In what seems to be a post-COVID era, it’s no big deal to talk about ‘testing’ when your symptoms are similar to that of the flu. But what about STD testing? How often are you actually asking your partner about their sexual history? How often are you getting tested? Let’s talk about it, and let’s talk about why it’s hard to talk about.

What are STDs? What are the rates of STDs in the Bay Area? 

STDs or Sexually Transmitted Diseases are infections that are spread through sexual contact. There are dozens of STDs, and they are caused by a wide range of bacteria, viruses, and parasites. They can also be transmitted nonsexually such as through mother to child via the placenta, or breastmilk. Or, even through the sharing of needles or blood transfusions. Some of the most talked about STDs, HIV, Gonorrhea, Syphilis, and Chlamydia, is where the bulk of STD research is centered around. CDC surveillance data published in 2020 reports that STD rates are generally climbing since 2016, even in the face of the COVID-19 pandemic. Their study showed that Chlamydia cases went down by 1.2% (which the CDC attributes to the closing down of many clinics during the pandemic and not necessarily due to a decline in infection rate.) Gonorrhea cases went up by 45% since 2016. Syphilis h is up by 52% since 2016, and congenital Syphilis cases (which are spread from mother to child) are up 235% since 2016, with a total prevalence of 2148 cases in 2020. 

So, what is stigma, and what does it have to do with STD testing?

Stigma is any discrimination against a group of people, nation, or place. It is talked about extensively by sociologist Erving Goffman, who identified three main types of stigma: 1) that which surrounds mental health illness, 2) physical deformation, and 3) self-identity with relation to race, sexual-orientation, gender, ethnicity, religion, etc.  It can manifest in many different ways, but throughout this article we can think about stigma as the negative ideas people have about STDs and their association with communities of color, sex workers, and the queer community.

Stigma is dangerous from a public health standpoint because not only does it target specific populations who already struggle with higher burdens of mental illness and disease, like the BIPOC and LGBTQ+ community, but it also contributes to a larger culture against sexual health maintenance.

 A 2015 study found that PrEP is associated with ideas of sexually ‘risky’ behavior that is often stigmatized through the use of negative language like “Truvada whore.” The study found that these stigmas were actually undermining the effectiveness of the preventive drug. In a study conducted regarding a group of MSM, of which 80% qualified for PrEP use, 78% didn’t think they needed PrEP. Stigma around sexual behavior, sexual pleasure, and sex within the queer community is dangerous from a public health standpoint, because it keeps people from seeking preventive care.

Stigma also keeps people from getting tested. In a different study focusing on the relationship between HIV testing and stigma from family, anticipated healthcare stigma, and general social stigma, there was a “significant positive relationship between stigma from family and being tested for HIV” and that “site-level HIV-specific criminalization laws were associated with an approximate 5% reduction in the prevalence of receiving any HIV test.” This evidence further suggests that stigma from those closest to us have the greatest impact on testing, and that societal stigma from policies that require self-disclosure are linked to a reduction of testing too. This is quite dangerous on a larger level because without testing early detection and treatment can’t occur. With higher levels of stigma in communities of color and LGBTQ+ communities, there is a higher risk of hospitalizåtion and death from STIs, even though most cases can be treated with drugs.

Stephen Hinshaw, Distinguished Professor of Psychology at the University of California, describes how there might be “a fairly ‘automatic revulsion’ towards individuals or groups we fear could be contagious,” as part of our innate human desire to “stay healthy.” Wanting to be healthy isn’t wrong, but the issue of stigma comes into play when the people who are getting sick are perceived to be fundamentally different from the healthy population. For STDs, because the burden is unequally distributed among LGBTQ+ communities and communities of color, stigma is especially harsh. This type of thinking has led to the punishment of many minority groups through the avenue of public health mandates, for example the HIV disclosure laws previously mentioned. “Such extreme outsiders may well be less than human – so we denigrate them as animals, as vermin – in order to eliminate them,” says Dr. Hinshaw. “The ‘secret’ is to promote the scientifically accurate and humanizing view that people vary in their risk for various medical and mental conditions… thus, reducing intrinsic blame… but that recovery is possible with disclosure, assessment, and treatment… thus, emphasizing responsibility as well.” 

This stigma is dangerous no matter who you are, and no matter what your risk for STDs is. Stay safe and get tested today!