Abstract
OBJECTIVES: Individuals aged 15–29 years have the highest rates of diagnosed sexually transmitted infection (STI), and in Canada routine STI testing is recommended for sexually active individuals under 25 years of age. Despite its being readily available to most Canadian university students, testing is not accessed by all sexually active students. This study examines correlates of STI testing among sexually active heterosexual university students. Specifically, we sought to determine: i) the lifetime incidence of STI testing overall and stratified by biological sex; ii) whether those most at risk of STI are being tested; and iii) which other characteristics are associated with ever having been tested for STI.
METHODS: A cross-sectional survey of undergraduate students at eight universities in Maritime Canada was carried out in 2012, gathering information on student demographic characteristics, sexual behaviours and use of sexual health services. We conducted a sex-stratified descriptive analysis of each covariate and of STI testing at three levels of STI risk. We then performed multiple logistic regressions to determine the factors associated with lifetime STI testing.
RESULTS: Only 34% of the study population and 51% of those at higher risk of STI acquisition had ever been tested for STI. Individuals at moderate or higher risk of STI were more likely to be tested than those at lower risk. In both sexes, older students, those who reported experiencing non-consensual sex while enrolled at university and those with more sexual health knowledge were more likely to be tested. Higher perceived risk was associated with STI testing only among females.
CONCLUSIONS: Individuals at higher risk of STI acquisition are more likely to be tested; however, STI testing rates are low in this sample. Health promotion with campaigns designed to increase general sexual health knowledge may be more effective in increasing testing when targeting younger students.
Key words: Student health services; sexually transmitted diseases, bacterial; reproductive health; health knowledge, attitudes, practice; heterosexuality
RÉSUMÉ
OBJECTIFS: Les 15 à 29 ans ont les plus hauts taux d’infections transmissibles sexuellement (ITS) diagnostiquées, et au Canada, le dépistage systématique des ITS est recommandé aux personnes sexuellement actives de moins de 25 ans. Bien que le dépistage soit aisément accessible à la plupart des étudiants d’université canadiens, tous les étudiants sexuellement actifs ne s’en prévalent pas. Notre étude porte sur les corrélats du dépistage des ITS chez les étudiants d’université hétérosexuels sexuellement actifs. Nous avons cherché à déterminer: i) l’incidence (globale et stratifiée selon le sexe biologique) du dépistage des ITS au cours de la vie; ii) si les sujets les plus à risque de contracter des ITS se font dépister; et iii) quelles sont les autres caractéristiques associées au fait d’avoir subi un test de dépistage des ITS.
MÉTHODE: Nous avons mené en 2012 une enquête transversale auprès des étudiants de premier cycle de huit universités des provinces maritimes du Canada afin de réunir de l’information sur leur profil démographique, leurs comportements sexuels et leur recours aux services de santé sexuelle. Nous avons effectué une analyse descriptive stratifiée par sexe pour chaque covariable et pour le dépistage des ITS selon trois niveaux de risque d’ITS. Nous avons ensuite effectué plusieurs analyses de régression logistique pour déterminer les facteurs associés au dépistage des ITS au cours de la vie.
RÉSULTATS: Seulement 34 % de la population étudiée et 51 % des sujets plus à risque de contracter des ITS avaient subi un test de dépistage des ITS. Les sujets à risque modéré ou élevé de contracter des ITS étaient plus susceptibles d’avoir subi un dépistage que les sujets à faible risque. Chez les deux sexes, les étudiants plus âgés, ceux qui ont dit avoir eu des relations sexuelles non consensuelles pendant qu’ils étaient inscrits à l’université et ceux dont les connaissances en matière de santé sexuelle étaient supérieures étaient plus susceptibles d’avoir subi un dépistage. Un risque perçu plus élevé n’était associé au dépistage des ITS que chez les femmes.
