Medieval Wenches and Other Icky Connotations: How Young People's Constructions of Sexually Transmitted Infections Deepen our Understanding of Their Sexual Health

Abstract

Purpose: Genital chlamydia infection mainly affects young people and can have long term health consequences. Despite Australian guidelines recommending chlamydia screening for all sexually active young people, testing rates remain low and the epidemic continues to grow. This qualitative study involved interviews with participants from a randomized controlled trial and employed Foucauldian discourse analysis to explore in depth how young people understand sexually transmitted infections (STIs) and the subject positions they take in relation to testing, diagnosis and communication with partners. Methods: Young people (16 e 25 years) who completed a randomised controlled trial about a chlamydia testing intervention were invited to take part in a subsequent, qualitative study using indepth interviews. The interviews were unstructured but guided by topic prompts and explored participants’ views on chlamydia testing and the meanings attributed to STIs. The interviews were audio-recorded and transcribed. Two researchers read and analysed the transcripts in order to describe the discursive fields and subject positions taken by participants when discussing their understandings and experiences of STIs. The study was approved by the relevant ethics committee. Results: Seven young people (5 female, 2 male) participated in indepth interviews. Sources of knowledge, information seeking and interpersonal communications about STIs were constructed as proximal or distant and these constructs played different roleswhen coming to terms with STIs. Participants were more comfortable discussing STIswith close friends thanwith sexual partners and took up a position of caring for others in doing so. Themedical consulting roomwas seen as the most appropriate place to get personal advice but even here proximity and distance played out. STIs were unanimously constructed as negative entities in participants’ lives. However as their proximity to STIs increased, the struggle to resist these negative beliefs led to taking up a new subject position of caring for self. Participants unanimously attributed their negative beliefs about STIs to sexual activity itself. Sexual activity among young people, especially females, was taboo. Within the discourse of shame, participants found ways to resist being positioned in negative ways by carefully choosing others with whom they could discuss STIs, by taking up roles as informal peer educators or by gradually rejecting notions of guilt, shame or immorality. Participants produced subject positions for individual STIs. Not all STIs were equally negative. Different STIs had different meanings including ‘gross’ ‘disgusting’, ‘serious’, ‘scary’, a ‘medieval wench’ and ‘having icky connotations’. Conclusions: By emphasising ‘risks’ associated with sexual activity, health and education professionals could be reinforcing negative discourses about shame. Instead, approaches to STIs could acknowledge the struggle young people face in resisting negative discourses about their own sexual activity. By focusing on positive concepts such as caring for self and caring for others, young people might find safer spaces to seek help and discuss STIs with their partner/s and health care providers. Sources of Support: The study was supported by a grant from the Australian Commonwealth Department of Health and Ageing.