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Theoretical Background and research questions/hypothesis: Various studies have found emergency contraception (EC) users to be younger, inconsistent condom users, and report higher numbers of sex partners. EC users are also less likely to have visited a gynecologist in the past year, and more likely to report ever having an STI compared to non-users. Stigma and privacy issues, among others, may cause EC users to avoid seeking STI testing. The internet provides individuals with a confidential space for seeking STI information and linking users to STI services such as self-collection STI screening kits. This study explored whether EC users represent a missed opportunity for STI screening, and assesses: 1) the feasibility of targeting EC users for STI testing online, and 2) the acceptability of purchasing home-based kits in pharmacies.
Methods: Three Facebook ads targeted EC users to connect them with free, home-based STI test kits via online ordering. Women had to have taken EC within the past 30 days, be living in New York, and between the ages of 18 and 35 years. Participants completed a brief self-administered survey and received self-collection kits by mail. Their lab results were returned within 1-5 days. Data analysis includes clients enrolled between September 2011 and July 2012.
Results: Facebook ads led to more than 45,000 click-throughs. Of the 2,738 who took the eligibility screen 804 were eligible, 382 completed the survey and referred to www.iwantthekit.org. Of these 290 requested kits, only 81 (28%) were returned for testing. Participants were mostly in their late teens (18-19 years) (40%) or early 20s (30%), White Non-Hispanic (51%), and had some college (56%). Overall, 62% had purchased EC before, 57% purchased EC because they did not use birth control at their last sexual encounter. Only 15% reported having been tested for STIs in the past year and 63% reported a new partner in the past 3 months. Four participants tested positive for chlamydia and 2 for trichomonas. Almost all participants (93%) agreed that pharmacies should offer STI testing and most reported that they would be willing to purchase an STI take-home kit at the pharmacy (74%).
Conclusions: This study found low screening uptake among EC users; however, Facebook ads were successful in reaching EC users and morbidity was detected. Linking EC users to self-screening tests for STIs may be a way to treat new infections, prevent further transmission, overcome issues of privacy and stigma, and reach younger women, who may not seek traditional healthcare.
Implications for research and/or practice: Future research should explore how different permutations of expanding screening in non-traditional settings, like pharmacies, could improve testing uptake and detect additional cases.