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Pictured Above: Teen Girl. From https://teenpregnancy.acf.hhs.gov/resources/story-survival-adolescent-pregnancy-prevention-runaway-and-homeless-youth

Stigma and disease have always gone hand in hand, with some diseases more stigmatized than others. Over the millennia, people living with diseases ranging from leprosy to AIDS have been burdened by moral judgments, while people with conditions like common colds or Alzheimer’s disease are seen as randomly — and innocently — afflicted.

Even the most “sex-positive” among us might find ourselves inadvertently stigmatizing others.

These days, stigma swirls around the novel coronavirus that causes COVID-19, arising from the fear and anxiety that has recently gripped the world. As reports of hate crimes against people of Asian descent show, some people are confusing vigilance about protecting public health with excuses to lash out at certain populations. This stigma can also show itself in seemingly benign comments, like apologizing for coughing and promising that it’s “only allergies” — which I have seen happen even in conversations taking place in “virtual spaces” like Zoom or Skype, where disease transmission wouldn’t have been possible. The idea is that a COVID-19 infection is shameful, while allergies are socially acceptable.

Probably no set of diseases is more stigmatized than sexually transmitted diseases (STDs) — despite the fact that they’re also some of the most common infections across the spectrum of humanity. In fact, we’re in the midst of an STD epidemic, with tens of millions of cases every year in this country alone. Gynecologist Jen Gunter writes about how an STD diagnosis, like no other disease save cancer, has the unique power to bring a patient to tears. A common STD like herpes or genital warts can make someone feel like “damaged goods.” But clearly it’s not the virus itself that makes someone “damaged goods” — it’s the way it was transmitted. For proof, look at the way people react to infections caused by genetically related viruses, such as the herpesvirus that causes chickenpox or the strains of HPV that cause warts on someone’s fingers or toes.

Using Stigma to Punish

Even the most “sex-positive” among us might find ourselves inadvertently stigmatizing others when we talk about having a “clean” STD test or make people with herpes the butt of a joke. When we do that, we participate in a system that frames STDs as just punishments for engaging in the “wrong” kinds of sexual activities.

The view of STDs as punishment can be seen throughout history. Last century, debates raged over whether to help soldiers prevent STDs or if it was better that they suffered the consequences of unprotected sex so they’d learn their lessons. Later that century, when reliable birth control became available in the form of hormonal contraception, people fretted that women would be able to have sex whenever they wanted without the consequences that were deemed necessary to keep them in line. Does that way of thinking sound antiquated? You can still see it today in debates over needle exchanges or PrEP to prevent HIV transmission, or the HPV vaccine to prevent cervical cancer.

When we separate people into the “guilty” and the “innocent” — say, by shaming someone with chlamydia while not batting an eye at someone with a urinary tract infection, even though both are cured with antibiotics — we stigmatize people with health conditions and add to their suffering.

The Flip Side of “Clean”

Stigma can rear its head in even the most innocently uttered phrases, like “She looked clean” and “Don’t worry, I’m clean” to describe people who are perceived to be or who claim to be free of STDs. Calling someone “clean” doesn’t seem like a damning accusation, but the flip side to “clean” is “dirty.” The unspoken implication of “I tested clean” is that someone with herpes, genital warts, HIV, or any other STD is dirty.

This language is just an extension of the “purity” language that pervades so many conversations around sex. Many abstinence-until-marriage sex education programs, for example, employ purity language to promote the concept that sex is only appropriate within a heterosexual marriage. Upholding this concept of purity requires the implicit accusation that anyone who has had sexual contact outside of marriage is tainted in some way. Elizabeth Smart, who was kidnapped at the age of 14 and held captive for nine months, explained the consequences of promoting “purity” in the most heartbreaking terms:

“I remember in school, I had a teacher who was talking about abstinence. She said, ‘Imagine you’re a stick of gum. When you engage in sex, that’s like getting chewed. And if you do that lots of times, you’re going to become an old piece of gum, and who is going to want you after that?’ I thought, ‘I’m that chewed-up piece of gum.’ Nobody re-chews a piece of gum. You throw it away. And that’s how easy it is to feel you no longer have worth. Your life no longer has value.”

That stigma doesn’t only harm survivors of assault — it harms everyone. With all the stigma that surrounds STD status, it can be difficult to ask a partner to use a condom or dental dam, since we might worry our partners will think we don’t trust them or are underhandedly questioning their “cleanliness.” These sorts of fears can cloud our judgment when it comes to protecting our health, and turn potentially healthy conversations about safer sex into awkward dialogues fraught with accusations and defensiveness.

Can Language Fight Stigma?

Paying attention to language usage, like removing “clean” from your STD vocabulary, is a good first step. Further attempts to destigmatize STDs can be found in shifting terminology. For example, many health care professionals, sexual health advocates, and others believe the term “sexually transmitted disease” is itself stigmatizing and push for a shift to “sexually transmitted infection,” believing that infections are less stigmatized than diseases — and that people will be more likely to get tested for “infections” than they would for “diseases.”

There’s some evidence for the idea that “STI” is less stigmatizing than “STD.” A couple of researchers found that college students were more likely to react negatively to the idea of STDs than to STIs. Nearly 11% described STDs with terms like “gross,” “scary,” or “embarrassing,” compared to nearly 5% of respondents describing STIs — a small but interesting difference. It’s not known, however, if the widespread adoption of “STI” would actually motivate more people to be tested and seek treatment for symptoms.

As Dr. Gunter says, “shame and stigma are effective weapons of control that have been used throughout history to marginalize women, people of color and the LGBTQ+ community.” We can do our small part to strip this stigma of its sting by practicing non-judgement and refraining from language like “clean” when discussing STD status.

You can learn more about STDs, and receive testing and treatment, from a health care provider at a Planned Parenthood health center.

Tags: herpes, HPV, genital warts, HIV, sexually transmitted infections, Prep, STI, sexual health, STD Awareness, stigma, covid19, clean, taboo

About Anna C. 

Anna first volunteered for Planned Parenthood as a high school student in the 1990s. Since then, she has received a bachelor’s degree from UC Berkeley and a master's degree in epidemiology from the University of Arizona. As an ode to her fascination with microbes, she writes the monthly STD Awareness series, as well as other pieces focusing on health and medicine.