Background Young minority men in the US bear a disproportionate burden of STI, but comprise one of the population groups least likely to access services. STI service utilisation is not only constrained by access to quality care but also potentially impacted by socio-cultural factors, including STI-related stigma and shame, which can undermine efforts to promote testing and treatment. STI-related stigma and shame may also provide a disincentive for young men to participate in partner notification programs, including partner-delivered therapy. We hypothesised that young men who perceive increasing levels of social stigma related to STI would be less likely to seek out STI-related services or notify their sexual partners about STI.
Methods Between June and July, 2010, 108 African American young men (15—24 years) responded to a brief, self-administered intercept survey on a hand-held device. Recruitment was conducted on the street and in residential areas of a low income urban neighbourhood with elevated STI rates. The survey included socio-demographic questions, an 11 item scale measuring STI-related stigma and shame, and questions regarding STI testing history, preferences for notifying partners, and interest in partner delivered therapy. The association between stigma and shame scores and STI testing and partner notification preferences was evaluated with multivariate logistic regression, adjusting for age and education.
Results The median (range) STI-stigma score was 12 (5–25) and the shame score was 15 (6–30); higher scores indicate more stigma or shame. Most participants had ever been tested for STI (73%), indicated willingness to personally notify their main partners (72%) or other partners (66%), and said they would deliver STI therapy to a partner (68%). Increasing STI-related stigma was significantly associated with a history of STI testing, such that every SD increase in stigma score was associated with 50% decreased odds of having been tested (OR: 0.5, 95% CI 0.3 to 1.0). Participants with higher levels of stigma and shame were also significantly less likely to be willing to personally notify their partners of STI or to deliver therapy.
Conclusions STI-related stigma and shame, common in this population, could undermine STI testing, treatment, and partner notification programs. Efforts to expand access to care should be accompanied by efforts to change socio-cultural attitudes and norms around STI testing and treatment.
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