Ending the Epidemic of Sexually Transmitted Infections Starts with Talking


The ambitious American combination of prudery and criminally
neglectful government attention to health care has resulted in another victory
for the forces of darkness: a
new record in STD transmissions for 2008.
  Will
Wong analyzed the data for RH Reality Check
.  As you can imagine, this public health disaster hurts black
Americans more than white, young people more than adults, gay men more than
straight, and people who rely on public health care more than those who
don’t.  The only real surprise in
this is that syphilis is on the rise, since there was a genuine reason to
believe we might actually wipe that one out.

So how did it get so bad?  Considering the role young people play in this—half of the
19 million estimated STD transmissions occur in those 15 to 24—it’s tempting
to say the abstinence-until-marriage programs that became ubiquitous in the
past decade have something to do with this.  And I’m going to give into the temptation and say it’s
likely.  Abstinence-only
education—a
legislative fetish that refuses to die
—often teaches that condoms don’t
work.  Educators like to believe
that scaring kids off condoms will keep them from having sex, but of course,
the likelier result is that scaring kids off condoms will simply scare them off
condoms.  As Will noted, most of
the STDs that we’re talking about can be prevented with regular condom use.

Another way that the prudery behind abstinence-only helps
the spread of STDs is through inculcating shame about sexual activity and
feelings that you’re “dirty” if you get an STD.  I think a lot of people would like to believe that shaming
people about STDs helps reduce their transmission, but actually, it has the
opposite effect.  Shame causes
denial, specifically the denial that the symptoms you’re showing should be
taken seriously.  A lot of people
who show symptoms take a “wait and see” attitude, hoping that it’s not the STD
that it looks like, but something more minor that will clear up on its
own.  The problem with this is that
avoiding treatment often results in the infection getting worse, which can
cause scarring and infertility. 
And it often means you’re having sex while waiting and seeing, which
means that you’re likely to spread the infection.  And, as Will noted, having STDs like syphilis makes you more
vulnerable to catching others, such as HIV.

Of course, another reason people take the “wait and see”
attitude is they don’t have health care coverage, and they really can’t afford
to pay for treatment out of pocket. 
For this reason alone, we can expect the STD transmission rate to
improve if we manage to pass a workable universal health care bill.

But simply having more health care access will not be
enough.  As Will explains in his
piece, public resources to combat STDs have been rolled back in recent years,
due to lack of funding.  Since
these kinds of groups are the only people out there talking about how to treat
and prevent STDs, this is no small issue.

This is a situation that can be fought on several fronts,
and average people can really do a lot to fight our ridiculously high STD
transmission rates.  Yes, you can
do more than insist on using condoms every single time you have sex outside of
the context of a tested, monogamous relationship.  After all, reducing the stigma attached to sexual activity
and STDs will mostly require social change, and that’s best effected by opening
your mouth (or your blog) and talking.

Dan Savage set an excellent example years ago when he wrote
about his youth, when he contracted gonorrhea.  (Reciting this from memory, since I can’t find a link to
it.)  Or more specifically, when he
contracted gonorrhea and, out of shame, failed to tell his partner about it,
who contracted gonorrhea from Dan as a result.  Luckily, his partner rolled with it, which is exactly the
attitude you want to have in order to reduce the shame and stigma around
STDs.  And Dan learned the lesson,
and came out with this story so that the rest of can see that the world doesn’t
end if we’re honest about STDs.

Sex educators have exposed me to the idea that getting
people talking about their own experiences with STDs can have the
counterintuitive effect of reducing STD transmission rates.  Even herpes, which has the superpower
of getting around latex barriers, can be reduced through honesty and lack of
shame.  After all, if you
communicate openly and without shame about break outs with your partner, you
can shift into sexual practices that reduce the potential for transmission
during those times.  It’s not
foolproof, by any means, but it can help.

And while most people don’t have the courage to come out in
a public forum like Dan Savage did, I’ve found that talking about your
experiences with STDs with friends needn’t be as fraught as some people
fear.  I’ve certainly heard people
talk about contracting chlamydia, gonorrhea  or herpes in straightforward, humorous terms that normalized
the experience….and made me realize that if I ever showed symptoms, it would be
no big deal to go straight to doctor with my head held high.

Because of this, I’m grateful that the HPV vaccine, which targets strains of the virus that can cause cervical cancer, has
started a national conversation about the prevalence of STDs.  There are many strains of human pappilloma virus (HPV), and while most are relatively benign, a few have been shown to cause cervical cancer in some women.  Because it is easy to transmit HPV, most people have one or another strain.  Yet until recently, misinformation about HPV, as well as other sexually transmitted infections, left us with little recourse except to treat the symptoms.  Even a few years ago, I would have
found it hard to believe that so many people would easily accept that
contracting HPV was more likely than not if they didn’t get vaccinated at a
young age, and not feel weird or ashamed about that.  And while there’s been a lot of hysterics who want to turn
contracting HPV into some kind of moralistic theater, there’s been more people
who happily take their daughters to get the now available vaccine to protect them against the most dangerous strains.  If we can see more of that attitude,
and expand it to other sexually transmitted infections, we’ll have taken a big step towards reducing the
transmission rate.

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  • harry834

    you can get tested for other STDs. My doctor offered tests for chlamydia and gonorrhea as well as HIV. I took them all, all negative :) When your doctor offers these tests, ask about the copay, and take them.

    My conversation with my doctor suggests that they feel different tests are recommended fort different groups. As a straight man, they gave me the above tests. As a South Asian, I was tested for blood sugar for diabetes.

    Of course, one may want or need other tests. It will depend on personal sexual history among other health variables.