When someone gets diagnosed with a sexually transmitted infection (STI), the next step is usually to get medication that can treat it. That’s especially true for highly treatable STIs, like gonorrhea and chlamydia, which often can be cured in a couple doses of antibiotics. But, according to a May 2019 study from researchers at Children’s National, fewer than 60% of young women who are diagnosed with an STI in the emergency room actually fill their prescriptions for antimicrobial drugs. And what makes that statistic particularly scary is the fact that untreated gonorrhea and chlamydia can lead to pelvic inflammatory disease (PID) in people with uteruses.
PID is caused by an infection in the vagina spreading into the uterus, fallopian tubes, and ovaries. If it’s not treated, PID can cause scarring on the reproductive organs or abscesses on the fallopian tubes and ovaries — and all of those can lead to severe pain or even infertility. And while infections other than chlamydia or gonorrhea can also cause PID, chlamydia and gonorrhea are the leading cause of it, according to the Mayo Clinic.
So why aren’t young people filling their prescriptions for these very treatable STIs, which can cause such serious health problems? Rebecca Thimmesch, a Program Associate at Advocates for Youth, tells Bustle that the whole system around getting a prescription just doesn’t work for many young people.
“There’s just a lot of issues with our current system that fill young people with a sense of dread either about getting tested, filling a prescription, or even asking to get tested,” Thimmesch tells Bustle. “So those are big hurdles, particularly for young person who is working in addition to being in school or is from a marginalized community, like young people who are experiencing homeless or young people who are uninsured. There are just a lot of additional factors that make it harder.”
Thimmesch says that there are “two buckets” of barriers to access to prescription drugs: accessibility concerns and cost. When it comes to accessibility, teenagers may need to rely on public transportation or aren’t available for clinic business hours that are only during school or work. Or maybe they have to take time out of their day to go to the clinic and the pharmacist and do it all within business hours. Each hurdle is a point where a young person may decide to just give up.
And while cost is “always an issue in terms of healthcare,” it’s “particularly true for young people,” Thimmesch says. Young people have to choose between paying for a prescription out of pocket, or using insurance — and risking their parents finding out about their diagnosis.
“Even though in theory what you say to the doctor is confidential, there are a lot of places where that confidentiality can fall apart,” Thimmesch says. “And billing is a huge one. So a lot of times when young people are actually getting a prescription for a medication filled, it will show up as a medication on their insurance. Same thing with STI testing, because those are two things that can be expensive, and are often covered by insurance.”
Another area where confidentiality may fail, Thimmesch says, is if a receptionist calls the young person’s home and reaches a parent instead of the young person. And the combination of all of the factors contributes to the high number of young people not filling their STI prescriptions.
But there are structural changes that can be made to lower that number, Thimmesch says. Advocates for Youth is currently working with medical practices to help them figure out better ways to maintain patient confidentiality. That includes locking electronic records and working with front desk and billing departments to ensure that confidentiality is respected in those areas. They also advise medical practices to bill clients as Title X — a program that provides government funding for birth control and reproductive health care — walk-ins, even if they have insurance, because then there’s no concern about confidentiality being breached when it goes on their parent’s insurance.
Additionally, Advocates for Youth is working with two innovative programs that are increasing the number of young people who do get their prescriptions. One is the Children’s National center in Washington, D.C., which stocks STI medication in the clinic. This reduces one hurdle for young people, as the doctor can prescribe and then immediately hand over the meds — no need for a second trip to the pharmacy. Another is El Rio’s Reproductive Health Access Project, a youth-led sexual health program in Tucson, Arizona, where teens give other teens the information they need about sex and sexual health. Thimmesch says that both programs have led to an increase in young people getting and taking their STI medication.
In addition to structural changes — which Thimmesch acknowledges can be difficult to implement and therefore take a lot of time — there are things that individuals can do to increase their own likelihood of accessing STI medication. Thimmesch suggests asking questions every step of the way. In many cases, clinics have grant money that can help them cover the cost of medications, so it’s always worth it to ask. She also suggests double checking about billing if it’s a “do or die” situation for a young person if it shows up on their parent’s insurance.
“Be really aware of your needs are and be empowered to self-advocate in the exam room,” Thimmesch says. “But at the end of the day, there’s only so much a young person can do for themselves if the system is not set up for them to succeed.”