“Pissing in the Wind” Why Young Men Refuse Chlamydia Screening

Background:
With the advent of nucleic acid amplification techniques (NAAT), screening of high risk populations for asymptomatic CT infections are readily and universally available with consequent detection, treatment, contact tracing and prevention of significant morbidity in female sexual partners. Despite this a high proportion of young men offered screening in a juvenile custodial facility decline to be screened.

Objective:
Young men admitted to a juvenile custodial facility who refused universal, free and confidential screening for CT infection by urine NAAT were retrospectively interviewed to ascertain the reasons for their refusal.

Method:
During a twelve month period from 2007 to 2008, 200 young men admitted to a juvenile custodial facility were offered screening for asymptomatic CT infection. Of the 200, 74 refused screening. These young men were contacted retrospectively and interviewed. Demographic information was obtained and the reason for refusal was documented.

Result:
Of the 200 young men offered screening, 73 refused screening. Attempts were made to contact these young men and of the 73, 8 were not able to be contacted. Of the 65 contacted, the reasons given for refusing were as follows: “not at risk” (29%), “not important/not interested” (22%), “too embarrassed” (11%), “unable to void” (3%), “recently tested” (20%), “confidentiality concerns” (3%), “don't understand” (6%), “emotionally disturbed” (3%) and “other” (3%).

Conclusion:
Young men at high risk of infection declined screening for asymptomatic CT infection largely through ignorance of the consequences for themselves and their sexual partners.

Implications:
Interventions should be aimed at educating young men of the risks and implications of untreated CT infection.