BMC Public Health 2009, 9:311 http://www.biomedcentral.com/1471-2458/9/311 And I know a girl who had it at one stage so. When someone in your circle of friends has had it you're thinking well like maybe it's more common than a lot of people think. That was the only reason I was think- ing it. (M/SH/early 20 s/-). Just that somebody close to me had done it and it was grand. It kind of brought it more down to earth rather than something that gets done. You know what I mean like. It was always there, this STI check but now some- body had actually gone for it in DIT as well, so it was close by. It was more real than something I just saw on a poster. (M/SH/early 20 s/-). Together health promotion materials and contact with individuals who had attended for STI testing appeared to disrupt what sociologist Anthony Giddens [15] referred to as respondents' 'protective cocoons', the psychological fil- ters that they used to screen out threatening anxieties. These included thoughts that they could have, or might be at risk of having, STIs, and which they used to maintain feelings of invulnerability and 'personal specialness'. Health promotion and by-proxy awareness of STIs inter- fered with the psychologically protective delusions that respondents might otherwise have had about STIs, such as 'only 'bad' people get STIs' and 'the chance of contracting an STI is miniscule'. They revealed to respondents that many people contracted STIs, including people 'like them'. Delayed testing A number of respondents immediately followed through on their decision to go for testing. The feature that all of these respondents had in common was an immediate, pressing anxiety to know if something was wrong with their bodies. This stemmed from a perceived high risk that they could have an STI. I kissed a fella who had syphilis. I was like to him, I'm not being bad but I have to get checked now (M/MSM/ late 20 s/-). I had to find out what it [symptom] was. (M/GP/ late20/-). Most respondents, though, delayed to varying extents on following through on their decision to attend a health service for STI testing. This'procrastination period could last from several weeks to, in one instance, over seven years. Anxieties about the potential social consequences of being diagnosed with an STI were common reasons for delay. Respondents felt that STIs were highly stigmatised infections in Ireland and that even being known to attend a health service for testing could discredit young adults' identities. People are afraid of the consequences of what's going to happen if you do have this thing. (F/FP/late 20 s/+). Feelings of shame and embarrassment encouraged delay. These feelings could be associated with the STI testing process, such as having to take clothes off in front of healthcare professionals (this concern was much stronger amongst female respondents). The reason I hadn't gone before was because of plain mortification. Because of stripping off for the doctor or whatever and it's a bit embarrassing really. (F/FP/ late 20 s/-). They could also stem from respondents' original reasons for going for testing. For example, respondents who wanted to go for testing because they had had unprotected sex, and were ashamed about this, were often concerned that their healthcare provider would judge them and their behaviour as 'shameful'. Respondents without symptoms often indicated that while testing was a positive practice to engage in, it was not an urgent one. I went about a year later. There wasn't any cause for concern. There was nothing obvious happening. (M/ SH/early 20 s/+). Lack of urgency here was connected to feelings of invul- nerability, feelings that the individual could not really be at risk if everything appeared to be functioning normally. I would have had unprotected sex with men before but I just assumed I was fine. I presumed it was perfect, I was grand. This kind of immortality vibe, you're grand, you're healthy, everything is fine. (F/FP/late 20 s/+). The cost of attending a health service for STI testing could also discourage respondents from seeking immediate help. I mean you could go to your GP and maybe get some- thing done quicker but I went to the clinic where it was free because I couldn't afford to pay whatever to your GP like 50 or 60 euro to see him on top of whatever it costs to get those tests done. (F/STI/late 20 s-). Several respondents from poorer areas noted that they needed to spend several weeks saving up enough money to pay for their STI tests. In Ireland individuals whose income falls below a certain level can apply for 'medical cards', which entitle them to free healthcare at their local GP practices. Respondents from poorer backgrounds who Page 6 of 10 (page number not for citation purposes)