In Bruce Link and Jo Phelan’s article, “On Stigma and Its Public Health Implications,” they describe the ways in which stigma negatively impacts multiple public health outcomes. Here are a few of the effects:
- The stress of belonging to a stigmatized group can worsen a health condition
- People with stigmatized conditions may delay seeking treatment,not comply with treatment recommendations, or avoid treatment altogether. (e.g. “I’m not one of those people, I don’t actually need to see a doctor”)
- Stigma can create an environment that feels hostile even when the goal is for someone to seek help there (who wants to go somewhere they feel pathologized or like they might be locked away?)
- Stigmatized conditions may receive less research funding over time, especially if it’s difficult for people to disentangle attributed moral causes from actual causes of a disorder or condition
When the stigmatized condition in question is having an STI, this issue becomes especially sticky, thanks to the longstanding moral implications of acquiring a sexually-transmitted disease. As I’ve discussed regarding syphilis, the moral taint of the disease was a major factor in cultural innovations meant to disguise and deal with it. People went out of their way to hide their shame in any way they could. And unfortunately, public thought about STIs doesn’t seem to have changed much.
Sex educator Charlie Glickman points out that sexual shame is a public health issue, due to insights in the sex ed community about how a sense of self-worth has been linked to “how much people engage in risk-reduction and harm-reduction behaviors.” Since shame and stigma are related phenomena, and since people are often shamed for contracting an STI, it’s worth considering how our public dialogue around STIs influences people’s decision-making processes.
We know that half of all people will have an STI at some point in their lifetime. Further, one in four teenagers will contract an STI – and most STIs have fairly minor consequences if they are treated quickly. However, the polarized way in which sex ed is taught in U.S. classrooms (when it’s taught at all) means that these important public health points are often eclipsed.
Dr. Nancy Kendall summarizes the problems with taking a shame- or fear-based approach to STIs in her ethnographic study of American sex ed, The Sex Education Debates:
The framing of STIs as horrifying diseases resonates deeply for many people around the world. For centuries, STIs have been fearful killers, and even today the effects of some STIs are long lasting and life changing. However, adopting a fear-based approach means that teachers and curricula cannot emphasize there important points: first, that the vast majority of people will have an STI during their lifetime; second, that most of the STIs contributing to high teen STI rates are not only fully treatable, they have no significant health consequences if treated in a timely manner; and third, that stigmatizing STIs and those who have them makes it harder for people to quickly and easily receive preventative care or treatment for STIs (133, italics in original).
This is huge. We could be teaching about STIs in a way that helps the 1/4 of teens affected by STIs to more easily seek treatment that prevents them from, say, later experiencing infertility. Or contributing to the spread of completely preventable and treatable infections (not to mention the ones that are lifelong or likely to cause damage). Or experiencing social stigma. Or simply having genital pain or discomfort. No gain is too small to overlook, in my opinion.
But wait: according to a recent poll, 68% of teenagers said they weren’t using sexual protection because they were worried their parents would find out. So it’s not just a formal sex education issue that can be tackled institutionally; it’s also a part of family culture and dynamics that we need to change.
As Dr. Kendall writes: “from a public health perspective, fear-based approaches that do not emphasize prevention and treatment and that do not address the negative consequences of stigmatizing people with STIs are likely to be less effective and to have unintended negative consequences” (133).
Not only are fear-based approaches unhelpful from a public health standpoint as discussed above, they also don’t bloody work! So why are we doing this to our kids? The sociology and public health research all clearly points to reducing stigma as a major strategy in terms of bettering public health around STI treatment. In my mind this illustrates just how much of a moral issue sex (and by extension STIs) is, and how we must continue to make an evidence-based case for the importance of sex education.