Table 3.

Illustrative quotations from young men regarding influences of sexual and reproductive health care use

Contexts & Themes	Illustrative quotations	Group
Personal context
Self-risk assessment on decisions to seek care	“If you’re using a condom, there’s no need for a clinic.”	20–24 gay/bisexual AA
	“I mean…if you know you are going to have a whole bunch of females running around the clock…you might wanna get yourself checked out.”	15–19 heterosexual AA
	“If it’s not an emergency…you don’t want to go, or maybe you don’t have time…, very simply you don’t need to…”	15–19 heterosexual Hispanic
STI testing anxiety	“If I get gonorrhea I’m just going to wait until the symptoms arrive, because I’m not getting that test no more. I’ll take the HIV test…the blood test. But that rod thing, no. You’ve got to find a better way.”	15–19 heterosexual AA
	“…If you know you got an STI but you don’t want to hear you got one, you just hoping it’s something else. But you know for a fact that you were not with a clean woman and…did not use a condom then you go to the free clinic and you get an answer you don’t want to hear. That’s what keeps some people from going ‘cause they already know the answer.”	15–19 heterosexual AA
Social context
Social network context
Having credible SRH information sources	“Some people don’t have a good role model or male role model at that. Your mother don’t tell you everything… It’s good for a male to explain to you, or somebody that had been through something, to sit down and talk to you: ‘Like, it ain’t good, to just be out and having sex with everybody…’”	15–19 heterosexual AA
	“I’d rather learn from somebody that experienced it than somebody that just threw it up on the Internet.”	15–19 heterosexual AA
Fact checking	“I like to get [my] sexual health counseling from [named clinic]. But, also I want to check up on it. You know…ask them about…‘Was this true that I read on the Internet? …Is that true’?”	20–24 gay/bisexual AA
	“…The doctor…cause he went to school for this, …he know what he talking about. …I’m goin[g] to listen to him first…even though I might check up on what he told me…”	20–24 heterosexual AA
Needing help finding a healthcare provider	“I wouldn’t go…any place that’s unknown, that no one has told me that that’s a good place to seek information because no one recommended them to me and you don’t know what you will find in that place.”	15–19 heterosexual Hispanic
Healthcare provider context
Choice in provider	“Listen, if I go in there and I straight tell them that I do not want a male [doctor], you feel me, like I can have a request.”	15–19 heterosexual AA
Being understood	“If they spoke to us in Spanish, they’d understand us better there.”	15–19 heterosexual Hispanic
	“We feel more comfortable with someone from the same race…that speaks your own language. And we feel like…they are a good person.”	15–19 heterosexual Hispanic
Providers’ interpersonal communication style	“They’re supposed to tell you before they do that. Like my doctor she [says] ‘I’m about to check your testicles. Is that okay?’. Then I say ‘Yes.’ They’re supposed to ask.”	15–19 heterosexual AA
Non-judgmental	“I got so pissed off at my…doctor! All of a sudden I say, ‘I’m bi-.’ And then [provider] is like ‘oh, you gotta do this, …you high risk, because this and that’. This [provider] won’t shut up. So…I really can’t stand when they automatically, if you say you’re gay or bisexual…going to say: ‘this is what you do’…I just hate that.”	20–24 gay/bisexual AA
Discomfort in being touched	“During a check-up, truthfully, I don’t like it when they have to touch [me] and examine your genital parts and all that. I know it’s part of the job, but…it makes you feel a little…let’s say, abused.”	15–19 heterosexual AA
Content to learn from the provider	“…It would be good to know about your body so you can understand it better. Like about sexuality, it would be good to learn about…how to control yourself and how to be prepared…to be an adult.”	15–19 heterosexual Hispanic
	“…To know the right moment to have sex, the best time to do it and to know what precautions to take to prevent an unwanted pregnancy or a disease.”	15–19 heterosexual Hispanic
Self-confidence in answering/asking questions	“Yeah, I don’t feel right. …I’m not going to lie. When they start talking to you by yourself you don’t feel sure…how to answer the question[s]. [The doctor] be asking questions like ‘have you ever had sex before?’”	15–19 heterosexual AA
Structural context
Clinical operations
Time to be seen	“When you’re done and they got to sign you out you wait like an hour. An hour just to leave! Like, ‘I can’t leave?’ ‘No, you got [to] wait for this paper’. I’m like ‘look, I’m about to leave, f--k this. I don’t even care what this paper is for.’”	20–24 heterosexual AA
Confidentiality concerns	“…I don’t want it to be announced. You go, and like, “Well, he’s walking in here to get tested.” Nobody wants that to happen. You look around. I like the system [clinic name] do. Nobody knows or says your name in there. They just call you by the number they give you.”	15–19 heterosexual AA
Cost of care	“Sometimes when you don’t have insurance…that is necessary. And sometimes that’s why…you pay more. Sometimes you can’t go for the check-ups.”	15–19 heterosexual Hispanic
	“You can’t go to the doctor all the time, because it would be costing money out of my insurance.”	15–19 heterosexual AA
Clinical spaces
Stigmatized settings	“A lot of times…someone is going to get their checkup, someone else finds out, and that person goes and tells. Like if they see someone coming into the clinic…the one that is like about diseases, a person…that likes to gossip…they spread [gossip] among a lot of people and the same people discriminate or they say things that can, well not hurt, but make you uncomfortable when they say things like that.”	15–19 heterosexual Hispanic
	“First of all, it’s an old building, and the lights are off, and there will be some people in the back with some problems. Some of them could have diseases, and some of them don’t. …If I got AIDS, I’m going to go here. I’m going to just look, and walk on out. Who wants to sit there in a depression? …They need to do something about these clinics.”	15–19 heterosexual AA
Cultural context
Young men’s lack of socialization into healthcare	“If I was a female or whatever I’d be [expected to be] in the clinic…I ain’t that though…”	20–24 heterosexual AA
	“Yeah…it’s females that go. Most likely females got a good relationship with the[ir] doctor. They talk to the[ir] doctor about anything.”	15–19 heterosexual AA
Tipping points into care	“Cause I had sex with this girl last night and everybody told me about a day later about what was going on…Like is she a freak? Now y’all tell me…I gotta go to the free clinic and get checked up.”	20–24 heterosexual AA
Waiting it out	“Alright, I might got that. It ain’t like…that can kill me so I can ride this out for a minute”	15–19 heterosexual AA
Taking more immediate action	“No…you go to the Internet…see what’s wrong with you. It pops up, and if it’s what you thought it was, that’s when you go to the doctor without your mother. You just walk out the door and don’t say anything.”	15–19 heterosexual AA

AA=African American