title: Sexually Transmitted Infection Services for Adolescents and Youth in Low- and Middle-Income Countries: Perceived and Experienced Barriers to Accessing Care.
abstract: Access to sexual and reproductive health (SRH) services is vital for sexually active adolescents; yet, their SRH care needs are often unmet.
  
  
  
  We conducted a qualitative systematic review of mixed methods studies to assess adolescent and provider views of barriers to seeking appropriate medical care for sexually transmitted infection (STI) services for adolescents. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (aged 10-24 years) and/or health service providers. Nineteen studies were identified for inclusion from 15 countries. Thematic analyses identified key themes across the studies.
  
  
  
  Findings suggest that youth lacked knowledge about STIs and services. In addition, youth experienced barriers related to service availability and a lack of integration of services. The most reported barriers were related to acceptability of services. Youth reported avoiding services or having confidentiality concerns based on provider demographics and some behaviors. Finally, experiences of shame and stigma were common barriers to seeking care.
  
  
  
  Adolescents in low- and middle-income countries experience significant barriers in obtaining STI and SRH services. Improving uptake may require efforts to address clinic systems and provider attitudes, including confidentiality issues. Moreover, addressing barriers to STI services may require addressing cultural norms related to adolescent sexuality.
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: anewto3@emory.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Newton-Levinson
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jami S
authors.initials: JS
authors.lastname: Leichliter
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Venkatraman
authors.initials: V
authors.lastname: Chandra-Mouli
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D003219:Confidentiality; D003906:Developing Countries; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D034121:Reproductive Health Services; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control / Q000628:therapy*; D057545:Social Stigma
keywords: Access; Adolescent; Barriers; Health services; STD; STI; Youth