Community Approaches to Reducing STDs: Challenges in Identifying Structural Interventions to Reduce Chlamydia and Gonorrhea Among Youth

Background:  While personal behaviors are important for the transmission of STDs, an emerging body of evidence suggests that social determinants contribute to STD disparities in communities. Most current STD prevention interventions focus on individual behavior change, but interventions that also address factors external to the individual are needed for long-term, sustainable reductions in STD transmission. As part of a community mobilization effort to identify and implement structural interventions to reduce chlamydia and gonorrhea among adolescents and young adults, we sought community input into the social determinants of STDs of concern and the needed interventions acceptable to the community. 

Methods:  We conducted in-depth interviews with 27 key informants, including service providers, other stakeholders (i.e., policy makers), and young people (15-24 years) in two Baltimore City zip codes with a high concentration of STDs.  Interview transcripts were analyzed using a modified thematic constant comparative approach to identify themes.

Results:  Key informants identified family and environmental factors, including economic disadvantage and drug use, which influence relationship formation and STD acquisition and transmission within their communities, and reduce the ability of young people to prioritize STD prevention in their lives. In response to these challenges, suggested interventions aimed to improve sexual health outcomes by increasing knowledge and awareness of STDs. In discussing these interventions, informants’ suggestions reflected key themes, including: 1) the importance of physical and emotional reach; 2) the importance of parental or caretaker guidance; and 3) making “good decisions.” Only two informants discussed structural intervention strategies.

Conclusions:  We observe a notable mismatch between the levels (structural vs. individual) at which informants identified young people’s sexual health challenges and solutions to those challenges. This finding is reflective of the dominant biomedical, individual-behavioral public health discourse, and is significant because they expose a barrier to the formulation and implementation of upstream intervention.