Fear is one barrier that keeps some young men from racial and sexual minority groups from getting proper sexual health care.

A study in the Journal of Adolescent Health used information from several dozen black and Hispanic guys between 15 and 24 years old to determine their own perceptions of factors that work for or against their reproductive health care. Of the young men in the study, 16 percent were gay or bisexual. The researchers from Johns Hopkins University School of Medicine found that some young men reported concern about the stigma of being seen at certain clinics, like those where health care professionals test for sexually transmitted diseases. They said that was something that could keep them from getting adequate care for their sexual and reproductive health. They also expressed concerns about long wait times at clinics, privacy issues, and the cost of care.

Read: What Men Don't Know About Their Own Fertility

There were also disparities among the group in terms of what they thought their needs were. Johns Hopkins said in a statement that to prevent or treat STDs, some in the group relied purely on condoms while others got tested based on their own assessment of whether they had engaged in risky behavior. “Many said that in the absence of physical symptoms, they saw no reason to seek care or they feared results of a positive test for an STI.”

That could be important because the Centers for Disease Control and Prevention recently reported that sexually transmitted diseases like syphilis, chlamydia and gonorrhea — all of which can be cured with antibiotics — are spreading more than ever. Gay and bisexual men and young people were particularly affected by the infection increases.

Dr. Arik Marcell, a professor of pediatrics at Johns Hopkins and the paper’s first author, said in the statement that it shows “no one particular factor is responsible for young men’s lack of engagement” in getting sexual and reproductive health care. “We need to think about working at multiple levels to effect change rather than focusing solely on the individual level, which may place undue blame on the individual.”

Study results show that the young men surveyed talk to people in their lives, like their mothers and friends, about their health but didn’t always know where to go for care. Self-consciousness also played a role in their care: “Some participants also discussed needing greater self-confidence when asking and answering questions about their health in general, especially about their sexual health,” the university said.

Read: STDs Are Spreading Faster Than Ever

The authors suggest that a lack of knowledge or health care could have a gender basis: According to the study, the culture around health care in the U.S. is “focused on women’s health” and males are influenced by “traditional masculinity scripts.”

“Few men also have received sexual and reproductive care because historically, few clinical guidelines have outlined care that providers should deliver to this population, and few public health efforts have focused on engaging this population,” Johns Hopkins said.

Care is not the only way men lag behind women when it comes to sexual and reproductive health. Another recent study showed that men don’t know a lot about their own fertility. A survey of hundreds of Canadian men found they were generally not aware of many of the factors that could reduce their sperm counts. And the authors of that study suggested one of the reasons could be that men are not are likely as women to ask questions about their own health.

Although the new study shows men have less knowledge and receive less care than women when it comes to their sexual health, some are getting a level of care. According to Johns Hopkins, about half of the men they surveyed had health insurance and a regular source of health care, and a majority had received a physical exam in the last year. Additionally, 35 of the 70 were tested for HIV.

Source: Marcell AV, Morgan AR, Sanders R, et al. The Socioecology of Sexual and Reproductive Health Care Use Among Young Urban Minority Males. Journal of Adolescent Health. 2017.

See also:

Syphilis in the Male Body

What Gonorrhea Looks Like in Men