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Addressing sexual health-related anxiety among sexual health service users


Anxiety and other mental health concerns are common among people accessing sexual health services, many of whom are not connected to mental health supports(1). A team of researchers from the BC Centre for Disease Control (BCCDC) and Simon Fraser University developed ‘Supporting and addressing anxiety in sexual health care: A resource for providers’, which aims to help sexual health service providers connect service users with appropriate mental health services and support. 

Anxiety is the most prevalent mental health concern reported by sexual health service users; previous research suggests that almost one third (28%) experience anxiety(1). In some instances, heightened feelings of stress and anxiety are shaped by factors specifically related to their sexual health needs, including symptoms of sexually transmitted infections (STIs), testing, diagnosis, or implications of a positive STI test result (e.g. partner notification)(2-5).  In other cases, sexual health service users may be experiencing ongoing mental health challenges.

The team used data from the SmartSexResource chat service to characterize expressions of anxiety among chat users and nurse responses to anxiety. Findings informed the development of resources to assist sexual service providers to identify and respond to sexual health anxiety, including how and where they can refer clients for mental health support.


The SmartSexResource chat service allows users to chat with a BCCDC STI Services nurse in real-time, to ask questions about sexual health. No personal information is collected through the service, however it is restricted so that only those connecting from devices in Canada can access it. Chat transcripts were stripped of any potentially identifying information shared during the chat session, and analyzed using inductive thematic analysis.


Sexual health-related anxiety was common among chat users. Many described persistent worry and anxiety about their sexual health, particularly with regard to HIV. Commonly recurring topics of concern were:

  • HIV transmission risk, including recurring worry over low-risk sexual experiences and behaviours.
  • Symptoms, including non-specific symptoms not commonly associated with HIV.
  • Uncertainty and asking for confirmation of test accuracy, even after repeated testing.
  • Shame and stigma related to sexual experiences.

Notably, in these instances chat users’ concerns were typically not resolved with information provided by the nurse (i.e., explaining how HIV is transmitted) or testing interventions (offering another HIV test), suggesting that alternative supports may be beneficial.

Implications for Practice

Supporting and addressing anxiety in sexual health care: A resource for providers’ was developed by the team in collaboration with BCCDC STI Services nurses & physicians, and other sexual health / mental health professionals. It aims to help service providers recognize and respond to sexual health anxiety among service users, and offers information about sexual health-related anxiety including common concerns expressed by service users, and highlights effective strategies used by providers to address anxiety among service users.

To help providers connect clients with trusted, reliable, and accessible mental health services, the team also developed MindMapBC, an online database of accessible mental health services and supports. All of the services listed on MindMapBC accept self-referrals, most are free or low-cost, and many are LGBTQ2+ affirming (lesbian, gay, bisexual, trans, queer, Two-Spirit, and other gender- and sexually-diverse people). Website visitors can filter services based on a number of criteria (e.g. cost, mode of service delivery, location), in order to locate services that are appropriate, accessible, and affirming. Explore services at: https://www.mindmapbc.ca.

We aim to expand the reach of MindMapBC by including more services outside of the Lower Mainland. Help us expand MindMapBC by telling us about great mental health supports in BC. Our team continues to work with sexual health providers to improve the integration of mental health services.

If you would like to become involved, contact:
Sarah Watt: sarah.watt@bccdc.ca
Travis Salway: travis_salway@SFU.ca


This work was led by Travis Salway, Oralia Gómez-Ramírez, Aidan Ablona, Lindsay Barton, Hsiu-Ju Chang, Heather Pedersen, Devon Haag, Natasha Vitkin, James Young, Angel Kennedy, Rowdy Reeves, and Mark Gilbert, and in collaboration with Joelle LeMoult, the Community-Based Research Centre, and the Health Initiative for Men. We would like to thank all those who participated in this research – in particular the team of sexual health nurses at BCCDC – for their support for this project.

Graphic design services were provided by Natasha Vitkin and Molly Wells at Designs that Cell.


1. Salway T, Ferlatte O, Shoveller J, Purdie A, Grennan T, Tan DHS, et al. The Need and Desire for Mental Health and Substance Use-Related Services among Clients of Publicly Funded Sexually Transmitted Infection Clinics in Vancouver, Canada. J Public Heal Manag Pract. 2019;25(3):E1–10.
2. Arkell J, Osborn DPJ, Ivens D, King MB. Factors associated with anxiety in patients attending a sexually transmitted infection clinic: Qualitative survey. Int J STD AIDS. 2006;17(5):299–303.
3. Ransom JE, Siler B, Peters RM, Maurer MJ. Worry: Women’s experience of HIV testing. Qual Health Res. 2005;15(3):382–93.
4. Worthington C, Myers T. Factors Underlying Anxiety in HIV Testing : the Patient-Provider Power Dynamic. 2003;13(5):636–55.
5. Shoveller JA, Knight R, Johnson J, Oliffe JL, Goldenberg S. Not the swab!’ Young men’s experiences with STI testing. Sociol Heal Illn. 2010;32(1):57–73.