Covering all the BASEs? Barriers and facilitators to STI testing among international students living in England

Background: The emergence in England of ceftriaxone-resistant Neisseria gonorrhoeae, the bacteria which causes gonorrhoea, is a public health concern. Most cases of ceftriaxone-resistant gonorrhoea in England are travel-associated. We assessed the barriers and facilitators to sexually transmitted infection testing among international students living in England. Methods: We conducted semi-structured interviews (March-August 2025) with international students attending a university in London. We recruited students through various university networks and snowball sampling. We used the Capability, Opportunity and Motivation (COM-B) model and conducted a thematic analysis. Results: We conducted 15 interviews. Most participants were from China (n=8) and Nigeria (n=2), with other participants from countries in Europe, Asia, the Middle East and the Americas. Most participants were 25-34 years old and in a postgraduate programme. Two-thirds of our sample had previously been tested for STIs (7 in England, and 3 in their home country). STI language and knowledge were key psychological capability barriers to STI testing, awareness of STI testing options was a facilitator. Under physical capability, no STI symptoms influenced testing for some, but prompted testing for others. Belief in confidentiality, privacy, and anonymity of testing, alongside perceived social and individual benefits of STI testing, were identified as facilitators under reflective motivation. Perceived risk varied based on relationship status. Anticipated judgement and stigma were the main social opportunity barriers, while trust in health professionals was the main facilitator. Fragmented services and poor proximity were key physical opportunity barriers; perceived availability of services and access to free, straightforward testing were facilitators. Conclusions: We integrated these findings into national STI public health messaging targeted at university students in the England. The findings can be used to create culturally appropriate resources to raise awareness of STI-related symptoms and, among those with a need, promote STI testing.