August 18, 2022

Young people aged 15-24 are less than a quarter of the population, yet they get half the estimated 20 million new cases of STIs each year. STIs and unplanned pregnancies disproportionately affect youth in juvenile facilities, foster care or experiencing homelessness. Communities of color and LGBTQ+ young people are also impacted at higher rates. Youth of color are overrepresented in systems like child welfare and vulnerable settings like shelters.

New research from the Institute for Health Policy Studies convened focus groups of youth from highly affected and underserved groups to explore their concerns and attitudes about the risks and consequences of pregnancy and STIs.

They found that both male and female young people were more concerned about pregnancy than STIs. The focus groups expressed greater concern about stigma associated with HIV/AIDS compared to other STIs, suggesting they may view HIV/AIDS as a separate risk category.

Concern about unplanned pregnancy compared to STIs was influenced by ideas about long-term consequences. Some felt pregnancy was a greater concern because of the lifelong commitment to raising a child and how that could impact their careers. On the other hand, a few members of the group brought up that there are options to end a pregnancy, while long-term consequences of certain STIs, especially HIV/AIDS, were more significant.

Young people also noted a lack of communication or information about STIs compared to messaging and education around preventing pregnancy. Sexual health education program and clinical settings need to better integrate information about STI symptoms, prevention strategies, testing and treatment, along with information about pregnancy prevention.

These findings also identified different underlying concerns about STIs and pregnancy among different youth populations. For young people experiencing homelessness or other unstable housing situations, STIs were lesser concerns that other immediate needs like safety, food and shelter. Relationship status and dynamics, such as trust and number of partners, were factors that shaped their concerns and risk perceptions. Members of the focus group of young gay men felt there was less motivation and regular condom use among young men in their community because pregnancy wasn’t a concern. For female focus groups, most of them were more concerned about pregnancy.

Young people need interventions tailored to their specific context and concerns, especially youth experiencing homelessness. Sexual health education and clinical services must also ensure they’re responsive to the needs of LGBTQ+ youth. Though some innovative STI interventions for young men who have sex with men have shown promise, most of them are relatively small and virtually no programs focus on bisexual young women.

This research can help sexual health education programs develop more integrated curricula and incorporate thoughtful discussion of relationships, power dynamics, and contraceptive decision making. Tailored information should be available in community-based settings beyond schools, including foster care facilities and shelters. This work reinforces the need for adolescent and young adult health clinics, researchers, and educators to address how social conditions and discrimination shape disparities in sexual health outcomes for marginalized youth. Addressing young people’s individual needs through improved programs and increased access to health care must be supported by interventions that target structural determinates of sexual health inequities.