title: Integrating gender and sex to unpack trends in sexually transmitted infection surveillance data in British Columbia, Canada: an ethno-epidemiological study.
abstract: Surveillance data frequently indicate that young men and women experience high-yet considerably different-reported rates of sexually transmitted infections (STIs), including bacterial infections such as chlamydia. We examined how several sex-based (eg, biological) and gender-based (eg, sociocultural) factors may interact to influence STI surveillance data trends.
  
  
  
  Employing ethno-epidemiological techniques, we analysed cross-sectional qualitative data collected between 2006 and 2013 about young people's experiences accessing STI testing services in five communities in British Columbia, Canada. These data included 250 semistructured interviews with young men and women aged 15-24 years, as well as 39 clinicians who provided STI testing services.
  
  
  
  The findings highlight how young women are socially and medically encouraged to regularly test, while young men are rarely offered similar opportunities. Instead, young men tend to seek out testing services: (1) at the beginning or end of a sexual relationship; (2) after a high-risk sexual encounter; (3) after experiencing symptoms; or (4) based on concerns about 'abnormal' sexual anatomy. Our results illustrate how institutions and individuals align with stereotypical gender norms regarding sexual health responsibilities, STI testing and STI treatments. While these patterns reflect social phenomena, they also appear to intersect with sex-based, biological experiences of symptomatology in ways that might help to further explain systematic differences between young men's and women's patterns of testing for STIs.
  
  
  
  The results point to the importance of taking a social and biological view to understanding the factors that contribute to the gap between young men's and women's routine engagement in STI care.
authors: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada.
authors: Rod
authors: R
authors: Knight
authors: Health Research and Policy, Stanford University, School of Medicine, Stanford, California, USA.
authors: Titilola
authors: T
authors: Falasinnu
authors: University of British Columbia, School of Nursing, Vancouver, BC, Canada.
authors: John L
authors: JL
authors: Oliffe
authors: Ontario HIV Treatment Network, Toronto, Ontario, Canada.
authors: Mark
authors: M
authors: Gilbert
authors: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors: Will
authors: W
authors: Small
authors: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors: Shira
authors: S
authors: Goldenberg
authors: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada.
authors: Jean
authors: J
authors: Shoveller
mesh_terms: D000293:Adolescent; D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012737:Sex Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000523:psychology; D055815:Young Adult
keywords: QUALITATIVE RESEARCH