CONCLUSIONS: Les personnes dont le risque de contracter des ITS est plus élevé sont aussi plus susceptibles de se faire dépister; néanmoins, les taux de dépistage des ITS sont faibles dans l’échantillon de l’étude. Les efforts de promotion de la santé, avec des campagnes conçues pour accroître les connaissances générales sur la santé sexuelle, pourraient être plus efficaces pour accroître le dépistage lorsqu’ils ciblent les étudiants les plus jeunes.
Mots clés: services de santé pour étudiants; maladies sexuellement transmissibles bactériennes; santé de la reproduction; connaissances, attitudes, pratiques en santé; hétérosexualité
Footnotes
Conflict of Interest: None to declare.
References
- 1.Public Health Agency of Canada. STI & Hepatitis C Statistics. 2012. [Google Scholar]
- 2.Farley T, Cohen D, Elkins W. Asymptomatic sexually transmitted diseases: The case for screening. Prev Med. 2003;36(4):502–9. doi: 10.1016/S0091-7435(02)00058-0. [DOI] [PubMed] [Google Scholar]
- 3.Public Health Agency of Canada. Canadian Guidelines on Sexually Transmitted Infections. 2015. [Google Scholar]
- 4.Centers for Disease ControlPrevention. The Role of STD Detection and Treatment in HIV Prevention–CDC Fact Sheet. 2010. [Google Scholar]
- 5.Hodgins S, Peeling RW, Dery S, Bernier F, LaBrecque A, Proulx JF, et al. The value of mass screening for chlamydia control in high prevalence communities. Sex Transm Infect. 2002;78(Suppl1):i64–68. doi: 10.1136/sti.78.suppl_1.i64. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Centers for Disease ControlPrevention. CDC Recommends Chlamydia Screening of All Sexually Active Women 25 and Under. 2011. [Google Scholar]
- 7.Thomas J, Tucker M. The development and use of the concept of a sexually transmitted disease core. J Infect Dis. 1996;174(Suppl2):S134–43. doi: 10.1093/infdis/174.Supplement_2.S134. [DOI] [PubMed] [Google Scholar]
- 8.Crosby R, Miller K, Staten R, Noland M. Prevalence and correlates of HIV testing among college students: An exploratory study. Sex Health. 2005;2(1):19–22. doi: 10.1071/SH04047. [DOI] [PubMed] [Google Scholar]
- 9.Caldeira K, Singer B, O’Grady K, Vincent K, Arria A. HIV testing in recent college students: Prevalence and correlates. AIDS Educ Prev. 2012;24(4):363–76. doi: 10.1521/aeap.2012.24.4.363. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Thomas P, Voetsch A, Song B, Calloway D, Goode C, Mundey L, et al. HIV risk behaviors and testing history in historically black college and university settings. Public Health Rep. 2008;1236Suppl3:115–25. doi: 10.1177/00333549081230S314. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Buhi E, Marhefka S, Hoban M. The State of the union: Sexual health disparities in a national sample of US college students. J Am Coll Health. 2010;58(4):337–46. doi: 10.1080/07448480903501780. [DOI] [PubMed] [Google Scholar]
- 12.Siegel DM, Klein DI, Roghmann KJ. Sexual behavior, contraception, and risk among college students. J Adolesc Health. 1999;25(5):336–43. doi: 10.1016/S1054-139X(99)00054-3. [DOI] [PubMed] [Google Scholar]
- 13.Bontempi J, Mungo R, Bulmer S, Danvers K, Vancour M. Exploring gender differences in the relationship betwen HIV/STD testing and condom use among undergraduate college students. J Health Educ. 2009;40(2):97–105. [Google Scholar]
- 14.Wolters MEG, Kok G, Mackenbach J, de Zwart O. Correlates of STI testing among vocational school students in the Netherlands. BMC Public Health. 2010;10:725–25. doi: 10.1186/1471-2458-10-725. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Adam P d, Wit J, Bourne C, Knox D, Purchas J. Promoting regular testing: An examination of HIV and STI testing routines and associated socio-demographic, behavioral and social-cognitive factors among men who have sex with men in New South Wales, Australia. AIDS Behav. 2014;18(5):921–32. doi: 10.1007/s10461-014-0733-z. [DOI] [PubMed] [Google Scholar]
