P4A217: Stigma, Fear, and Other Barriers to Testing: A Qualitative Study of Adolescents’ Perspectives on Sexually Transmitted Infections

Background: Sexually transmitted infections (STIs) affect a disproportionate percentage of adolescents, with approximately half of all new STI cases occurring in persons aged 15-24 years. This project aimed to assess adolescents’ knowledge and perceptions of STIs using qualitative research to provide context and depth to existing quantitative data.

Methods: Private semi-structured interviews were conducted with adolescents aged 13-17 hospitalized at a children’s hospital in 2021. Interviews were coded and analyzed using thematic analysis. Themes were developed through an iterative process of engagement with the data and focus on the primary research aim. The study was approved by our Institutional Review Board, including a waiver of parental permission.

Results: Thematic saturation was achieved with 20 hospitalized adolescents. Patient-reported demographics are shown in Table 1. There was a wide variety of knowledge and perspectives regarding STIs amongst teens. Themes included 1) Variation in adolescent knowledge of STIs, 2) Stigma associated with STIs, 3) Varied personal experience with STI testing and multiple barriers identified, and 4) Lack of knowledge regarding free and confidential STI testing. General knowledge of STIs ranged greatly, from simply having heard of them to detailed knowledge of prevention, symptoms, and testing. Many participants associated STIs with negative connotations, including pain and stigma, and conversations regarding STIs among their peers centered on poking fun at those who have had an STI. Personal experience with STI diagnosis or testing varied from never to regular testing. The most salient barrier that emerged for adolescents getting STI testing was parents and parental knowledge of their sexual activity. Additional barriers identified included access to testing (transportation, cost, low frequency of doctors’ visits in adolescence), privacy (especially in LGBTQ youth), and fear of stigma, disease, and testing. Participants identified a variety of locations that STI testing could be completed (primary care offices, emergency department, Planned Parenthood) but the majority denied knowledge of locations where testing could be done without parental knowledge. Thirty-five percent of participants were offered STI testing during the hospitalization, with one participant who was not offered testing endorsing a desire for STI testing during the hospitalization.

Conclusion: This qualitative study highlights adolescents’ vast range of knowledge regarding STIs. It further emphasizes the impact of barriers such as parental knowledge and access to testing and the limited knowledge that adolescents have regarding free and confidential STI testing. Given the increased prevalence of STIs among adolescents and long-term consequences of untreated infection, increased STI screening of adolescents should be pursued, aligning with the American Academy of Pediatrics policy statement on the Hospitalized Adolescent. Routinely offering testing at every medical visit (including emergency department visits and hospitalizations) as well as confidential communication regarding free and confidential testing sites will increase adolescent knowledge of and access to testing.