Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE (Open Access)

‘Every strategy needs to be contributing to erasing the stigma’: Māori and Pacific young people talk about overcoming barriers to testing for sexually transmitted infections

Sally B. Rose https://orcid.org/0000-0002-5626-5142 A * , Abby Dunlop A , Tracey Gardiner A , Marama Cole A , Susan M. Garrett A and Eileen M. McKinlay A
+ Author Affiliations
- Author Affiliations

A Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington 6242, New Zealand.

* Correspondence to: sally.rose@otago.ac.nz

Handling Editor: Martin Holt

Sexual Health 21, SH23186 https://doi.org/10.1071/SH23186
Submitted: 7 November 2023  Accepted: 1 March 2024  Published: 21 March 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Māori and Pacific young people are disproportionately impacted by sexually transmitted infections (STIs). Access to STI screening is important to reduce transmission and reproductive health complications.

Methods

Between November 2022 and May 2023, we held four wānanga (workshops) with Māori and Pacific participants (15–24 years old) to find out what barriers they encounter to STI testing, and hear their ideas about how to overcome these. Participants were recruited via youth-focused community organisations in the Wellington region of Aotearoa New Zealand. Inductive thematic analysis was used to understand data generated from discussions, drawing on Māori and Pacific models of wellbeing to frame themes.

Results

Thirty-eight participants were involved in the wānanga. Barriers to STI testing related to five themes: (1) differences in cultural values and expression; (2) family/friends; (3) educational gaps; (4) psychological factors; and (5) structural obstacles. Suggested strategies to improve access to sexual health care included the need for free, flexible services, education and health promotion activities to reach young people in their spaces (e.g. church, marae, social media). Participants stressed the need for approaches to be community-based, delivered by trusted individuals using culturally appropriate messages, and saw participation in STI testing as beneficial for whānau/family and communities.

Conclusions

To improve access to STI testing, participants described the need for free services, together with education and health promotion to improve inter-generational sexual health knowledge. Reframing messages around STIs to align with Māori and Pacific models of wellbeing was identified as a way to normalise conversations, in turn reducing the stigma surrounding STI testing.

Keywords: chlamydia, gonorrhoea, health promotion, Māori, Pacific, sexual health, sexually transmitted infections (STIs), young people.

References

Family Planning New Zealand. The sexual and reproductive health and rights of young people in Aotearoa New Zealand; 2022. Available at https://sexualwellbeing.org.nz/about/equity-in-aotearoa/position-statements/reproductive-rights/ [verified 1 November 2023]

Tipene J, Green A. He Pukenga Korero: Rangatahi and STIs in the Waikato. Online report; 2017. Available at http://tewhariki.org.nz/assets/He-Pukenga-Korero-Final-Report-31-Aug-2017.pdf [verified 1 November 2023]

New Zealand Sexual Health Society. STI management guidelines for use in primary care; 2021. Available at http://sti.guidelines.org.nz/ [verified 1 November 2023]

Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019; 97(8): 548-62P.
| Crossref | Google Scholar | PubMed |

Price MJ, Ades AE, Soldan K, Welton NJ, Macleod J, Simms I, et al. The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis. Health Technol Assess 2016; 20(22): 1-250.
| Crossref | Google Scholar | PubMed |

New Zealand Sexual Health Society. Syphilis in pregnancy. Antenatal management guidelines for maternal and congenital syphilis; 2020. Available at https://www.nzshs.org/docman/guidelines/management-of-sexual-health-conditions/syphilis/syphilis-in-pregnancy/397-syphilis-in-pregnancy-v1-sep-2020/file [verified 1 November 2023]

The Institute of Environmental Science and Research Ltd. New Zealand sexually transmitted infection (STI) surveillance dashboard; 2023. Available at https://www.esr.cri.nz/our-research/nga-kete/infectious-disease-intelligence/sexually-transmitted-infection-sti-surveillance/ [verified 1 November 2023]

Manatū Hauora Ministry of Health. Sexual and reproductive health – STI testing coverage for 15–24 years olds; 2021. Available at https://nsfl.health.govt.nz/dhb-planning-package/system-level-measures-framework/data-support-system-level-measures/youth-slm--4 [verified 1 November 2023]

Te Puawai Tapu. To Tatou Hokakatanga: Action and Intervention in Sexual and Reproductive Health. A Report Prepared for the Health Research Council of New Zealand; 2007. Available at https://teatawhai.maori.nz/research-projects/to-tatou-hokakatanga-action-and-intervention-in-sexual-and-reproductive-health/ [verified 11 March 2024]

10  Institute of Environmental Science and Research Limited. Sexually transmitted infections in New Zealand: supplementary annual surveillance report; 2023. Available at www.esr.cri.nz/digital-library/sexually-transmitted-infections-annual-surveillance-report-2022/ [verified 1 November 2023]

11  Health Quality & Safety Commission. A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on Māori health equity | He matapihi ki te kounga o ngā manaakitanga ā-hauora o Aotearoa 2019 – he tirohanga ki te ōritenga hauora o te Māori; 2019. Available at https://www.hqsc.govt.nz/assets/Our-data/Publications-resources/Window_2019_web_final-v2.pdf [verified 1 November 2023]

12  New Zealand Sexual Health Society. STI guidelines: Māori sexual health framework; 2021. Available at https://sti.guidelines.org.nz/maori-sexual-health-framework/ [verified 1 November 2023]

