Destigmatizing genitourinary medicine and sexually transmitted infections in the UK

Places and people: the perceptions of men who have sex with men concerning STI testing: a qualitative study

Objectives

To explore the experiences and views of men who have sex with men (MSM) on attending clinical sexual health services and their preferences regarding service characteristics in the context of the disproportionate burden of STIs experienced by this group. The wider study aim was to develop a risk assessment tool for use in sexual health clinics.

Methods

Qualitative study comprising eight focus group discussions with 61 MSM in four English cities. Topics included: experience of attending sexual health services, perceptions of norms of attendance among MSM, knowledge of, and attitudes towards, STIs and views on ‘being researched.’ Discussions were audio-recorded and transcribed and a thematic data analysis conducted.

Results

Attending sexual health services for STI testing was described as embarrassing by some and some clinic procedures were thought to compromise confidentiality. Young men seeking STI testing were particularly sensitive to feelings of awkwardness and self-consciousness. Black and ethnic minority men were concerned about being exposed in their communities. The personal qualities of staff were seen as key features of sexual health services. Participants wanted staff to be friendly, professional, discreet, knowledgeable and non-judgemental.

Conclusions

A range of opinion on the type of STI service men preferred was expressed with some favouring generic sexual and reproductive health clinics and others favouring specialist community-based services. There was consensus on the qualities they would like to see in healthcare staff. The knowledge, conduct and demeanour of staff could exacerbate or ameliorate unease associated with attending for STI testing.

Do women requesting only contraception find attendance at an integrated sexual health clinic more stigmatizing than attendance at a family planning-only clinic?

Purpose

Both sexually transmitted infections and the genitourinary medicine clinics that patients attend for management of sexually transmitted infections are stigmatized by patients’ perceptions. The aim of this study was to assess whether women requesting contraception only find attendance at an integrated sexual health clinic (ISHC) more stigmatizing than attendance at a family planning (FP)–only clinic.

Patients and methods

Women requesting contraception only were asked to complete a stigma assessment questionnaire in the waiting room of the clinic they attended. Ease of understanding was assessed for each item of the questionnaire prior to commencement of the survey. The questionnaire was given to women attending either an ISHC or a FP-only clinic.

Results

One hundred questionnaires that fulfilled the inclusion criteria were returned. The users of FP-only services were generally older than the users of ISHCs and were more likely than the users of ISHCs to classify themselves as UK white. Stigma perception was significantly higher for the ISHC than the FP-only clinic.

Conclusion

The results of this research indicate that among women who request contraception only, perceived stigma is higher when they attend an ISHC than when they attend a FP-only clinic. As this survey only enrolled clinic users, the authors were unable to assess whether integration generates sufficient stigma to deter some women from accessing contraception from integrated services. Of all stigma-related issues, disclosure concerns are likely to be the most important to the service user. Stigma is not an issue of overriding concern for most service users.

Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections

Stigma has long accompanied sexually transmissible infections (STI) and hindered prevention and control efforts. It not only acts as a formidable barrier to STI testing, treatment and disclosure, but has a multitude of consequences for the health and quality of life of infected individuals. This review summarises the literature related to STI stigma and offers practical approaches to counter STI-associated stigma through multi-level efforts. Specifically, it describes the key sources that breed and perpetuate stigma, outlines how STI-associated stigma has been conceptualised and measured in the literature, documents the impact of stigma on infected and uninfected individuals, and summarises the stigma reduction strategies recommended in the literature. Gaps in the literature are identified and areas for further research are suggested, along with practical strategies for moving forward.