As discussed in the previous section, a tangible link between the health promotion message and football performance was felt to be important. This immediately created a problem for delivering sexual health promotion in the clubs. No immediate or obvious connection between being free of sexually transmitted infections and performance on the pitch could be seen by participants.
P “…on the whole, Chlamydia and football don’t really seem to really overlap. So that could be seen as a slightly strange message to be receiving...”
Participant 014
Furthermore, discussing sexual health and promoting safer sex was viewed by some as completely polar to the very behaviours which these men already exhibited and wanted to demonstrate to their peers. Being one of lads requires a certain ambivalence to these issues. To appear too concerned with good sexual health does not fit in with ideals of hegemonic masculinity.
P “…on an afternoon playing football you wanna talk about women, football and beer, not about sexual health to be honest.”
Participant 007
In spite of this, rather counterintuitively, many participants did not seem to be concerned that there was no obvious link between sexual health and performance.
Instead, it was enough for some men to see that there might be other benefits of targeting young men at football clubs who were probably sexually active. As with general health promotion, some of these benefits were about reducing the time taken to seek out information from other sources - the internet or specialists for example. For others, although it was felt that men liked to feel they appeared knowledgable about sex, many felt they lacked important knowledge and would
personally benefit from receiving more information. As discussed in Chapter 5, men were already discussing sex with each other at the clubs. Therefore, as one participant put it, introducing sexual health promotion would not be “completely left field” [Participant 013].
J “And do you think that’s (the football club) a good place to have access to that kind of service (STI testing kits)”
P “…,I’d say, yeah, ‘cos you’ve got a lot of lads who would go out on a Saturday night and, do you know what I mean, pull a lady. So it makes sense for it to be there, do you know what I mean?… So it makes textbook sense for that to be brought to the attention at the one place where every lad is on a Saturday before going out.”
Participant 012
Men’s previous experiences of testing for STIs was variable, with some men never having had a test whilst others had received previous STI diagnoses. Many factors had an impact on their reluctance to test. Testing for STIs, even curable ones, could be a frightening experience for men, especially when considering the possibility of receiving an unfavourable diagnosis. For these men, avoiding a test meant avoiding being labeled as sick, even when they knew that they may have an undiagnosed asymptomatic infection.
P “I don’t bother to search for it because I think I’m okay, like everybody does. Another thing is you are always afraid of the result so you tend to think, I’m okay, I don’t want to know. It’s stupid, but you tend not to go because you are afraid of the results.”
Participant 018
Therefore, unless men felt that something was wrong, they would not actively seek out health information or help. It was not the case that men feel their sexual health was unimportant, rather that to pursue a test when they lacked symptoms required several significant barriers to be overcome. As seen in the results of the stratified random probability sample survey (Chapter 4), being offered a test is acceptable. It is the act of seeking the test out that puts men off. For some men this was about being seen by other people at a clinic. For others it was the requirement to talk to a stranger about their sex lives and to have an intimate examination.
P “Actually examining you. Everyone is different. Talking might be a bit awkward to some. I wouldn’t care about that. Just the examination part.”
J “So that might put people off going?”
P “Yeah. I’m sure that’s why the majority of people don’t get themselves checked, because they don’t want to get examined.”
Participant 017
Many other significant barriers existed for men. There was a considerable time cost attached to attending a clinic. Finding, traveling to and spending time at a clinic were all barriers to testing for men. Therefore, having an opportunity to test within the context of their daily routines and activities was popular. The idea of enjoyment and fun also factored into why men avoided clinics. They are not seen as places that men want to spend time.
P “…with men there’s a great deal of apathy about anything that’s not a big heap of fun to do outside their general busy lives. …It’s just quite low down on most bloke’s radars. I think most guys, beyond a misguided few, will admit that they should do it. It’s just you need to give them a much, much easier opportunity to do it…”
Participant 003
Some men highlighted that attending a clinic did have some positive aspects. The opportunity to speak to an expert in sexual health was especially valued as was the ability to be seen and treated if they had symptoms. However, as previously mentioned, there was less impetus to attend a clinic when asymptomatic. Clinics were also viewed as anonymous and discreet by some men. Therefore, for most men, the decision of whether or not to attend a clinic was made on a weighing up of the pros and cons - the barriers and motivators. Having symptoms was a strong motivator for men. If they felt unwell or feared something was wrong with their genitals then they would find the time to seek out help. This demonstrates that
diseased sexual organs, or being unwell and unable to perform daily expected duties, outweighs any threat from health seeking behaviours.
P “…from a personal point of view I wouldn’t really want to get tested unless I was ill almost. And I know that’s wrong but it’s kind of the way it is and kind of like, you know, to sweep something under the carpet almost.”
Participant 009
Therefore, having sexual health promotion delivered at the club was a useful way to gain information that men wouldn’t actively seek. For some men it also meant that potentially health could be discussed in an environment in which they felt at ease rather than having to navigate the barriers involved in going to see a doctor.
The club setting was seen as an environment which was familiar and
unthreatening, and fellow team mates were viewed, by some, as people that were trusted.
P “…as a team, as a club, you probably put your trust in them, so maybe you can be comfortable to speak with them about this. Yeah, you only need to give the chance to talk about it.”
Participant 011