<b>‘</b>Repeat testing without having ‘the talk’ is not meaningful’—healthcare providers’ perceptions on finding a balance between <i>Chlamydia trachomatis</i> testing and primary prevention strategies. A qualitative study in Stockholm, Sweden

Nielsen, Anna; Costa, Ayesha De; Gemzell‐Danielsson, Kristina; Boman, Jens; Salazar, Mariano

doi:10.1136/bmjopen-2019-034179

Cited by 5 publications

(5 citation statements)

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“…For example, a British study [ 38 ], revealed that the screening program in the UK failed to reach both young men and women engaging in risky sexual behaviour. In the same setting as the present study, health care providers described the importance of finding a balance between primary prevention (condom promotion) and secondary prevention (testing) [ 39 ], and that the encounter at the clinic facilitated finding those at risk, given that sufficient time was dedicated to each individual seeking health care.…”

Section: Discussionmentioning

confidence: 99%

Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden: A qualitative study

et al. 2021

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Introduction Chlamydia trachomatis (C. trachomatis) infection is the most commonly reported sexually transmitted infection in Sweden and globally. C. trachomatis is often asymptomatic and if left untreated, could cause severe reproductive health issues. In Sweden, men test for C. trachomatis to a lesser extent than women. Aim To explore factors facilitating and constraining Swedish young men’s health care utilization for C. trachomatis detection and treatment. Method A qualitative situational analysis study including data from 18 semi-structured interviews with men (21–30 years). Data collection took place in Stockholm County during 2018. A situational map was constructed to articulate the positions taken in the data within two continuums of variation representing men’s risk perception and strategies to test for C. trachomatis. Results Based on the informants’ risk perception, strategies adopted to test and the role of social support, three different discourses and behaviours towards C. trachomatis testing were identified ranging from a) being indifferent about C. trachomatis -not testing, b) being ambivalent towards testing, to c) being proactive and testing regularly to assure disease free status. Several factors influenced young men’s health care utilization for C. trachomatis detection, where the role of health services and the social support emerged as important factors to facilitate C. trachomatis testing for young men. In addition, endorsing traditional masculinity domains such as leaning on self-reliance, beliefs on invulnerability and framing men as more carefree with their sexual health than women delayed or hindered testing. Conclusion Testing must be promoted among those young men with indifferent or ambivalent discourses. Health systems aiming to increase testing among those at risk should take into consideration the positive role that young men’s social support have, especially the level of social support coming from their peers. Additionally, endorsement of traditional masculinity values may delay or hinder testing.

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Section: Discussionmentioning

confidence: 99%

Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden: A qualitative study

et al. 2021

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“…One possible explanation is that in the acculturation process, migrants could adopt a more open stance to casual sex and other sexual risk behaviours to integrate better into the new society [ 21 ]. However, these risky behaviours can be detrimental to young people´s mental health as they might worry about the negative social and health consequences of their actions, as shown in a study among youth in Sweden [ 29 ]. The cross-sectional nature of our data does not allow us to establish a temporal or causal association; however, the association between poor mental health and sexual risk behaviours must be addressed in intervention aiming to tackle poor mental health among migrants.…”

Section: Discussionmentioning

confidence: 99%

“…The interrelationship between sexual risk behaviour and mental health is complex, as one can catalyse the other [ 27 , 28 ]. For example, sexual risk behaviours in the form of unprotected sex with strangers can generate anxiety due to fears of contracting a sexually transmitted infection (STI) [ 29 ]. On the other hand, mental disorders and the medication used to treat them can increase sexual risk behaviours or impair sexual desire and people´s abilities to enjoy pleasurable sexual relations [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and associated factors for poor mental health among young migrants in Sweden: a cross-sectional study

