April 26, 2002
Participants included undergraduate students aged 18 to 22 years who were enrolled in the first or second summer session at an urban university in 1997. Each student was paid $15 for participating in the study.
In an effort to simulate the conditions of making actual decisions, researchers presented participants with a hypothetical scenario concerning a friend of the same gender:
Your friend comes to you and tells you that he/she recently had sex with someone for the first time. At first he/she wasn?t worried, but now he/she is wondering if he/she should be tested for any STI. What additional information would you want to know to help decide whether to get tested?
After the initial responses, participants were prompted to think of as many factors as possible that would be relevant to the decision and to elaborate on each suggestion.
When asked for negative consequences that might influence a person?s decision to seek testing for STIs, participants said: what others would think (88%); embarrassment (61%); fear of positive test results (56%); negative emotions (29%); fear of procedures (24%); future will be affected (12%).
When asked for personal characteristics that might influence a person?s decision to seek testing for STIs, participants chose: denial that one might contract an STI (29%); would rather not know (22%).
When asked what might make one vulnerable to STIs, participants said: partner characteristics (93%); symptoms (88%); specifics of sexual encounter (80%); past sexual history; nonsexual exposure (10%).
When asked for social norms that might influence a person?s decision to seek testing for STIs, participants pointed to: a social stigma surrounding the idea of sexually transmitted diseases (56%); sex and STIs are private issues (49%).
When asked for benefits that might influence a person?s decision to seek testing for STIs, participants said: it is better to know the results than not know (44%); relief from negative test results (42%); health benefits of knowing the results (39%); concern for partner (10%).
When asked for provider characteristics that might influence a person?s decision to seek testing for STIs, participants chose: gender of provider (41%); provider?s knowledge (27%); comfort with physician (20%).
When asked for testing and setting characteristics that might influence a person?s decision to seek testing for STIs, participants pointed to: reputation (78%); cost (60%); confidentiality (60%); convenience (56%); services unavailable (37%); unsure where to go (20%).
The authors believe one of the most striking findings was the number and diversity of comments related to perceived negative consequences of testing. Many of the respondents stated they would ?rather not know? than take an STI test. The social stigmas related to STIs, mentioned directly by more than half of the people in the sample, may underlie many of the perceived negative consequences of testing.
The authors believe their data allowed them to describe STI-related social stigmas in detail: seeking testing may cause an individual to experience guilt, shame and fear and to worry that others will see them as dirty, loose, disgusting, or dumb.
The authors note that participants were asked about hypothetical scenarios and actual behavior was not assessed. The study population was limited to students at a single university, and the sample was not a random selection of all students. Despite the limitations, the authors feel this research has implications for STI testing services, especially on college campuses.
To reduce barriers to STI-related care, the authors note that college health clinicians, health educators, and other professional staff may need to increase their emphasis on STI prevention at both campus and national levels. Health-system factors, such as accessibility and confidentiality, may prove more amenable to change than individual behavior.
For more information: K. R. Barth, M.D., et al., ?Social Stigma and Negative Consequences: Factors That Influence College Students? Decisions to Seek Testing for Sexually Transmitted Infections,? Journal of American College Health, vol. 50, no. 4, pp. 153-58.
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