Barriers and enablers for young Aboriginal people in accessing public sexual health services: A mixed method systematic review

Background A mixed method systematic review was undertaken to address the research question, Do young Australian Aboriginal people barriers in accessing public sexual health services? Aboriginal people are disproportionally affected by significantly higher incidence rates of sexually transmissible infections (STIs), compared to the rest of the Australian population. This problem is particularly acute for young people under 30 years of age who suffer from the consequences of STIs due to the number of sexual partners and challenges faced in accessing healthcare. Methods The study inclusion criteria were: papers published between January 1999 and September 2019 inclusive; published in any language, discussed healthcare barriers and facilitators; included people under 30 years of age; contained research with one or more of the following terms; Aboriginal, Health, Access, Barriers and Sexual Health; was published or discussed Australia research. Articles were extracted from MEDLINE, Embase, PsychINFO, Proquest Social Sciences, Open Grey and NLM Bookshelf. An initial search identified 770 articles; 23 duplicate articles were removed. 642 were excluded for not meeting inclusion criteria following a title and abstract review of articles. 60 articles underwent full text review by two reviewers and 15 articles were included in analysis. Results This review found that novel approaches to service delivery such as incorporating STI testing into other targeted initiatives, providing self-testing kits and achieving high levels of cultural competency were key facilitators to access. Whereas location of services, inconsistent service provision, shame and differing levels of knowledge about the effects of STIs were key barriers. Conclusions This systematic review identified barriers and facilitators of access to sexual health services for Aboriginal young people. System level changes are needed to improve physical environments, service integration and consistent provision of culturally competent services. This review highlights the need for further research focussed on assessing the real-world pressures of young Aboriginal people and how healthcare providers can better offer a person-centred service.