13  McDonagh LK, Saunders JM, Cassell J, Curtis T, Bastaki H, Hartney T, et al. Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review. Implement Sci 2018; 13(1): 130.
| Crossref | Google Scholar |

14  Bender SS, Fulbright YK. Content analysis: a review of perceived barriers to sexual and reproductive health services by young people. Eur J Contracept Reprod Health Care 2013; 18(3): 159-67.
| Crossref | Google Scholar |

15  Kennedy EC, Bulu S, Harris J, Humphreys D, Malverus J, Gray NJ. “Be kind to young people so they feel at home”: a qualitative study of adolescents’ and service providers’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu. BMC Health Serv Res 2013; 13: 455.
| Crossref | Google Scholar |

16  Newton-Levinson A, Leichliter JS, Chandra-Mouli V. Sexually transmitted infection services for adolescents and youth in low- and middle-income countries: perceived and experienced barriers to accessing care. J Adolesc Health 2016; 59(1): 7-16.
| Crossref | Google Scholar |

17  Denison HJ, Bromhead C, Grainger R, Dennison EM, Jutel A. Barriers to sexually transmitted infection testing in New Zealand: a qualitative study. Aust N Z J Public Health 2017; 41(4): 432-7.
| Crossref | Google Scholar |

18  Rose SB, Garrett SM, McKinlay EM, Morgan SJ. Experience of sexual healthcare by Māori and non-Māori young people: an online survey of 15–24 year olds in Hawkes Bay, New Zealand. Int J Sex Health 2022; 34(1): 118-29.
| Crossref | Google Scholar |

19  Rose SB, Garrett SM, McKinlay EM, Morgan SJ. ‘Be nice to us, we’re still learning’: an online survey of young people in Hawkes Bay, New Zealand, about unmet need for sexual health care and improving access to services. Sex Health 2021; 18: 394-404.
| Crossref | Google Scholar |

20  Green A, Waiti J. Planning a national STI website that appeals to young Māori; 2014. Available at https://tewhariki.org.nz/assets/stief-project-report-and-appendices-2014-for-distribution.pdf [verified 1 November 2023]

21  Veukiso-Ulugia A. Best practice framework for the delivery of sexual health promotion services to Pacific communities in New Zealand. Report prepared for the Ministry of Health; 2013. Available at https://tewhariki.org.nz/assets/best-practice-sexual-health-framework-for-pacific-people-final-170kb.pdf [verified 1 November 2023]

22  Ministry of Health. Aotearoa New Zealand sexually transmitted and blood borne infection strategy 2023–2030. Wellington: Ministry of Health; 2023. Available at https://www.health.govt.nz/publication/aotearoa-new-zealand-sexually-transmitted-and-blood-borne-infection-strategy-2023-2030 [verified 1 November 2023]

23  Rose SB, Gardiner T, Dunlop A, Cole M, Garrett SM, McKinlay EM. Māori and Pacific young people’s perspectives on testing for sexually transmitted infections via an online service: a qualitative study. J Prim Health Care 2024;
| Crossref | Google Scholar |

24  Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
| Crossref | Google Scholar |

25  Pulotu-Endemann K. Fonofale model of health. In: Ministry of Health, editor. Strategic directions for the mental health services for Pacific Island people. Wellington: Ministry of Health; 1995. Available at https://d3n8a8pro7vhmx.cloudfront.net/actionpoint/pages/437/attachments/original/1534408956/Fonofalemodelexplanation.pdf?1534408956

26  Manatū Hauora Ministry of Health. Māori health models – Te Whare Tapa Whā (Mason Durie); 2017. Available at https://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha [verified 1 November 2023]

27  Ikihele A, Nosa V. Mothers and sisters: educators of sexual health information among young Niue women born in New Zealand. Pac J Reprod Health 2019; 1(9): 513-20.
| Crossref | Google Scholar |

28  Young CD, Taumoepeau MM, Hohmann-Marriott BE, Girling JE, Bird RJ. Sexual and reproductive health knowledges: a study with Pacific young people enrolled in an Aotearoa New Zealand tertiary institution. Cult Health Sex 2024; 26: 265-83.
| Crossref | Google Scholar |

29  Green JA, Tipene J, Davis K. Mana Tangata Whenua: national guidelines for sexual and reproductive health promotion with Māori. First edition. Hamilton: Te Whāriki Takapou; 2016. Available at https://tewhariki.org.nz/assets/National_Guidelines_for_SRH_Promotion_with_Maori.pdf [verified 1 November 2023]

30  Ministry of Education. Relationships and sexuality education. A guide for teachers, leaders, and boards of trustees; 2020. Available at https://hpe.tki.org.nz/assets/healthpe/pdfs/RSE+Guide+y9-13.pdf [verified 1 November 2023]

31  Dixon R, Robertson J, Beliveau A, Reid S, Maitland R, Dalley J. New Zealand secondary school teachers’ perspectives on teaching relationships and sexuality education; 2022. Available at https://healtheducation.org.nz/wp-content/uploads/2022/11/RSE-secondary-teachers-experiences-full-report.pdf [verified 1 November 2023]

32  New Zealand Sexual Health Society. Request for action on the development of a national sexual health strategy and action plan; 2011. Available at https://www.nzshs.org/docman/about/nzshs-policy-submissions/188-development-of-a-sexual-health-strategy-and-action-plan [verified 1 November 2023]

33  Allen L. Don’t forget, Thursday is test[icle] time! The use of humour in sexuality education. Sex Educ 2014; 14(4): 387-99.
| Crossref | Google Scholar |