In the United States, sexually transmitted infections (STIs) are on the rise, reaching record levels in 2017. Young people aged 15-24 account for half of new STIs each year, due in part to barriers they face in accessing sexual health services. Many young people are reluctant to seek sexual health services due to stigma or concerns about privacy and confidentiality, or they may face barriers related to affordability and accessibility including transportation or conflicts between school and clinic schedules. In honor of STD Awareness Month, we’re highlighting two local health departments (LHDs) that have sought to overcome these barriers by meeting young people where they are and offering STI testing in convenient, youth-friendly settings.
School-Based STI Services in Berkeley, CA
The City of Berkeley Department of Public Health in Berkeley, CA, works closely with the Berkeley Unified School District to offer a comprehensive array of health services through a school-based center located at Berkeley High School. Offering health services on campus eliminates the need for transportation and reduces missed class time. The integration of health services into the academic structure “allows a young person to take control of their own health,” according to Lisa Sterner, MPH, Director of Berkeley High School Health Center (BHSHC), and ultimately “get into care sooner and get care they might not otherwise access.”
BHSHC offers HIV testing and STI testing and treatment on-site and has a strong referral system to support students who test positive for HIV or who are interested in pre-exposure prophylaxis (PrEP) for HIV prevention—even ensuring a mental health clinician and a case manager from a local, youth-friendly HIV clinic are on-site for delivery of a positive HIV diagnosis so the student has the support they need.
The staff at BHSHC also routinely survey students to understand and address any barriers they face in accessing services. Teachers are reminded each year to respect students’ privacy when they ask to visit BHSHC and when students arrive, they indicate the reason for the visit on a form rather than sharing it out loud. Peer educators promote the Health Center through classroom presentations and help address stigma. “They can reassure their classmates about how the clinic is run and how their confidentiality is protected,” according to Sterner.
BHSHC offers a model for LHDs seeking to increase youth access to and use of STI testing and treatment. As a result of these efforts, STI screening rates are high—more than 90% of sexually active students have been tested for chlamydia in the past year—and students report that the Health Centers are a safe place and that staff help them work through their problems.
Non-Traditional STI Testing Sites in Omaha, NE
The Douglas County Health Department (DCHD) in Omaha, NE, offers STI testing in diverse locations—from libraries to health fairs to sporting events, and even a haunted house. The program first began more than a decade ago, after the Board of Health and Health Director declared STIs an epidemic in 2004. After working with community partners and the state health department, DCHD was able to secure funds for outreach testing.
Early on, Sherri Nared, STI/HIV Prevention Specialist, and Liz Berthold, MS, Supervisor for the STD Prevention and Control Program at DCHD, were planning a teen health education event at a local library and wanted to offer STI testing to attendees. While the library was hesitant, Nared visited a neighboring church and made the case to the pastor, who agreed to open their doors to DCHD to offer STI testing after the event. During the event, many of the teens were surprised to discover how easy it is to get an STI, and that you can have an STI even if you don’t have any symptoms. More than forty teens visited the church to get tested after the event, and 15 percent tested positive for an STI. The high positivity rate made it clear to DCHD and their partners that they needed to reach more young people. Not only was the library on board to host future events, but soon other branches were eager to partner with DCHD and offer STI testing.
Since then, DCHD has expanded and diversified its partnerships, using different outreach strategies in different locations. In addition to their testing events, they offer condoms year-round at nearly 100 locations across the city, including in bars, coffee shops, and other businesses, and they offer take-home testing kits at local colleges and barber shops.
DCHD has used incentives such as movie passes or gift cards to encourage young people to get tested but, according to Nared, incentives aren’t as important as the motivation that comes from wanting to know your status and be healthy. “We talk to them about loving themselves…and remind them how important they are,” says Nared. Word of mouth has also been key to the success of DCHD’s outreach testing efforts. Young people can vouch for DCHD staff and tell their peers that they are trustworthy and nonjudgmental.
DCHD’s efforts to promote and offer STI testing throughout the community all started with one person and one event. The success of the program and the clear need for accessible STI testing—demonstrated by high positivity rates—has paved the way for new partnerships and new opportunities.