Tackling STI stigma through education

Brook Education and Wellbeing Specialist, Amber Newman-Clark, explains why relationships and sex education about STIs needs to do better than using scare tactics and is key to breaking down stigma and opening up conversation.

“This is what will happen if you have sex without a condom!” our supply teacher said to my class as they revealed images of genitals erupting with numerous boils, warts and bumps. This was my experience of sex and relationships education at school and, unfortunately, I’m not alone.

Scare tactics like these are a common method used to discourage young people from having sex, but they simply don’t work. We must acknowledge the harmful message this sends when discussing STIs. Rather than encouraging people to use condoms, it means people are too scared to get tested and ashamed to discuss safer sex with sexual partners. It’s unhelpful and it needs to change.

Furthermore, there is a gaping flaw in this technique which is that most STIs have no symptoms. The most prevalent STIs among under 25s are gonorrhea and chlamydia. But 75% of women with chlamydia and 50% of men don’t have any obvious signs or symptoms. Similarly, half of women and 1 in 10 men have no symptoms of gonorrhea.

“What’s the difference between an STI (sexually transmitted infection) and an STD (sexually transmitted disease)?” is something I get asked all the time. I love this question because it is a great opportunity to pick apart the stigma around STIs which is so prevalent. Firstly, I draw a distinction between an infection and a disease, explaining that using the word ‘infection’ correctly implies an STI can be cured or treated. Describing it as an STD is not accurate because that suggests there is no cure or they’re hard to treat. The term ‘disease’ feels stigmatising in this context, and making this distinction in our language is a really easy way to highlight that STIs are a part of life, just like any other infection.

We still have a lot of work to do to ensure people feel confident in their knowledge about how STIs are treated and how they are passed on. I believe the statement ‘knowledge is power’ is particularly true for this topic.

The lack of knowledge on STIs from everyone (not just under 25s) is astounding! Here are the top 4 myths I hear the most:

1) Blue waffle. Blue waffle is not real! I say it in almost every STI lesson I deliver. It is a made up STI that has managed to weasle it’s way into many generations of teenagers physce. It is photoshopped genitals and not something we ever need to worry about! When blue waffle inevitably comes up it’s always a good time to let people know that STIs are often symptomless, so the only way to know for sure if you have an STI is to get tested.

2) If you have HIV or herpes your sex life is over. This myth stems from a lack of understanding on how STIs are passed on and how viral infections are treated. “In 2018 the UK continued to achieve the UNAIDS 90-90-90 target with 93% of those living with HIV being diagnosed, 97% of those on HIV treatment and 97% of them having an undetectable viral load”. Viral infections can be treated and people who are HIV and HSV positive can still have healthy, enjoyable sex lives.

3) People with STIs are dirty and people who don’t have an STI are clean. The language used to discuss STIs is the key to destigmatisation. Words like ‘dirty’ ‘clean’ and ‘catch’ are all unhelpful and inaccurate when describing STIs. This language promotes that idea that if you have an STI you are in some way impure or promiscuous. Firstly, having multiple sexual partners is not a problem provided people use condoms and get tested regularly. Secondly, people who have had lots of sexual partners can have an STI as well as someone who has only had one sexual partner. STIs don’t discriminate and can affect anyone. You cannot tell by looking at someone if they have an STI.

4) You can get an STI from toilet seat. Another myth which has been around for years and years. It has managed to maintain it’s popularity because many people don’t understand how STIs are transmitted. STIs, like many infections, can’t survive outside of the body for very long at all. People transmit STIs from certain bodily fluids or skin on skin contact, not toilet seats.

An STI diagnosis comes in two phases, one is knowing about the infection, the other is the shame society places on an STI diagnosis and not knowing how people will react to the diagnosis. The thing many people dread the most about an STI diagnosis is not the actual diagnosis but how people will react if they found out. My hope is that one day STIs will be treated by people the same way we treat any other infection. We don’t need this unnecessary stress and stigma piled on top of a diagnosis just because an STI is passed on during sex.

Partner notification should be a more natural part of sexual encounters, and discussing how to talk to partners about STIs and testing is a vital part of any STI education. I often advise practising the conversation. Acknowledging that it might feel scary at first but these conversations get easier the more you have them.

Many people are worried their partner will judge them if they bring up the topic of STIs or that bringing it up could offend the person. All it should say about you is that you care about you and your partners sexual health.

It’s super easy to get tested now with (discretely packaged)  online testing kits sent straight to your door. Also, most clinics will offer an anonymous texting service to notify partners of a positive diagnosis without naming the person who was diagnosed.

Things are changing for the better, we are having more open conversations STIs. There are people such as Jonathan Van Ness and Gareth Thomas making amazing progress for HIV positive visibility. But things are not changing fast enough, which is why RSE around STIs needs to do more than list STIs and be about breaking down stigma and encouraging open communication.