General

STIgmatised

More than ever, the world seems comfortable with casually talking about sex. With this rise in discourse, many subjects such as sexual orientation and fetishes have seen de-stigmatisation or increased acceptance, and as a result, many myths have been debunked. No longer do people believe that masturbation leads to blindness or hairiness, or that having sex means getting pregnant and dying contrary to what a particular PE teacher in pop-culture would have you believe. Despite this, misconceptions persist around sexually transmissible infections. This is concerning as STIs are on the rise, especially among young adults. It’s time to put the record straight.

Popular media has a longstanding history of perpetuating misconceptions surrounding STIs, even if for satirical purposes. Photo: Guanhao Cheng.

From the start of 2021 until the end of June, the WA Department of Health recorded 247 cases of infectious syphilis in Perth and the southwest region, with numbers still increasing due to a recent outbreak. Chlamydia cases have also seen a rise in numbers over the same period with the Sexual Health Quarters, which provides treatment for and advice about STIs, recording 65 cases from the 30-and-under age range at the Northbridge clinic alone. The WA Department of Health has also published its Sexually Transmissible Infections Strategy 2019-2023, which outlines young people as one of its priority groups. Infectious diseases like syphilis can have major consequences if left untreated, including causing infertility. As such, it is increasingly important to begin getting more comfortable with the idea of getting screened for STIs, especially for the younger age group who often represent a large portion of STI reports.

Of course, this is easier said than done. Culturally, Australia still hasn’t moved past associating sexually transmissible infections with a whole host of undesirable traits such as dirtiness, promiscuity, and carelessness. As such, contracting an STI can be a source of embarrassment and frustration. However, these ideas need to be challenged as testing positive for an STI can still happen to the most hygienic, chaste, and careful of individuals.

STIs are experiencing a surge in numbers and may be more common than you think. Infographic: Guanhao Cheng.

Hygiene

Musician Jayden Briggs, 23 of Beechboro, says he prides himself on the extra attention he puts into being clean. So, when he tested positive for chlamydia, the result was a badge of shame for him as he didn’t believe he’d be the kind of person to contract an STI.

Jayden Briggs says having an STI didn’t affect his life as much as the stigma did. Video: Guanhao Cheng.

“I’m a quite hygienic person so contracting something like that… I was quite annoyed.

Jayden Briggs is more open to discussing his health than most but admits he feels the shame associated with being STI positive. Picture: Guanhao Cheng.

“When I got it, I would wash my hands religiously, for like two weeks after that. I swear, I would do it every few minutes,” he says.

“If I got that on my face, what else could happen?”

Although these negative notions have been culturally ingrained and are difficult to shake, SHQ clinical nurse manager Karen Bonte says having an STI is not, and should not, be understood as a reflection of a person’s character.

“Just because you have chlamydia doesn’t mean you’re not clean, it doesn’t mean you’re dirty. It just means you have picked up an infection that needs to be treated with antibiotics. Once it is treated you no longer have the infection but it is important to let sexual partners know so that they can be tested and treated too,” she says.

“Getting an infection anywhere should be seen as another infection and you can treat it and it goes away.”

Good advice for young adults who have dealt with their own status as an STI positive person and are wrestling with what that means. Yet for those who haven’t, it’s worth examining the mindset from the outside looking in.

Illusions

A survey conducted from November 2020 to the beginning of 2021 by the Sexual Health and Blood Borne Virus Applied Research and Evaluation Network, known as SiREN, looked at the experiences young people had with sexual health care and how that affected accessibility.

The study acknowledged stigma played a role in whether young people decide to seek help or testing for their sexual health. Curiously enough, the stigma only promiscuous or dirty people contract STIs was found to give some people a false sense of invulnerability from infections, as these were not characteristics they associated with themselves. The taboo of promiscuity often comes hand in hand with STI positive people, and this has resulted in people in monogamous relationships developing a misconceived sense of security from STIs.

SiREN project senior research officer Dr Kahlia McCausland, who worked on the survey, didn’t anticipate that a large portion of the participants would feel that they didn’t require testing.

The most common negative experience was feeling like assumptions were made about patient bodies and sex lives. Audio: Guanhao Cheng.

“Some of our results looked at young people’s perceived susceptibility to STIs. Among the total sample, about 33 per cent to 51 per cent of young people thought it was unlikely and very unlikely they would acquire an STI, which was kind of surprising,” she says.

“Among sexually active young people, this figure increased slightly to about 40 and 55 per cent.

“There were some main reasons for that. They thought they knew their partner’s sexual history, they were in a monogamous relationship, and they trusted their sexual partner.

“People are having sex and they don’t think that they’re necessarily susceptible to STIs which was a little bit concerning, especially if they’re not using barrier contraception, or if they’ve had multiple partners, so that’s something that could be amplified in young people.”

Master of Sexology student at Curtin University Roisin Glasgow-Collins, who undertook qualitative interviews for the project, added that participants were also aware that people of their own age group had an idea of ‘invincibility’, but individuals who brought up the idea often would not associate that feeling with themselves.

