Using Qualitative Research to Improve Sexual Health Services for Students in the Los Angeles Unified School District

Background: Sexual health services (SHS) are often underutilized by students in the Los Angeles Unified School District (LAUSD). We used qualitative research to better understand student knowledge and attitudes towards HIV/STDs and SHS, with the aim of improving service utilization and reducing HIV/STD infections among students, including young men who have sex with men (YMSM). 

Methods: We conducted nine focus groups from July 2014 through March 2015 at nine different high schools with a wellness center on campus. Participants were recruited from gay-straight alliance clubs and through wellness center staff. Discussion topics included knowledge and attitudes about HIV/STDs and testing, school and community SHS, and each school’s condom availability program. Participants (n=43) were all male; 98% were Latino or African-American. Participants received a $10 gift card. Qualitative data were analyzed inductively for themes. 

Results: Participants reported low concern for HIV and STDs and infrequent testing among peers. Students could generally identify some community HIV/STD testing resources, but few mentioned their campus wellness center, even though all wellness centers offer testing. Overall knowledge of wellness center services, including that services are free and confidential, was low. Participants' suggestions to increase SHS usage at wellness centers included frequent reminders that these services are available, promoting HIV/STD testing along with non-SHS services offered, emphasizing that services are confidential and free, and making appointments easier. Many suggested normalizing HIV/STD testing through sustained promotion to all students, not only those at higher risk such as YMSM. Participants had favorable views of the condom availability program, which most said was well promoted and widely utilized.

Conclusions: Despite the availability of SHS for students, services remain underutilized, especially HIV and STD testing. Our qualitative study revealed several ways to feasibly increase service utilization. Among the most important suggestions was increased effort at schools to normalize testing.