Causevic,

Ekström,

Orsini

et al. 2024

Global Health Action

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Background Young migrants face multiple challenges that can affect their mental, sexual and reproductive health. Objective To assess the prevalence of self-reported poor mental health and its associated demographic, post-migration and sexual risk behaviour factors among young migrants (aged 15–25) in Sweden. Methods Data were drawn from a cross-sectional survey conducted with migrants aged 15–65 years old in Sweden between December 2018 and November 2019 ( n = 6449). Among these, 990 participants aged 15–25 were eligible for the study. Mental health was measured using the Refugee Health Screener-13. Missing data indicator analysis and multivariable logistic regression models were conducted to estimate the association between mental health, sexual risk behaviour, demographic and migration-related variables. Results Of the 990 participants, 59% reported poor mental health. Participants reporting poor mental health were more likely to be female (AOR:1.63, 95% CI:1.18–2.25), to have lived in Sweden more than three years (AOR:2.16, 95% CI:1.17–3.97), to engage in any sexual risk behaviour (AOR:1.99, 95% CI:1.25–3.17), and to live alone (AOR:1.95, 95% CI:1.25–3.03) or with friends they already knew (AOR:1.60, 95% CI:1.37–4.91). People arriving from the Americas (AOR:0.54, 95% CI:0.33–0.88), Asia (AOR:0.44, 95% CI:0.22–0.86), Europe (AOR:0.30, 95% CI:0.14–0.61) and Africa (AOR 0.37, 95% CI: 0.23–0.60) had lower odds of poor mental health than those arriving from Syria. Conclusion The prevalence of poor mental health among young migrants in Sweden was high, with specific subgroups (women, asylum seekers, people arriving from Syria, and those residing longer in Sweden) being particularly vulnerable. Our results indicate the interconnectedness between poor mental health and sexual risk behaviour in this population. Thus, policies targeting young migrants should ensure that healthcare services screen for both poor sexual and mental health at the same time.

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“…Our results indicated that risky sexual behaviour (e.g., condomless sexual contacts with casual partners, and higher numbers of sexual partners) were still at high levels amongst the men and at moderate levels for women in the high-risk classes (class 4 and 3, respectively). Another, more recent study in Sweden suggested that young adults might apply repeated testing as a behavioural strategy to avoid using condoms, with no corresponding change in sexual behaviour [65]. Condoms are effective in reducing the risk of chlamydia acquisition [66], and modelling studies have shown that high levels of condom use reduce chlamydia prevalence substantially [67,68].…”

Section: Discussionmentioning

confidence: 99%

Patterns of Sexual Behaviour Associated with Repeated Chlamydia Testing and Infection in Men and Women: A Latent Class Analysis

Veličko

Ploner

Marions

et al. 2021

Preprint

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Background: Adolescents and young adults are at higher risk of acquiring Chlamydia trachomatis infection (chlamydia), so testing is promoted in these populations. Studies have shown that re-testing for chlamydia is common amongst them. We investigated how sexual risk behaviour profiles are associated with repeated testing for chlamydia.Methods: We used baseline data from a cohort of 2,814 individuals recruited at an urban STI -clinic. We applied latent class (LC) analysis using 9 manifest variables on sexual behaviour and substance use self-reported by the study participants. We fitted ordered logistic regression to investigate the association of LC membership with the outcomes repeated testing during the past 12 months and lifetime repeated testing for chlamydia. Models were fit separately for men and women.Results: We identified four LCs for men and three LCs for women with increasing gradient of risky sexual behaviour. The two classes with the highest -risk among men were associated with lifetime repeated testing for chlamydia: adjOR = 2.26 (95%CI: 1.50 - 3.40) and adjOR = 3.03 (95%CI: 1.93 -4.74) as compared with the class with lowest risk. In women, the class with the highest risk was associated with increased odds of repeated lifetime testing (adjOR =1.85 (95%CI: 1.24-2.76)) and repeated testing during past 12 months (adjOR = 1.72 (95%CI: 1.16-2.54)). An association with chlamydia positive test at the time of the study and during the participant´s lifetime was only found in the male high-risk classes.Conclusion: Prevention messages with regard to testing for chlamydia after unprotected sexual contact with new/casual partners seem to reach individuals in high-risk behaviour classes who are more likely to test repeatedly. Prevention efforts should involve enhanced targeting and promotion of safe sex.

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‘Repeat testing without having ‘the talk’ is not meaningful’—healthcare providers’ perceptions on finding a balance between Chlamydia trachomatis testing and primary prevention strategies. A qualitative study in Stockholm, Sweden

Cited by 5 publications

References 42 publications

Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden: A qualitative study

Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden: A qualitative study

Prevalence and associated factors for poor mental health among young migrants in Sweden: a cross-sectional study

Patterns of Sexual Behaviour Associated with Repeated Chlamydia Testing and Infection in Men and Women: A Latent Class Analysis

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