We've become a lot more comfortable with uncomfortable conversations — topics like politics, mental health or even sexuality were once deemed taboo — but still draw a hard line when it comes to sexually transmitted infections. The question is: why?
While we seem to be living in an increasingly sex-positive society, we still have a hard time digesting the topic. STIs, like herpes and chlamydia, have come to function as punchlines or ways to diminish someone’s worth. They are so stigmatized that creating a conversation around them often causes the discourse to end before it truly begins.
Where does STI stigma come from?
This stigma around STIs stems from a combination of sociological and psychological factors that we absorb at a young age, which can make it hard to reverse.
“STI stigma first enters our psychology in a number of ways, and it depends upon the person and their environment,” Jenelle Marie Pierce, executive director of The STI Project, told TMRW. “Sometimes, stigma starts in adolescence and is taught by our family, our peers and/or our religion.”
Other times, Pierce said, it is something that we are taught. It can be an abstinence-based sex-ed class we took in high school, the countless pieces of media we consume or biased health care practices among other factors that teach us that a positive STI status is something of which we should be ashamed.
“Perhaps understanding sexual health as an aspect of overall health and seeing its connection to mental health would put this at ease,” Courtney Brame, founder of Something Positive for Positive People, told TMRW. “Discussions around our bodies, consent in relationships, conversations around consent and healthy boundaries with others can make this conversation a little easier to have.”
Why don’t we talk about it more?
Half of all new STI cases in the United States are young adults ages 15-24, according to the Centers for Disease Control and Prevention. Yet, there is still little knowledge about just how common STIs are.
A recent poll conducted by the Kaiser Family Foundation found that a large portion of the population is blind to the fact that over half of the people in the U.S. will become infected with a STI in their lifetime; only 13% were correct in this response. This finding pairs hand-in-hand with internalized STI stigma.
“Generally speaking, I think that most people remain ignorant about STI stigma until life shows them an ‘other’ or an exception,” Emily Depasse, sexologist and founder of SexELDucation, told TMRW. “Whether that other is ... facing a positive diagnosis (yourself), a friend who confides in you about their diagnosis or a sexual partner disclosing to you, we’re not engaged until we have to be, and that’s when the learning — or unlearning — begins.”
Depasse, who received her positive herpes diagnosis five years ago, said that she also believes that there is an unspoken hierarchy around STIs — it separates those with a positive status and those without — which perpetuates stigmas. It also feeds into the harmful belief that only a “certain kind of person” can receive a positive STI diagnosis.
Another reason STIs, such as herpes, are not often spoken about is because getting a diagnosis requires that people put in the work themselves, specifically when they are going to get tested — which already tends to be something most people are not comfortable speaking about.
Most panels that test for STIs do not include testing for HSV-1 or HSV-2, the two main types of the herpes simplex virus. So if someone does not intentionally ask to be tested for either type, they may never know that they are a carrier since herpes can present itself as an asymptomatic infection. Depasse said this lack of knowledge combined with the fact that young people tend to feel “invincible” makes an STI diagnosis seem distant and unlikely to happen to them.
So, how do we educate ourselves?
The first step is engaging in conversation.
“Proper sex education requires ongoing conversations and needs honesty,” said Brame, who received his positive HSV-2 diagnosis in 2012. “It requires consistent messaging from the education system, to home, to the community, to the media consumed in order for it to be what we collectively deem to be successful.”
If you’re looking to educate yourself, reading about symptoms and reports can also be a first step. But Pierce said it is important to note that even official health reports from institutes like the CDC can support stigmas through their language.
“Using language like ‘skyrocketing,’ ‘devastating,’ and ‘astronomical,’ for example, is fearmongering, and it only serves to further stigmatize STIs by extrapolating one component of a giant report without including thoughtful analysis, supportive resources or content that moves the conversation around STIs forward,” Pierce, who has been living with HSV-2 since she was 16-years-old, said.
The conversation requires speaking up and, as with most things, normalizing an experience by sharing it with others. These personal conversations might be the first step to reversing the stigma, Pierce said, but they're not the easiest to have, as sexual health is often a very private topic.
How would we begin to approach "reversing" stigma?
“It just starts with those of us impacted by it relaying our realities, because stigma thrives in our unwillingness to say, ‘Nah that ain't true’ and ‘Here's what happened for me and how I found out I had it,’” Brame said.
Conversations also need to take mental health into consideration. This is the primary reason behind Brame's founding of Something Positive for Positive People as a suicide-prevention resource for those navigating an STI diagnosis.
“I've spoken to more people with herpes who've attempted suicide than I've heard about in media for any other reason,” Brame said.
While outward-facing conversations are important to have, it is necessary to reckon with internalized beliefs, too. Depasse said this allows us to understand three things: “No one is immune to an STI, that STIs are more common than most people realize and that testing positive isn’t indicative of one’s character.”
While some STIs, such as HIV, have seen progress in destigmatization, other STIs have not seen that same progress. Brame points out that often the risk, fear and anxiety of being stigmatized can deter mobilization that could help reverse the stigma in years to come.
Moving forward there are still plenty of questions we need to ask in order to foster a conversation that is focused on providing the proper means of education to a culture that lacks an understanding of sexual health beyond the surface level.
It may require changing to a more personal scope in order to even begin engaging with the conversation around STIs. DePasse put it this way: “What if I told you that … one of your loved ones had herpes? Would you still tell that joke, or laugh at the joke your friend told? Would you seek to learn more? Even if you were fortunate to have a more comprehensive classroom, what conversations were missing? Who was left out? And how did you cope with those absences?”