STI Services for Youth in Low and Middle Income Countries: Help Seeking and Care Seeking Behaviors

Background:  Access to sexual and reproductive health services (SRH) is vital for sexually active youth; yet, their care needs are often unmet. Given high global sexually transmitted infection (STI) morbidity (approximately 489 million new cases in 2008), further understanding of the facilitators and barriers for youth in obtaining STI services is needed.

Methods:  We conducted a qualitative systematic review of mixed methods studies to assess youth and provider views about the behaviors of youth in help-seeking and care seeking for STI services.  We searched peer-reviewed literature for studies published between 2001-2014 with a study population of youth (aged 10-24 years) and/or health service providers.   Eighteen studies were identified for inclusion from 19 countries. Thematic analyses identified key themes across the studies. 

Results:  The majority of studies (11) included discussion of  youth not seeking treatment, resorting to self-treatment, or waiting to access care, suggesting that many adolescents still do not seek timely care for STIs.  Many youth acknowledged that they did not recognize symptoms or waited until symptoms worsened.   At the same time, many youth were able to identify a number of sources for STI related care including public hospitals and clinics, private clinics, pharmacies, alternative healers, and NGOs. Youth’s help-seeking and care-seeking preferences were frequently influenced by desires for confidentiality, friendliness, and cost.   Youth often expressed a desire for more information on STIs and SRH and cited barriers related to fear or cultural taboos in obtaining help or information, especially from providers or parents.

Conclusions:  Youth in low and middle income countries experience significant barriers in obtaining STI and SRH services and often do not seek or postpone medical care. This has important implications for their health. And will not go away unless systematically addressed.  Improving uptake may require efforts to address clinic systems, provider attitudes, confidentiality and cultural norms related to adolescent sexuality.