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STIs – Stigmatized and On the Rise

By Emma Smith (she, her, hers), intern, Mabel Wadsworth Center

Why are sexually transmitted infections (STIs) a topic of avoidance? What makes them stigmatized – giving them a negative connotation? When should we be concerned about them? Why do they seem scary? 

The Centers for Disease Control and Prevention released a report in 2018 with U.S. statistics showing that cases of some STIs were increasing in their report regularity. 

With a lack of clinical studies on the ways STIs get spread, it isn’t clear what factors are contributing to this rise more than others. 

This absence of clinical study and engagement on ways STIs spread is a deficit in the U.S. education and healthcare system, which has been legislatively designed to result in a lack of evidence-based education on sexual health and thus inadequate public understanding.

Regardless if people are having more sex or not, or more partners – we as a culture remain stuck in a past of sex stigma, which shames people for the sex they have and is stigmatizing for what is preventable, and incredibly common in the U.S. today. 

The stigma around STIs has amplified in the U.S. since legislators created funding for abstinence-only education, beginning in 1996 and still in effect, using tax-payer dollars today. Legislatively designed to teach based on the main tenet that the only way to stay truly safe, happy, and in fulfilling relationships(or critically, a relationship), is to abstain from sex until marriage. This education targets kids between the ages of 12-18. In an education system like this, there is barely any room to discuss the implications of sex, in some cases at all. This is meant to be intimidating – thus maintaining a cultural stigma for the sake of conservatism. 

With this lack of education and discussion about STIs, it’s no wonder that people avoid getting tested and are unaware that they even should be getting tested. The purposeful avoidance of evidence-based sexual education in the U.S. reflects our deeply rooted societal discomfort with addressing sex at all, especially with emerging adults, and this has serious implications for the state of everyone’s health, relationships and livelihoods. Through the continued withholding of information, misconceptions and fear surrounding STIs have grown – holding people hostage from opening up and honestly assessing their health. This culture is cruel. 

STIs are packed with stigma in our culture today – for example, there is a connotation of being ‘clean’ when one doesn’t have STIs and being ‘dirty’ if one does. This clean/dirty connotation sums up the way many people think about STIs, and by associating having these infections with being ‘dirty’ we are furthering the stigma through shame, and this only does harm. 

To protect ourselves and others from the spread of STIs, and to work to reduce their stigma, are the same goal. Honest communication with one’s partner(s) and healthcare provider(s) is a necessary step for this goal; talking about the types of sex you have, the frequency of new partners, and whether or not you’ve had unprotected (without barriers) sex or shared needle use are all important topics your partner(s) and healthcare provider(s) should be aware of to properly assess risk. 

These essential conversations must be coupled with STI testing, because most STIs are usually asymptomatic, meaning they’ll often show no physical signs of infection but can remain contagious and can be harmful if left untreated. The suggested regularity of STI testing is different for different people; if you frequently (subjective, I know) engage in casual sex you should have STI screens fairly often, with the urge to screen always being after unprotected sex, and not just the penis-vagina type either – this goes for all sex involving each partners’ fluid contact. If you don’t have multiple partners, if you’ve had one or two, it’s still important to get tested for these reasons – because STIs can happen to anyone, regardless of the regularity of sex. 

Honesty with providers is crucial for them to properly be able to assess your risk of infection and transmission. STI screenings are not cut and dry – they are fitted for the patient, for example,  many screenings will not include a herpes test unless the patient expresses concern for exposure to herpes. This is because providers avoid testing for herpes because false positives are fairly common, and if one does test positive for herpes but is asymptomatic, the health and transmission concerns are often so minimal that the patient can go without knowing. 

But honest conversations with partners and providers, and STI testing, can only go so far if people are not taking steps for harm reduction during sex. Harm reduction looks different for different people and circumstances – sometimes harm reduction is using a barrier like a condom or dental dam, and sometimes harm reduction means abstaining from more high-risk sexual acts, for example, sex involving fluid contact. 

Condoms, dental dams, and gloves are all the best barrier options for safer sex – but still yet can’t provide complete protection against infection, especially with common STIs like HPV and the herpes virus, which get spread through skin contact and not fluid contact, like other STIs. 

However we find ourselves talking about STIs; whether it’s prefacing sex, in a clinical setting, or in ordinary discussion – there can not be effective conversations about preventing the spread of STIs if we do not abstain from stigmatizing language. This means, in short, being kind, and mainly working to not use(to others and internally) language that connotes STIs with being ‘dirty’ or shameful. If you get or have an STI(s), it’s absolutely not the end of the world – or your sex life. Preventative measures and treatments can be provided for the continuance of a fulfilling and pleasurable sex life. Be kind to yourself, remember STIs are as easy to catch, and as common, as the flu.