April is STD/STI Awareness Month. Look for more stories covering this topic in other issues of the Weekender this month.
Let’s talk about sex. It’s fun, it’s natural.
Now, considering that April is STD/STI Awareness Month, let’s take it one step further and talk about sexually transmitted diseases and infections, or STDs/STIs.
They’re not so fun and not “natural,” per se, but they can and do happen to many people. In fact, according to the American Sexual Health Association, or ASHA, “one in two sexually active persons will contract an STD/STI by age 25” and “more than half of all people will have an STD/STI at some point in their lifetime.”
Yet for the most part, society hasn’t entirely accepted the reality of STIs. Instead, mainstream conversations about STIs rely on seeing them as punchline. This quote from “The Hangover” is a good example: “Remember what happens in Vegas stays in Vegas. Except for herpes. That shit’ll come back with you.”
If STIs aren’t portrayed as comical, then they’re seen as shameful.
“Some people believe that having an STI is horrible and people who have them are bad,” explained John Baldwin, UC Santa Barbara sociology professor and co-author of “Discovering Human Sexuality.”
In other words, there is a stigma associated with STIs.
“It’s not a death sentence.”
– Reyna Perez
Reyna Perez, the clinic lead for UC Berkeley’s Sexual Health Education Program, or SHEP, defined STI stigma as “shame with oneself (about) having an STI or amongst other people.”
“(They think) they’re ‘dirty’ or (use similarly) negative terms,” Perez said.
She went on to explain that campus students often think contracting an STI is the end of their sex lives and lives in general. But this is not true.
“It’s not a death sentence,” Perez said. “Most of them are curable or at least treatable.”
Despite the prevalence of STIs, people don’t know much about them. This lack of understanding reinforces the misconceptions surrounding them.
To help resolve this issue of ignorance, Baldwin first shed light on the difference between STDs and STIs.
“STD is the common language that a lot of people use and (the Centers for Disease Control and Prevention, or the CDC) uses because it communicates with large numbers of people, but medical doctors sometimes like to use ‘STI,’ ” Baldwin explained.
According to Baldwin, the term “STI” is more inclusive because it also considers people who don’t have symptoms but are infected and could infect others.
It’s true: People can be asymptomatic and transmit STIs to their partners.
“Large numbers of Americans have HIV and no symptoms and have sex with lots of others and infect others,” Baldwin said.
Additionally, sexual intercourse isn’t the only method by which STIs can be transmitted, a fact that more people should be aware of. There are many ways in which STIs can be spread, but they often go unnoticed.
According to Perez, “(People) don’t realize how you can contract them and there’s a gap in knowledge.”
Perez said STIs can be transmitted through oral sex or, in rare instances, fingering, which many people are unaware of. She also pointed out that HIV can be spread through non-sexual bodily fluids such as blood and breastmilk.
STIs can also be transmitted by something as simple as skin contact — Elizabeth Wells, lead and co-facilitator of the Sex 101 DeCal, said genital warts and herpes can be spread this way.
Even when it comes to sexual intercourse, the way by which most people believe STIs are spread, people don’t always take preventative measures.
“It’s not like everyone is consistently using condoms or barrier methods,” Perez said.
Another notable fact is that some STIs aren’t even viewed as STIs at all. For instance, cold sores on the mouth region are a form of herpes.
“They don’t realize it until someone brings it up to them,” Perez said. “Once you attach the title of ‘STI,’ suddenly it becomes something to be ashamed of. But it shouldn’t be that way.”
When the facts are laid out like this, it becomes apparent that there’s no reason to make STIs something to feel ashamed about. Many people contract them at some point, and although there are preventative measures such as condoms and other barrier methods, there are many possible avenues through which people can get them.
“Shit happens,” Wells said. “Who are we as individuals and society and people who are sex positive to vilify people that made decisions in the heat of the moment, or it just happens (that) the condom breaks?”
Yet the stigma surrounding STIs persists, largely because of the long societal tradition of suppressing discussions surrounding sex as a whole.
Baldwin expressed his belief that the stigma stems from the Judeo-Christian tradition. Judeo-Christian culture has been a prominent force that has shaped society’s views for hundreds of years. It frowns upon sexual activity, and looking down on STIs — perceived to be spread through sexual means alone — is part and parcel of that general disapproval.
