Unpacking the Tote Filled with STI Stigma

fairies asks:

Heather Corinna replies:

Fairies question continued:

I dont think you or your boyfriend are dirty. I think youre people who have one of the most common infections in the world, an infection thats usually pretty harmless to most people, even though you feel ashamed about it right now and understandably upset, both about contracting the infection and about how your boyfriend has been reacting.

For most people, honestly, having herpes is pretty equivalent to having chronic acne: it can be painful with any outbreaks, but is mostly a cosmetic issue thats unlikely to impact your physical health, even though it can certainly can take a toll on your mental health and how you feel and can be treated by others socially. I also dont think you have been irresponsible. You both engaged in safer sex, including testing and latex barrier use, well and within the level of access you had from your healthcare services.

I want to make sure you know that illness, of any kind, is rarely about people being dirty. Even when you use the word clean here, that supports that idea. Its such a pity that language is so often used when people test/are negative for things, a term Id suggest you swap out clean for. People without certain infections or diseases arent automatically clean theyre just people who dont have certain infections and diseases, or who, in tests, have had negative results when tested for them. How clean or not someone is has nothing to do with this, just like how dirty someone is or isnt.

Sure, if we get a wound and dont tend to it properly, it will tend to get infected because of bacteria, and would have been less likely to if we cleaned the wound and kept it clean. As well, some kinds of illness are impacted by hygiene: in a real way, by how clean we, parts of our bodies or things we take into our bodies have or have not been, in the free-of-bacteria sense. For example, that can be a factor in urinary tract, E. coli and staph infections. Herpes (HSV), however, isnt a kind of infections where hygiene is a factor.

The idea that sexually transmitted illness, specifically, is about anyone being dirty is really about ignorance, misinformation and social stigma, not about science or medical facts. Very unfortunately, and quite maddeningly, we have a long cultural history of stigma around STIs being cultivated primarily out of the desire for social control. In other words, the idea that scaring people about sexually transmitted illness, or shaming people about it, will make it more likely for them to only have the kinds of sex, or sex in the kinds of contexts or relationships, other people want them to have because of their own personal beliefs, which they feel are superior to different beliefs others may have.

One of the reasons we know HIV became so epidemic is that for years (and sometimes still) after the infection came to light, it was publicized as the gay disease, a half-witted and homophopbic tag that resulted in far more people acquiring it than would have otherwise, which has an impact still, and which also played a negative part in how research was done to try and treat people with and prevent the further spread of HIV: that stigma made, and still makes all the wheels to help everyone turn much more slowly. Still today, stigma with HIV based on both it so often being sexually transmitted and on myths it only can happen to certain people results in more people acquiring the infection, less people knowing how to prevent it and being supported in prevention, limited access to healthcare and in the funding for developing better care for HIV-positive people. Similar harm has been done when other groups in history unmarried working-class women and people of color, for instance were stigmatized about sexually transmitted illness. Its safe to say that stigma placed on STIs has, in a lot of ways, done just as much harm or more to people as the infections themselves have.

And ultimately, the idea that STIs are about anything dirty is about the fact that some people think that because they think of sex or some kinds of sex, some ways of having it, or having it with certain kinds of partners or relationship models as dirty. In other words, you were doing something which, in their minds, was dirty and thus, getting an illness through that activity proves that dirtiness. Its flawed logic and much of it is based on shame about sex and things that just arent true, but which people really wish were (like the idea that not being gay means youll be safer, or that being married, all by itself, means people wont get STIs), but its the heart of where this framing of sexually transmitted illness comes from.

I dont think sex is dirty (messy, sometimes, sure, but not dirty). I dont think illness is dirty. And I dont think youre dirty. Youre a person who has engaged in sexual behavior the vast majority of people around the world and through history have, and in doing that, you acquired up an infectious disease, one of many some sexually acquired, some in other ways in our world people get and pass along just by being in close contact with each other, be that sexual or not sexual at all. Herpes, like other infections, is an illness. Its not a judgment from on high, a kind of mark on or of your character, and it doesnt have a thing to do with what kind of person you are or how much people who transmit illness between one another do or dont care about each other, especially when everyone involved did all they knew to do to prevent transmission, like i seems clear you both did here.

I thought you might appreciate some perspective on this from someone who knows a whole lot about infectious disease, but who doesnt share my politics or my job. So, I asked my mother. Thats less random than it sounds: my mother is the longtime, big-shot manager of infectious disease and control at one of the largest childrens hospitals in the United States.

I told her about your question, and she said a few things I thought we really spot-on that might give you some comfort.

She agreed with me that stigmatizing sexually transmitted infections arises primarily out of stigmatizing sex and certain people and out of ignorance and attempts to socially control people. She also agreed with me that stigmatizing sexually transmitted illness, or any kind of illness, does people real harm, both in terms of making them feel crappy.

sis can also lead to inflammation of the vagina, urethra and cervix and to pelvic inflammatory disease, and in pregnant women, the infection has been known to cause premature labor and result in more low-birth-weight babies.

The public health threat of trichomonas is compounded, Gaydos adds, by the fact that, unlike other common STDs, such as the bacteria Chlamydia trachomatis and Neisseria gonorrhoeae, confirmed cases of parasitic trichomonas infection do not have to be reported to local public health officials and the U.S. Centers for Disease Control and Prevention.

What we are really witnessing with trichomonas, especially in older women, is that no one ever looked, no one ever tested and diagnosed, and no one is really getting treated, so the infection persists year after year, says Gaydos. She says that in addition to encouraging women to get tested, federal agencies should make trichomonas a reportable condition, as are chlamydia and gonorrhea, so that public health officials can screen, track and develop better methods to halt infections.

Among the study's other key findings were that infection rates were highest among black women of all ages, at 20 percent, almost twice what earlier estimates had suggested and more than three times the rate in whites, at 5.7 percent. Gaydos says this finding mirrors results of other health surveys tying increased STD infection rates -- such as chlamydia and gonorrhea, too -- to high levels of poverty, unemployment, and lack of education in different racial and ethnic groups.

Such social and economic disparities, she says, also help explain why the infection rate in jails, in which a large proportion of the prison population is African American, was 22.3 percent; and why women in the relatively poorer Southeast United States have the highest regional trichomonas infection rate, at 14.4 percent, whereas women in the more affluent Northeast had the lowest, at 4.3 percent.

This survey information is vital to tailoring our efforts to get women, especially black women and women in jails, tested, diagnosed and treated, says Gaydos.

The Johns Hopkins team last December published survey results about trichomonas infection rates in men, in whom the disease is even harder to detect. Initial study data from 500 men tested for all three common STDs showed that at least 10 percent of all men participating in the study carried the parasite, wh.

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