The study also revealed the negative experiences young adults had when seeking sexual health advice most often came down to assumptions that professionals made about their patient’s body or sex lives as well as judgmental attitudes towards young people who seek help and get tested. These negative experiences could, in turn, discourage future attempts at seeking sexual health care from providers and can lead people to self-diagnose through unreliable methods.

A response from one of the SiREN survey participants sums this up: “The doctor seemed to be uncomfortable whilst completing the [sexual health screening] test, and I wasn’t completely sure what I was being screened for. I didn’t feel comfortable asking questions, so went home and googled information.”

SHQ’s Karen Bonte says googling sexual health information can actually leave people less confident in their health as symptoms can be due to many reasons and a lack of symptoms does not necessarily mean someone does not have an STI.

Sexual health experts say this is not to say young adults should begin irrationally fearing people who have STIs, but it should be realized that the stigma surrounding it can sometimes lead to an overestimation of how unlikely it is to contract an STI. Additionally, the line of thinking where ‘monogamy means insusceptibility’ perpetuates the stereotype that only a certain kind of person contracts STIs, which is untrue. Though, it’s difficult to blame people for having these reservations when fear has been used as a tool to educate young people about sexual health for so long.

The SiREN study looked at the barriers in young people seeking sexual health care. Infographic: Guanhao Cheng.

Fear

Cold sores, rashes, lumps and bumps of all shapes and sizes; a sexual education class can sometimes feel like a body horror exhibition. Students may leave the classroom with these extreme images of ‘herpes’ and ‘chlamydia’ burned into their minds. However, this does little to change the extreme perceptions of STIs and help prevent them.

Bonte feels that the ‘scared straight’ approach to sexual health education which can sometimes be employed is outdated and does more harm than good. She has experienced this approach firsthand, recalling her own and her daughter’s experiences with sexual education during schooling.

Karen Bonte believes the emphasis should be on relationships and preventative methods, not the horrors of infection. Picture: Guanhao Cheng.

“When I was at school we were shown terrible pictures, which I think was unhelpful because it was fear based and gave us the impression that if someone didn’t have any symptoms then we didn’t need to use condoms,” she says.

“My daughter came home after some education on STIs at school, and she was really frightened which was disappointing. Thankfully we could have a chat about it and I was able to reassure her.”

But Bonte acknowledges the sexual education received by students varies between schools.

“I do know some schools do some great work. We also have our own Education Team who go to schools and teach about healthy relationships and consent, sexuality and diversity. They prefer to teach about negotiating safe sex including using condoms and getting tested when a condom breaks or if you have forgotten to use one rather than describing every possible STI.”

She also notes one of the primary fears young people have about contracting certain STIs, is it signals the end of their sexual life. Especially incurable infections. She assured this was not the case, as incurable did not mean untreatable.

“HIV is not curable at the moment but it is treatable, so people live relatively normal lives for a long time now,” she says.

“If you’re taking a treatment and having regular checkups with your doctor, your viral load should be so low that undetected equals untransmissible.

“One of the aims of HIV treatment is to reduce viral load which lessens the likelihood of passing it on to someone else.”

When asked about the treatability of the STIs currently on the rise, Bonte says prevention is best by using condoms when having sex with a new partner or partners.

“However, we do understand that mishaps happen,” she says.

“We encourage people to get tested when starting a new relationship, if a condom breaks, or a person has any concerns or symptoms.

“While it is daunting to be told you have an STI, the great thing is, treatment is available and will prevent other potential health problems if treated early.”

Moving forward

The WA Health department’s Sexually Transmissible Infections Strategy 2019-2023 recognises the importance stigma plays in sexual health care and has set goals and targets which aim to eliminate stigma experienced by ‘priority populations’, one of which is young people.

To this end, the government has developed campaigns designed to promote sexual health such as ‘Could I have it?’ and ‘Get the Facts’, as outlined in their strategy under past progress, which aim to improve the accessibility of sexual health care.

In the same spirit are the responses received by researcher Glasgow-Collins about possibly implementing telehealth services. Such a service would allow young people to call in through video or audio and access sexual health information and testing. This is a pathway with the potential to be expanded. Respondents commented it would increase convenience as they wouldn’t have to tell their parents about going to the doctors, which boosts confidentiality and evades the fear of what their parents would think about them accessing a sexual health test.

Along with this, SiREN Project’s McCausland also suggested more pharmacies and clinics could install and make use of booths to discuss confidential matters to protect privacy and encourage young adults to open up about their needs and concerns. She also says pharmacists can practise lowering their voices when discussing sexual health medication as to not broadcast young people’s conditions when they are uncomfortable with the disclosure.

Bonte mentions that SHQ is looking at making the clinic more accessible to younger people in high school who might not be able to access the clinic past its usual close of business at 5pm, either through the provision of a telehealth service or extended hours.

Karen Bonte on the process of getting a sexual health screening at Sexual Health Quarters. Video: Guanhao Cheng.

Dr McCausland says the onus is often put on young people to seek care for their sexual health so it would be really good if health care professionals included some questions to young clients about their sexual health which can also help reduce stigma surrounding the discussion and normalise it.

If you are currently experiencing symptoms, it is recommended you see a doctor or call the Sexual Health Helpline on 1800 198 205 (country callers) or 9227 6178 (Perth metropolitan callers).