“Society doesn’t evolve very fast in terms of thinking that I think you still see that mindset permeating today,” Wells said. “(STI stigma) is rooted in this idea that we’re not going to be talking about sex.”
Delving even deeper into the issue of STI stigma shows that it is further problematic because it is linked to racism.
According to a 2015 report by the CDC, STIs are more prevalent among certain racial or ethnic minorities than they are among white people. Being part of a racial or ethnic minority group also entails a plethora of issues that make it generally more difficult to find and receive appropriate sexual health services.
“It’s largely an issue of access, and you’re seeing a lack of comprehensive sexual education in those areas,” Wells said.
To vilify someone for getting an STI when they don’t even have the resources to know how to prevent them is to vilify them for not having access to sexual health resources. It is to vilify them for structural inequalities in access to education — inequalities which they did not ask for and cannot control.
“Being part of a racial or ethnic minority group also entails a plethora of issues that make it generally more difficult to find and receive appropriate sexual health services.”
Not only is it problematic to treat STIs as a taboo subject when this attitude stems from sexually repressive and prejudiced notions, but STI stigma also is harmful because it inhibits people from seeking medical treatment.
“If someone has an STI, we shouldn’t stigmatize them,” Baldwin explained. “We should try to help them get the best medicine and treatment.”
STI stigma also causes “intense emotional distress,” according to Perez.
“It’s so difficult to start support groups at the Tang Center because there’s stigma,” Perez said.
Considering all these facts and issues, the obvious final question is, “How do we get rid of the stigma surrounding STIs?”
One key component is awareness.
Awareness that people with STIs can and do lead normal lives helps. Modern science has allowed for medication that can either cure or treat STIs.
“It’s a world changer,” Perez said.
When engaging in sexual activity during an outbreak, there is also world of possibilities.
“There are creative ways to have sex while having an outbreak,” Perez explained.
She expanded upon this statement to say that, for instance, partners could use strap-on dildos when the involved parties are having a herpes recurrence.
“I believe that we are moving away from the preceding era of ignorance and successfully moving to have more scientific knowledge of STIs and their treatment so that more people are, in fact, getting good care,” Baldwin said. “Our society is moving in the right direction.”
“The need for action if you are diagnosed with an STI is further reason to destigmatize STIs –– so people can recognize the symptoms and be unafraid to seek help.”
To promote awareness, according to Perez, the Tang Center and SHEP offer programs for people who are curious to find out more about STIs as well as for people who have already been diagnosed with an STI who desire health coaching and/or emotional and mental support.
Awareness includes being conscious of preventative measures.
“Just being aware of sexual health resources (is) also really important,” Wells said. “A lot of people don’t know about it because it’s not talked about, because sex isn’t talked about.”
Wells explained that, for instance, people can take pre-exposure prophylaxis, or PrEP, before having sex with someone who has HIV or AIDS. This will lower the chance that the partner without HIV/AIDS will also get the infection. Similarly, taking post-exposure prophylaxis, or PEP, after sex with someone who has HIV/AIDS will help prevent transmission of the disease.
Although STIs aren’t the end of the world, if left undiagnosed or untreated, they can become serious health risks. The need for action if you are diagnosed with an STI is further reason to destigmatize STIs –– so people can recognize the symptoms and be unafraid to seek help.
According to Wells, on the last Friday of every month, the Tang Center offers free STI tests that take approximately 20 minutes. She clarified that there is, however, a six-month period after the initial infection in which the tests might not detect its presence.
Another key factor to destigmatizing STIs is simply talking about them. To emphasize this point, Wells quoted a SHEP saying: “Communication is lubrication.”
In other words, people need to start talking about STIs so that it will become acceptable to talk about them as well as to prevent them.
“It shouldn’t be uncomfortable for people because the way I see it, it’s mutual respect within relationships,” Perez explained. “I’m respecting my partner and getting myself tested and taking preventative measures, and my partner should respect me back by also being open to talking about STIs and … getting tested and (taking) those preventative measures as well.”
The way in which the discussion around STIs is being framed is also something to consider. For instance, discerning between STDs and STIs is important. Likewise, it’s crucial not to define people by their STIs.
“We don’t even like to use the word ‘HIV-positive,’ ” Perez said. “We like to use the phrase ‘a person living with HIV’ because they’re a person first before their STI.”
Awareness and communication aimed at undoing the stigma around STIs are imperative for the sake of public health but also for the sake of true sex positivity.