STI and HIV testing: examining factors that influence uptake among domestic Australian-born, domestic overseas-born and international tertiary students studying in Australia

(2023) 23:505 Engstrom et al. BMC Public Health https://doi.org/10.1186/s12889-023-15418-z BMC Public Health Open Access RESEARCH STI and HIV testing: examining factors that influence uptake among domestic Australian‑born, domestic overseas‑born and international tertiary students studying in Australia Teyl Engstrom1*, Michael Waller1, Amy B Mullens2, Joseph Debattista3, Jo Durham4, Zhihong Gu5, Kathryn Wenham6, Kirstie Daken2, Armin Ariana7, Charles F Gilks1, Sara F E Bell1, Owain D Williams1, Kaeleen Dingle4 and Judith A Dean1 Abstract Objectives Sexual health knowledge among international students in Australia is lower than domestic students, however, little is known about what factors affect the uptake of STI testing, nor if there are differences for overseasborn domestic students. Methods We included sexually active respondents from a survey of university students in Australia (N = 3,075). Multivariate regression and mediation analyses investigated associations of STI and HIV testing with STI and HIV knowledge respectively, sexual risk behaviour and demographics, including comparisons among: domestic Australian-born, domestic overseas-born, and international students. Results STI and HIV knowledge was positively associated with STI and HIV testing respectively (STI OR = 1.13, 95% CI: 1.09, 1.16; HIV OR = 1.37, 95% CI: 1.27, 1.48). STI knowledge was significantly lower for international than domestic Australian-born students (10.8 vs. 12.2 out of 16), as was STI testing (32% vs. 38%); the difference in knowledge accounted for half the difference in STI testing rates between these two groups. International students from Southern Asia, and Eastern Asia reported the lowest STI testing rates. HIV testing was highest amongst international students from Africa and North America. Higher sexual risk behaviour, younger age, and identifying as gay or bisexual were positively associated with higher STI and HIV testing rates. Conclusions Our study supports greater investment and commitment by universities for the provision of sexual health education that can promote access to testing to improve the health of their students. Keywords Sexual health, STI testing, HIV testing, University students *Correspondence: Teyl Engstrom Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Engstrom et al. BMC Public Health (2023) 23:505 Introduction Young adults and overseas-born populations living in Australia are considered at an increased risk of acquiring sexually transmissible infections (STI) and blood borne viruses (BBV) including HIV. Notification rates of bacterial STI such as chlamydia, gonorrhoea and syphilis in Australia have steadily increased over the decade from 2009 to 2018 [1], with three-quarters of chlamydia infections in 2017 notified among those aged 15–29 years [1]. HIV notifications have declined over the last 5 years, however remain above average for those born overseas [1]. The majority of university students in Australia are aged below 30 [2], and almost a quarter are international students [3], suggesting the sexual health of this group should be important to university policymakers. Migrants and international students contribute significantly to the Australian society and economy and supporting their health and wellbeing is of critical importance. Over 28% of the Australian population was born overseas; international migration increases workforce participation, brings cultural diversity, new skills and knowledge which result in new businesses, markets and fresh perspectives [4]. Permanent and temporary skilled migrants contribute $9.7 billion to the economy throughout their lives [4], and international students contributed $22 billion to the Australian economy in 2018 [3]. International students are not covered under Australia’s universal healthcare system, and are required to purchase student health insurance cover while attending university in Australia [3]. Research consistently finds international and overseas-born university students in Australia have lower sexual health knowledge than Australian-born students [5–8]. There is some evidence of lower risk sexual behaviour among international and overseas-born students from Asian countries [6, 7]. However, international students report a lack of access to health services in Australia [9], which combined with new found freedoms, stigma, costs and cultural safety create vulnerabilities to STI, HIV and other BBV [9, 10]. The asymptomatic nature of most STI means that they can be unknowingly passed onto others and if left untreated, can result in serious health outcomes such as infertility and neurological disease; hence proactive regular testing is key to prevention [11]. STI testing rates among young Australians are sub-optimal [12, 13], however, STI testing behaviour of international and overseasborn populations in Australia have not been sufficiently studied – representing potential areas of hidden public health need. To our best knowledge, there are only two small studies to date in this area: one study compared the responses of a sexual health knowledge and behaviour survey designed for Chinese International students with those from a survey targeting Australian young people Page 2 of 11 and found sexually active Chinese international students had lower STI testing rates compared to domestic Australian students [7]. Similarly O’Connor et al., compared the results from different surveys in their study and found male Vietnamese migrants to Australia were less likely to have had a HIV test than other Australians [14]. Both young adults and people with culturally and linguistically diverse backgrounds (CALD) were identified as priority populations in Australia’s Fourth National STI Strategy [11]. Additionally, a HIV action roadmap for populations in Australia from high HIV prevalence countries [15] has been developed. (...truncated)