Table 2 Barriers and recommendations to improve bacterial STI testing: bacterial STI testing delivery

Sexual History Intake

Making assumptions about who requires a test based on demographics or symptoms

Normalizing sexual activity questions in healthcare

“I think doctors have to do a better job of not making assumptions, when they’re dealing with people of a certain age or a certain background and still have that conversation about, maybe you should have a test.” (FG1, P3)

“Another interesting thing is, if you are basing on male or female then it becomes like, sometimes they’ll ask you, who did you sleep with to get tested, at that time. So if you say, female, whether you’re like, what if I slept with a trans woman, what happens then? Right? I still am concerned with the same issues that I would, if I was sleeping with that male identified, or male partner, assigned at birth.” (FG3, P2)

“P4: Maybe if you ask me, can you tell me your sexual experiences since you last came to this clinic, and I tell you, I did this and I did this and I did this and I did this, then the nurse, with that information says, you should be tested for this and this and this and this, and a pharyngeal swab and a rectal swab and this is this, so it’s the type of questions that are being asked that will really, make effective decision making happen. P3: Preach!” (FG2)

Testing Offered

Lack of consistency and clarity on testing

Providing verbal and written communication explaining tests needed by sexual exposures

“I’ve done STI testing through my family doctor and I say, I would say to doctor, test everything, I mean, syphilis, chlamydia, everything, and I just assumed that gonorrhea was part of it, was part of the blood work. […] because I just thought that the blood work or a urine, or a urine sample, could test whether you have gonorrhea in any part of the body.” (FG2, P2)

“Break down what they’re testing you for cause a lot of the times you’re not being tested for what you think you’re getting. You’re getting tested for mostly chlamydia and HIV.” (FG2, P3)

“Another issue too, as well as people not knowing how to get tested, as well, for certain people, cause it can be at the, at the site of infection, so like, depending whether you get like, doing like a pee test or if you need like a swab.” (FG4, P2)

“Can you incorporate all of the symptoms […] into a one-page thing and say, these are the symptoms, these are, this is how you get tested. Like it’s not a one-day thing. You know, you’ve gotta go in, give blood, urine, whatever” (FG2, P6)

Follow-up & Test Results

Not provided test results

Clear communication regarding follow-up steps for testing, including sequence of events for a positive test and how results will be made available

“That’s another annoying thing is that, they don’t relate to timing for testing, is that they don’t call you if you’re negative. So you’re like waiting for a month.” (FG2, P5)

“I think people should know, prior to going in, what the, the outcome, like what’s the set of procedures, what if you test positive? You know, and, you know, how is treatment, how are you going to get onto treatment, things like that.” (FG1, P6)

“Maybe give me an information pamphlet on, OK, what, what do I do if I’m, if I test positive? Here is where you can go if you need support, end of story, and even access it online as well.” (FG4, P6)

“I: Would it be helpful at all to be able to access your lab results online?

P: Oh, yes

I: Yes, yes, yes? From this end? Yes?

P6: Yeah, so my ideal would be is that I can go anywhere, say I want to have this test done, give me whatever the cup I need to do, have it done, put it in the little box, leave, and be able to access the results online

Ps: I agree with that.” (FG4)

“P1: Like I mean even, even if it goes, the results go back to your doctor and your doctor contacts you, yeah. I mean, I don’t see a problem with that

P5: That would be alright

P1: I mean, that way your doctor is the best one to give you advice, give you medication

P5: And medication.” (FG4)

Public Health Reporting

HIV non-disclosure criminalization, lack of clarity on use of case and partner information

Affirming confidential testing and clarifying how testing information is utilized by public health

“If you do test positive for anything, they had a, a social worker there. […] You had to meet with them right after. And, that scared me because it’s like oh, […] you’ve been in contact with other people, it’s your responsibility, so I kind of felt oh my god, now on top of what I’m doing here, I’ve got this big thing put on my shoulders now that I’m responsible for all of the other people that I’ve slept with. So I have to now contact everybody and are they gonna be monitoring who I contact? Or are they gonna know who I contacted? […] I felt that, you know what, they’re, they were controlling what I was gonna do, and who I was gonna be with.” (FG4, P1)

“I also want to mention that like, there are a lot of undocumented folks here and access to care is really essential to this, folks don’t go to the doctor if they’re undocumented. A, they have to pay. And that’s a big barrier, at times. And B, like, they’re scared that the doctor might rat them out.” (FG2, P1)

“So when you admit that you had unprotected sex and you already know, have been living with HIV, that’s a serious thing to admit. And then it becomes reportable to public health, like is that not a barrier?” (FG4, P5)

“I prefer anonymous testing, because when you’re not anonymous in testing, they have to report it to Toronto Public Health and that really compromises my ability to control my own health.” (FG2, P1)

“One thing my doctor used to do is any test, especially for HIV, is he never, the test would go in with a number. Not with a name. And he kept his own sheet, and if it came back positive, then that’s how he dealt with it.” (FG4, P1)

“P5: What if we just provided like the phone number of the person who may have been in contact with Gonorrhea, and then they just get this beautiful text message saying, “Hey, you might want to like” …

P2: Well Halton sends the text message…

P4: Public Health does that. […]

P2: Well, in Peele they send a text message

P5: They send a message?

P2: I’ll get a message that says someone listed you a contact for this, if you find time please come in and get tested…

P4: And it’s totally anonymous

P3: That’s not too bad then” (FG4)

Multi-step Process

STI testing causes stress due to compromised anonymity and social stigma

Streamlining testing process by accessing testing lab requestions, and results online

“Yeah, so my ideal would be is that I can go anywhere, say I want to have this test done, give me whatever the cup I need to do, have it done, put it in the little box, leave, and be able to access the results online. […] Maybe give me an information pamphlet on, OK, what, what do I do if I’m, if I test positive? Here is where you can go if you need support, end of story, and even access it online as well. (P6, FG4)

I: So, something where you can have like, an online request, […] so you can request it and then they give you the paperwork. And then you can bring it to a lab, get your results, […] either through your doctor or online. Almost sounds like you could then have an extra couple of boxes, one that says where you want your prescription, if you’re positive, being sent to and you could click another box if you want counselling or some other support

P: Yeah!

P: Mm hmm

I: With it. And then, ta da!

P3: No, seriously, this is the twenty-first century, yeah. I mean …

P4: New ATM machines

I: Yeah, it’s kind of like the ATM of STD’s

P3: If you can meet somebody to screw online, you can get treated

P3: To me that should be the add (FG4)