Exploring the views and experiences of young people from BAME backgrounds around sexual health services

Healthwatch Brighton and Hove worked alongside Young Healthwatch to gather the views and opinions of BAME (Black, Asian, and Minority Ethnic groups) young people, aged 17-25 and living in Brighton and Hove around local sexual health services and STIs (Sexually Transmitted Infections). Young asylum seekers and refugees as well as young people living in the city temporarily to study English were also engaged around this topic.  They undertook a survey and interviews with 71 young people.

Young people had good knowledge of local sexual health services. Their experience using the services was mostly positive with many participants commenting on staff being welcoming and friendly and making them feel at ease. One of the common complaints was around waiting times being too long.

Language was a common barrier to access, especially for those who may have only recently moved to the UK and therefore had limited English skills. Young people felt lack of information and promotion around sexual health services is still a main barrier to access. Furthermore, promotional material was not seen as inclusive and representative of ethnic minorities living in Brighton and Hove, thereby making young people feel ‘the services are not for them’.

Young people shared a concern around confidentiality within services and a fear that personal information would be inappropriately shared with others, including parents. These worries were not based on any personal experiences but rather on pre-existing beliefs. The fear of parents finding out was perceived as a major barrier among many young people, especially younger participants (17-19) and those from Asian and Black African backgrounds. This was shown to have religious and cultural underpinnings, for example in relation to sex before marriage, sex being a taboo subject not spoken about within the family environment, and sex seen from parents as a main distraction from studying and focusing on academic achievements.

Young people said sexual health clinics are often not designed to be discreet and private. Patients may feel uncomfortable sharing private information and the reasons for their clinic visit upon arrival, especially if the waiting areas are busy or there are long queues where they feel they can be overheard. It was noted that typical seated cubicles on receptions lack robust privacy. Furthermore, some young peoples' worries around confidentiality are based on pre-existing beliefs which can operate as a barrier. These are likely to be mitigated once they visit the clinic and confidentiality is properly explained to them by the service provider. There is ample evidence to show that issues with privacy and confidentiality are salient to all young people, and not just those from BAME backgrounds.

Peer influence was identified as both an enabler and barrier to accessing sexual health services. As a barrier, participants felt being seen in a sexual health clinic by another peer, especially when testing for STIs, may affect their social status and reputation; where a social media post from the wrong person could ‘out’ a young person as having an STI, particularly for young people from close knit communities where particular cultural and social norms strongly stigmatise being sexually active at a young age or before marriage. As an enabler, participants suggested accessing sexual health services with friends and peers may normalise the whole experience, making it more social and therefore less daunting.

Religious beliefs were identified as a main barrier to access. Sex is still a taboo subject in some cultures and communities. Young people of faith may struggle with the internal conflict between their religion and being sexually active and consequently may not access services for the fear of being judged (by other people and peers at the clinic, but also by health professionals). The response of parents and carers was also flagged as the main reason for feeling embarrassed to communicate about sex, especially among younger participants from Asian and African backgrounds, ultimately preventing access due to the fear of parents finding out.

Participants showed a good knowledge of Sexually Transmitted Infections (STIs) which they said to have acquired mainly through Education. Most young people had a clear idea of the process involved in getting an STI test, including options for both male and female patients. None of the participants commented on testing options for people identifying as transgender. Some young people highlighted the stigma associated with STIs being a main barrier to testing, as diagnosis suggests engaging in unprotected sex, sex with multiple partners or sex with disreputable partners. Furthermore, absence of symptoms, the fear of reputation being ruined if seen going for a test, shame and embarrassment were identified as main barriers to testing.

The report contains five recommendations about improving information that was targeted at all communities, education for parents and carers, improving confidentiality and privacy, improving staff ethnic diversity and training and improving interpreting services.