Australian surveillance data document higher rates of sexually transmissible infections (STIs) among young Aboriginal people (15–29 years) in remote settings than non-Aboriginal young people. Epidemiological data indicate a substantial number of young Aboriginal people do not test for STIs. Rigorous qualitative research can enhance understanding of these findings. This paper documents socio-ecological factors influencing young Aboriginal people’s engagement with clinic-based STI testing in two remote settings in the Northern Territory, Australia. In-depth interviews with 35 young Aboriginal men and women aged 16–21 years; thematic analysis examining their perceptions and personal experiences of access to clinic-based STI testing. Findings reveal individual, social and health service level influences on willingness to undertake clinic-based STI testing. Individual level barriers included limited knowledge about asymptomatic STIs, attitudinal barriers against testing for symptomatic STIs, and lack of skills to communicate about STIs with health service staff. Social influences both promoted and inhibited STI testing. In setting 1, local social networks enabled intergenerational learning about sexual health and facilitated accompanied visits to health clinics for young women. In setting 2, however, social connectedness inhibited access to STI testing services. Being seen at clinics was perceived to lead to stigmatisation among peers and fear of reputational damage due to STI-related rumours. Modalities of health service provision both enhanced and inhibited STI testing. In setting 1, outreach strategies by male health workers provided young Aboriginal men with opportunities to learn about sexual health, initiate trusting relationships with clinic staff, and gain access to clinics. In setting 2, barriers were created by the location and visibility of the clinic, appointment procedures, waiting rooms and waiting times. Where inhibitive factors at the individual, social and health service levels exist, young Aboriginal people reported more limited access to STI testing. This is the first socio-ecological analysis of factors influencing young Aboriginal people’s willingness to undertake testing for STIs within clinics in Australia. Strategies to improve uptake of STI testing must tackle the overlapping social and health service factors that discourage young people from seeking sexual health support. Much can be learned from young people’s lived sexual health experiences and family- and community-based health promotion practices.

中文翻译：

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澳大利亚北部地区的年轻土著居民参与STI测试。

澳大利亚的监测数据表明，在偏远地区的年轻土著居民（15-29岁）中的性传播感染（STIs）发生率高于非土著年轻人。流行病学数据表明，相当数量的年轻土著人没有进行性传播疾病检测。严格的定性研究可以增进对这些发现的理解。本文记录了在澳大利亚北领地的两个偏远地区，影响年轻原住民参与基于临床的STI测试的社会生态因素。对35位年龄在16-21岁之间的年轻土著男女进行了深入采访；主题分析，检查他们对获得基于临床的STI测试的看法和个人经验。调查结果揭示了个人，社会和卫生服务水平会影响进行基于临床的STI测试的意愿。个人层面的障碍包括对无症状性传播感染的了解有限，对症状性传播感染进行测试的态度障碍以及缺乏与卫生服务人员交流有关性传播感染的技能。社会影响促进和抑制了性传播感染测试。在环境1中，当地的社交网络使代际学习者能够了解性健康，并为年轻妇女的陪同探访提供了便利。然而，在第二种情况下，社会联系阻碍了获得STI测试服务的机会。在诊所就诊被认为会导致同龄人受到侮辱，并担心由于与性传播感染有关的谣言而声誉受损。提供卫生服务的方式既增强又抑制了性传播感染测试。在设置1中，男性卫生工作者的外展策略为原住民青年提供了学习性健康，与诊所工作人员建立信任关系以及获得诊所服务的机会。在设置2中，门诊的位置和可见性，预约程序，候诊室和等待时间造成了障碍。在存在个体，社会和卫生服务水平的抑制因素的地方，年轻的土著居民报告获得性传播感染检测的机会有限。这是对影响年轻原住民在澳大利亚诊所进行性传播感染测试意愿的因素进行的首次社会生态分析。改善性传播感染检测的策略必须解决重叠的社会和卫生服务因素，这些因素阻碍了年轻人寻求性健康支持。