Youth's experiences with STI testing in four communities in British Columbia, Canada.

OBJECTIVES To analyse the experiences of youths accessing sexually transmitted infection (STI) services and to examine the perspectives of service providers in four British Columbia communities. METHODS In-depth qualitative interviews were completed with 70 young men and women (15-24 years). In total, 22 service providers (for example, clinicians, staff) were interviewed about their experiences providing STI testing services as well as the policies and practice guidelines that inform their work with youths. In addition, naturalistic observation was conducted at 11 clinic sites, including: youth clinics, doctors' offices, public health units and a large clinic specialising in STI testing. RESULTS "Youth-friendly" STI testing services were rare despite being strongly desired by youth and service providers. Participants identified five barriers to accessing and/or providing youth-friendly STI testing: geography isolates many youths from testing service times or services, and presents privacy concerns, especially for rural youths. Clinic décor was perceived to be tailored for women and most service providers were female. Disclosing risky sexual behaviour to clinicians may be difficult for youths, especially for lesbian, gay, bisexual and transgender youths-particularly in contexts that are perceived to be homophobic. Many young women mistakenly believe that Pap smears include STI testing procedures, while many young men avoid testing because they fear the urethral swab and are unaware of alternative methods of specimen collection. CONCLUSION This research reveals how structural and socio-cultural forces (for example, gender, place, physical space, culture) interact to shape the experiences of youths accessing STI testing services.