Youth Voices on the Sexually Transmitted Infection Risk Environment: Community Violence, Chronic Trauma, and Sexual Health Outcomes

Abstract

Sexually transmitted infections (STIs) disproportionately affect young people in the United States. Although social determinants have been identified as important in shaping STI prevalence and STI disparities, the voice of young people and key stakeholders representing young people is lacking to prioritize interventions aiming to improve these. The objective of this study was to use a community-based participatory research (CBPR) framework to explore how young people and community key stakeholders representing young people understand the context of STI risk experienced in their community, and gather information about their prioritization of social determinants of STIs and STI inequities in Baltimore City, Maryland. We conducted key informant interviews (n = 27) with young people ages 15 to 24 years and key stake-holders in neighborhoods with high rates of STIs. Interview transcripts were analyzed through a constant comparison approach. Participants overwhelmingly identified trauma as the key challenge among young people in their communities and largely focused on the role of community violence as a source of chronic trauma. Participants described two pathways through which this trauma contributes to young people's risk of STI acquisition and transmission: (1) competing short-term priorities in a struggle for daily survival, and (2) sex as an available resource for stress relief, self-medication, and escapism. These findings demonstrate a need to understand social determinants through youth voice and engage young people and key stakeholders in prioritizing and addressing STI disparities. Findings also support the urgent need for structural interventions for STI prevention.