- 16.Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley D, et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health. 2002;92(3):378–81. doi: 10.2105/AJPH.92.3.378. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Shoveller J, Johnson J, Rosenberg M, Greaves L, Patrick DM, Oliffe JL, et al. Youth’s experiences with STI testing in four communities in British Columbia, Canada. Sex Transm Infect. 2009;85(5):397–401. doi: 10.1136/sti.2008.035568. [DOI] [PubMed] [Google Scholar]
- 18.Denny S, Farrant B, Cosgriff J, Harte M, Cameron T, Johnson R, et al. Forgone health care among secondary school students in New Zealand. J Prim Health Care. 2013;5(1):11–18. doi: 10.1071/HC13011. [DOI] [PubMed] [Google Scholar]
- 19.Mansfield AK, Addis ME, Courtenay W. Measurement of men’s help seeking: Development and evaluation of the Barriers to Help Seeking Scale. Psychol Men Masc. 2005;6(2):95–108. doi: 10.1037/1524-9220.6.2.95. [DOI] [Google Scholar]
- 20.Hoddinott S, Bass M. The Dillman Total Design Survey Method. Can Fam Physician. 1986;32:2366–68. [PMC free article] [PubMed] [Google Scholar]
- 21.Ratliff-Crain J, Donald KM, Dalton J. Knowledge, beliefs, peer norms, and past behaviors as correlates of risky sexual behaviors among college students. Psychol Health. 1999;14(4):625–41. doi: 10.1080/08870449908410754. [DOI] [Google Scholar]
- 22.Langille D, Flowerdew G, Aquino Russell C, Strang R, Proudfoot K, Forward K. Gender differences in knowledge about chlamydia among rural high school students in Nova Scotia, Canada. Sex Health. 2009;6(1):11–14. doi: 10.1071/SH08041. [DOI] [PubMed] [Google Scholar]
- 23.Poulin C, Hand D, Boudreau B. Validity of a 12-item version of the CES-D used in the National Longitudinal Study of Children and Youth. Chronic Dis Can. 2005;26(2–3):65–72. [PubMed] [Google Scholar]
- 24.Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49(2):147–52. [PubMed] [Google Scholar]
- 25.WHO-International Union Against STI. European STD guidelines. Int J STD AIDS. 2001;12(3):4–6. [Google Scholar]
- 26.Wolters M, Kok G, Looman C, de Zwart O, Mackenbach J. Promoting STI testing among senior vocational students in Rotterdam, the Netherlands: Effects of a cluster randomized study. BMC Public Health. 2011;11:937–37. doi: 10.1186/1471-2458-11-937. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Galdas P, Cheater F, Marshall P. Men and health help-seeking behaviour: Literature review. J Adv Nurs. 2005;49(6):616–23. doi: 10.1111/j.1365-2648.2004.03331.x. [DOI] [PubMed] [Google Scholar]
- 28.Roterman M. Sex, condoms and STDs among young people. Health Rep. 2005;16(3):39–45. [PubMed] [Google Scholar]
- 29.McClean H, Sutherland J, Searle S, Howarth P. An exploratory study of information-giving used to promote chlamydial test-seeking by students at a college family planning clinic. Br J Fam Plann. 2000;26(4):209–12. doi: 10.1783/147118900101194814. [DOI] [PubMed] [Google Scholar]
- 30.Wolters M, de Zwart O, Kok G. Adolescents in The Netherlands underestimate risk for sexually transmitted infections and deny the need for sexually transmitted infection testing. AIDS Patient Care STDS. 2011;25(5):311–19. doi: 10.1089/apc.2010.0186. [DOI] [PubMed] [Google Scholar]
- 31.Cunningham SD, Tschann J, Gurvey JE, Fortenberry JD, Ellen JM. Attitudes about sexual disclosure and perceptions of stigma and shame. Sex Transm Infect. 2002;78(5):334–38. doi: 10.1136/sti.78.5.334. [DOI] [PMC free article] [PubMed] [Google Scholar]