We live in an increasingly sex-positive society with frank discussions around things like sexuality, contraception and pleasure. But this openness isn’t universal, nor has it extended to sexually transmitted infections (STIs) — the range of viruses, bacteria and parasites transmitted through sexual contact. The expression, experience and anticipation of STI stigma can impact a person’s physical and mental wellbeing, influencing whether they’ll get tested, take treatment and notify their sexual partners to prevent further spreading1.
State of play
About 16% of Australians — roughly four million people — report having an STI at some point in their lifetime2. Despite enormous developments in detecting and treating STIs, their prevalence has mostly worsened in recent years. With the exceptions of hepatitis and HIV, Australia's most common STIs are on the rise — particularly in Aboriginal and Torres Strait Islander people, men who have sex with men (MSM), and young people. In 2017, males accounted for more than half (56%) of all new STI cases and in over a decade their rate of chlamydia has doubled, gonorrhoea has increased four-fold and syphilis three-fold3.
Health-related stigma is when a person or a group is viewed in a negative way because of a condition and the socially undesirable attributes attached to it. STI stigma stems from society’s beliefs around sex and sexuality that view STIs as signs of irresponsible sexual behaviour.
From a young age, we’re directly and indirectly taught to feel embarrassed, ashamed, judged or condemned for a positive STI result, through education, media, family, peers and health care.
“The messaging about STIs, and sex in general, tends towards the negative — do X and Y will happen, and you don’t want that — so from a young age we are told that STIs are bad, and as a default, so are the people who get them,” psychosexual therapist Christopher Brett-Renes says. “We are also taught that STIs are connected with particular sexual behaviours, so again, if someone has contracted an STI, it is seen through this lens of behaviour that is deemed as not acceptable, and this can have a knock-on effect later in life.”
While most Australians (63%) say they would never behave negatively towards other people because of STIs, they were much more likely to expect that they would experience stigma or discrimination themselves if they were ever to have an STI4. Only 12% believed they would never experience stigma, 62% believed they would at least ‘sometimes’ experience stigma or discrimination and 19% believed this would happen ‘often’ or ‘always’ be the case.
Stigma can prevent people from attending health services to discuss their risk of STI, requesting an STI test or being offered a test, taking STI medication, seeking support from their family, friends and health care providers and notifying their sexual partners5. If left untreated, these infections can have serious consequences for long-term health.
Although it’s important to take protective measures to prevent STIs by discussing your status with sexual partners, getting regularly tested and using barrier methods like condoms, getting an STI isn’t a moral failing. STIs can infect people regardless of gender, sexual orientation, race or religion; whether you’ve had sex once or a thousand times.
“STI stigma creates the ‘it won’t happen to me’ fallacy and perpetuates the negative stereotypes that people have of a person with an STI,” Christopher says. “This can affect a person getting tested because they don’t believe that they would ever get an STI — but news flash, STIs don’t discriminate, and some can be asymptomatic.”
STI stigma can also have a significant impact on how a person deals with a diagnosis.
“Even though many STIs are treatable, and others like HIV are very manageable, the diagnosis can trigger a significant psychological reaction, including extreme levels of distress and even suicidal ideation in some instances,” Christopher says.
Genital herpes (herpes simplex virus type 2 or HSV-2) is especially stigmatised and misunderstood.
“People come in very distressed, worried that they will never have sex or a relationship again, and people have also ended relationships because their partner has herpes, saying that they don’t want to take the risk of becoming infected themselves,” Christopher says. “However, herpes is incredibly common and quite manageable.”
It also impacts the psychological health, self-esteem and physical health of stigmatised groups, regardless of diagnosis. Stigma and discrimination continue to be reported among LGBTIQ+ populations, sex workers, people with HIV, people who inject drugs, Aboriginal and Torres Strait Islander people and culturally and linguistically diverse populations6.
Shutting down shame
More research is needed to find the best strategies to address STI stigma, but normalising discussions around sexual health and improving sex education is a good start. Overall, there’s a critical need to improve the knowledge and awareness of STIs among priority populations, health professionals and the wider community. Understanding that STIs are common, can affect anyone, they’re easily treatable or manageable and do not determine your character, can help change how we perceive them.
1 The Kirby Institute. (2017). Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: Annual Surveillance Report 2017. University of New South Wales: Sydney.
3 Kirby Institute. (2018) HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2018. Sydney: Kirby Institute, UNSW Sydney
4 Adam, P.C.G., de Wit, J.B.F., Ketsuwan, I., Treloar, C. (in press). (2017) Sexual health-related knowledge, attitudes and practices of young people in Australia. Results from the 2017 Debrief survey. Sydney: Centre for Social Research in Health, UNSW Sydney
5 Hood, J. E., & Friedman, A. L. (2011). Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections. Sexual Health, 2, 159.
6 Australian Government Department of Health. (2018) Fourth National Sexually Transmissible Infections Strategy 2018 - 2022