In emerging countries, access to medical care in general is limited. People often have to travel long distances to get to a clinic and the testing process involves two or three visits:
- A visit to a family doctor for a referral to a clinic
- A visit to a clinic where the sample is taken and sent to the lab
- A return visit to the family doctor or clinic for the test results and treatment if necessary
Some clinics take patients without referral, so there are only two visits, both to the clinic.
In countries with the highest medical costs in the world, the three visits, including the lab analysis of the sample, can cost as much as $500 which makes annual testing impossible for the uninsured and causes insurance companies to limit the number of tests they will cover per year.
In addition, people need to take time off work for these appointments, which they cannot afford to do. Sometimes the clinics are so busy that people are asked to come back another day, meaning another day off work.
The number one social reason is embarrassment and the social stigma around STIs. People are afraid to discuss the issue, even with a trusted family physician. The sample taking is also very disconcerting. While there has been some success in STI testing from a urine sample, the standard test for women involves swabbing for vaginal fluids. This is uncomfortable and embarrassing.
In some countries, sexual health issues – particularly for women – are dominated by the abortion debate. The availability of clinics offering STI testing has been reduced in these countries over fears that they are performing abortions. This increases the difficulty for women to receive adequate health care which can have adverse consequences for their future quality of life.