Public health leaders are committed to safeguarding the well-being of communities and ensuring that everyone has equitable access to vital services. When it comes to addressing sexually transmitted infections (STIs), these leaders encounter a significant challenge: the persistent stigma that surrounds these conditions. By fostering inclusive approaches and equipping individuals with the tools to regain control over their sexual health, we at Color are building toward a future where understanding and empathy triumph over judgment and shame. To achieve empathy, we all must equip, engage and expand.
How does stigma affect STI testing and treatment?
Traditional healthcare settings are not ideal to serve those at greatest risk of STIs. The effect of stigma on care-seeking is especially powerful among groups already experiencing marginalization in the healthcare system, such as communities of color, youth, and individuals who identify as LGBTQIA+. Studies have shown that stigma surrounding STIs often leads to delayed testing and treatment. For youth, this relationship is often more pronounced. One study found that sexually active youth who perceive high levels of stigma towards STIs are roughly 40% less likely to get tested. Moreover, it’s not just perception of bias that predicts outcomes. Healthcare provider bias can further exacerbate this issue, as studies indicate that 28% of healthcare providers admit to treating patients with STIs differently, leading to disparities in care and reduced access to quality services. Below are a few lessons that we learned through our infectious disease work that can be applied to help the right care reach the people who need it the most.
What can we do about it?
Equip providers with better resources for target populations
Providers often feel ill-equipped to handle STIs compassionately. In qualitative studies, providers express frustration with a lack of awareness of treatment protocols and a lack of adequate time with patients during clinic visits. They also express discomfort asking about sexual history, especially when treating patients who are LGBTQ, sex workers, indigenous or intravenous drug users.
Similarly, our work with COVID-19 antiviral treatment taught us a lot about how best to meld public and private infrastructure to support care providers. When antiviral treatments first became available for COVID-19, providers were hesitant to prescribe a new drug. We developed a provider hotline to quickly connect providers with others who were familiar with prescribing a drug to make informed decisions about their patients’ care. We can use this approach for STI testing and prevention to ensure that providers are connected to nationwide networks of learning and support when they need to lean on their peers.
Engage communities where they live (physically and digitally)
Young adults aged 15–24 are approximately 25% of the sexually active population in the US, but account for over half of the 19 million STIs diagnosed per year. Studies also indicate that just 40% of young adult women are screened for chlamydia, and these rates are even lower for men. But, only 29 states require some form of sexual education in schools. This makes it challenging to deliver comprehensive sexual health information through traditional channels.
That’s why our partnership in Allegheny County, PA took a different approach to engagement. We co-created an STI awareness campaign to promote Allegheny County’s free Chlamydia and Gonorrhea testing program for young adults. The campaign included dating app ads, google pay-per-click, and a press release with the county.
Early results of this campaign are promising. 50.5% of total program landing page traffic was driven by Grindr ads. 70% of program enrollment was driven by marketing outreach. Together, we exceeded target engagement in less than 3 months.
Expand screening access and service integration
STI Screenings should be conducted regularly, and not just for populations assumed to be “at-risk.” For example, routine HepC screenings are not only recommended for persons who inject drugs, but are now recommended for mothers-to-be and sexually active seniors over 65. Reducing stigma sometimes means moving clinical services outside of traditional care settings. To do this effectively, we must build on trusted community partnerships to deliver care equitably. If self-swabbing reduces the potential of an embarrassing, shameful, or inconvenient doctor’s visit, why not make testing kits available at places they already trust?
We know drop-off occurs when you ask people to schedule a doctor’s visit, travel across town, or take time off from work. Color’s approach is to offer screenings and tests where people are — like their local church. This is exactly what we did at Color when we partnered with the Friendship Christian Center in Oakland and Third Baptist Church in San Francisco. In December 2021, Color and these two Northern California churches offered free HIV and STI testing services to their communities as an additional service at their existing COVID-19 vaccination sites. The results were astounding. A full 40% opted into the HIV testing, with over 200 people tested in one week alone. Even more encouraging, 48% of those tested were behind on their regular HIV testing, and 31% had never been tested before.
What’s next for Color
At Color, we are committed to applying our testing, treatment and prevention infrastructure in a way that reduces stigma at every step. From addressing provider needs to delivering care in everyday places, we’re on a mission to lead with empathy and eradicate health inequities.