e943259378fcCAS |
[12] Shoveller J, Knight R, Davis W, Gilbert M, Ogilvie G. Online sexual health services: examining youth’s perspectives. Can J Public Health 2011; 103 14–8.
[13] Jenkins WD, Wold B. Use of the Internet for the surveillance and prevention of sexually transmitted diseases. Microbes Infect 2012; 14 427–37.
| Use of the Internet for the surveillance and prevention of sexually transmitted diseases.Crossref | GoogleScholarGoogle Scholar |
[14] Bailey JV, Murray E, Rait G, Mercer CH, Morris RW, Peacock R, Cassell J, Nazareth I. Interactive computer‐based interventions for sexual health promotion. Cochrane Libr 2010; 9 CD006483
[15] Aicken CR, Fuller SS, Sutcliffe LJ, Estcourt CS, Gkatzidou V, Oakeshott P, Hone K, Sadiq ST, Sonnenberg P, Shahmanesh M. Young people’s perceptions of smartphone-enabled self-testing and online care for sexually transmitted infections: qualitative interview study. BMC Public Health 2016; 16 974
| Young people’s perceptions of smartphone-enabled self-testing and online care for sexually transmitted infections: qualitative interview study.Crossref | GoogleScholarGoogle Scholar |
[16] Gilbert M, Haag D, Hottes TS, Bondyra M, Elliot E, Chabot C, Farrell J, Bonnell A, Kopp S, Andruschak J, Shoveller J, Ogilvie G. Get checked… where? The development of a comprehensive, integrated internet-based testing program for sexually transmitted and blood-borne infections in British Columbia, Canada. JMIR Res Protoc 2016; 5 e186
| Get checked… where? The development of a comprehensive, integrated internet-based testing program for sexually transmitted and blood-borne infections in British Columbia, Canada.Crossref | GoogleScholarGoogle Scholar |
[17] Mortimer NJ, Rhee J, Guy R, Hayen A, Lau AY. A web-based personally controlled health management system increases sexually transmitted infection screening rates in young people: a randomized controlled trial. J Am Med Inform Assoc 2015; 22 805–14.
| A web-based personally controlled health management system increases sexually transmitted infection screening rates in young people: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |
[18] Mann TA, Uddin Z, Hendriks AM, Bouchard CJ, Etches VG. Get tested why not? A novel approach to Internet-based chlamydia and gonorrhoea testing in Canada. Can J Public Health 2013; 104 205–9.
| Get tested why not? A novel approach to Internet-based chlamydia and gonorrhoea testing in Canada.Crossref | GoogleScholarGoogle Scholar |
[19] Kuder M, Goheen MJ, Dize L, Barnes M, Gaydos CA. Evaluation of a new website design for iwantthekit for chlamydia, gonorrhoea, and trichomonas screening. Sex Transm Dis 2015; 42 243–5.
| Evaluation of a new website design for iwantthekit for chlamydia, gonorrhoea, and trichomonas screening.Crossref | GoogleScholarGoogle Scholar |
[20] British Columbia Centre for Disease Control (BCCDC). STI in British Columbia: Annual Surveillance Report 2014. BCCDC: Vancouver; 2015.
[21] Hottes TS, Farrell J, Bondyra M, Haag D, Shoveller J, Gilbert M. Internet-based HIV and sexually transmitted infection testing in British Columbia, Canada: opinions and expectations of prospective clients. J Med Internet Res 2012; 14 e41
| Internet-based HIV and sexually transmitted infection testing in British Columbia, Canada: opinions and expectations of prospective clients.Crossref | GoogleScholarGoogle Scholar |
[22] Gilbert M, Salway T, Haag D, Fairley CK, Wong J, Grennan T, Uddin Z, Buchner CS, Wong T, Krajden M, Tyndall M, Shoveller J, Ogilvie G. Use of GetCheckedOnline, a comprehensive web-based testing service for sexually transmitted and blood-borne infections. J Med Internet Res 2017; 19 e81
| Use of GetCheckedOnline, a comprehensive web-based testing service for sexually transmitted and blood-borne infections.Crossref | GoogleScholarGoogle Scholar |
[23] Peeling RW. Testing for sexually transmitted infections: a brave new world? Sex Transm Infect 2006; 82 425–30.
| Testing for sexually transmitted infections: a brave new world?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28jkvVCqtA%3D%3D&md5=34a449d72ec91d76b308d8771de651c2CAS |
[24] Platteau T, Fransen K, Apers L, Kenyon C, Albers L, Vermoesen T, Loos J, Florence E. Swab2know: An HIV-testing strategy using oral fluid samples and online communication of test results for men who have sex with men in Belgium. J Med Internet Res 2015; 17 e213
| Swab2know: An HIV-testing strategy using oral fluid samples and online communication of test results for men who have sex with men in Belgium.Crossref | GoogleScholarGoogle Scholar |
[25] Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015; 42 533–44.
| Purposeful sampling for qualitative data collection and analysis in mixed method implementation research.Crossref | GoogleScholarGoogle Scholar |
[26] Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. 2008.
[27] Morse JM, Field PA. Qualitative research methods for health professionals. 1995.
[28] Thomas DR. A general inductive approach for analysing qualitative evaluation data. Am J Eval 2006; 27 237–46.
| A general inductive approach for analysing qualitative evaluation data.Crossref | GoogleScholarGoogle Scholar |
[29] Woodhall SC, Sile B, Talebi A, Nardone A, Baraitser P. Internet testing for Chlamydia trachomatis in England, 2006 to 2010. BMC Public Health 2012; 12 1095
| Internet testing for Chlamydia trachomatis in England, 2006 to 2010.Crossref | GoogleScholarGoogle Scholar |
[30] Barker G, Ricardo C, Nascimento M, Olukoya A, Santos C. Questioning gender norms with men to improve health outcomes: evidence of impact. Glob Public Health 2010; 5 539–53.
| Questioning gender norms with men to improve health outcomes: evidence of impact.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cjisVOkug%3D%3D&md5=29cb8d4f04ea9434017801c6314b1405CAS |
[31] Magee JC, Bigelow L, DeHaan S, Mustanski BS. Sexual health information seeking online a mixed-methods study among lesbian, gay, bisexual, and transgender young people. Health Educ Behav 2012; 39 276–89.
| Sexual health information seeking online a mixed-methods study among lesbian, gay, bisexual, and transgender young people.Crossref | GoogleScholarGoogle Scholar |
[32] Knight R, Falasinnu T, Oliffe JL, Gilbert M, Small W, Goldenberg S, Shoveller J. Integrating gender and sex to unpack trends in sexually transmitted infection surveillance data in British Columbia, Canada: an ethno-epidemiological study. BMJ Open 2016; 6 e011209
| Integrating gender and sex to unpack trends in sexually transmitted infection surveillance data in British Columbia, Canada: an ethno-epidemiological study.Crossref | GoogleScholarGoogle Scholar |
[33] Gilbert M, Hottes TS, Kerr T, Taylor D, Fairley CK, Lester R, Wong T, Trussler T, Marchand R, Shoveller J, Ogilvie G. Factors associated with intention to use internet-based testing for sexually transmitted infections among men who have sex with men. J Med Internet Res 2013; 15 e254
| Factors associated with intention to use internet-based testing for sexually transmitted infections among men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
