Re-Framing The Discussion Around STIs

This post originally ran on on 12/30/12

As a sex & BDSM educator I spend a lot of time talking about sexually transmitted infections (STIs). Over time, I’ve noticed that how we talk about some STIs can be deeply problematic, and in ways that have serious consequences for public health.

Before I dig into that topic though, I’d like you to stop for a moment and try to guess what the most common illness transmitted by sexual activity is.

I’ll wait…

If you guessed Gonorrhea you’re not in the ballpark.

HSV1 & 2? You’re getting closer, but still not there.

HIV? Go to the back of the class.

No, the most common STI by a long shot would have to be the Rhinovirus, also known as the cause of the common cold.

Before you call “bullshit,” take a mental step back from the cultural box we usually put sexually transmitted illnesses in. Instead, think about the kinds of erotic encounters you personally enjoy (assuming that you enjoy erotic activity). Surely you can see how easy it is to catch a cold from a lover. In fact, I’d wager that the majority of you have at some point contracted or infected someone else with a Rhinovirus during a night of romance or lovemaking.

However, I’ll also wager that you didn’t think of the cold as an STI, which only goes to show that there’s something off in how we think about sexually transmitted infections.

That isn’t to say that you wouldn’t have every right to be mightily pissed off if a lover knowingly had sex with you without disclosing that they were getting over the flu.

It’s hardly news that in the LGBT community, and especially among gay men, there’s a ton of baggage when it comes to STIs. A lot of that has to do with the AIDS crisis of course. At the same time however, LGBT people also have a long history of being identified by society as sick, damaged or dangerous to the general public, a perception that the AIDS crisis unfortunately fed into perfectly. After all, before AIDS there was GRID, and frankly in the back of many people’s minds, in and out of the LGBT community, the stigma of GRID never really went away. Our enemies have not been quiet in their belief that HIV/AIDS is our “punishment” for being queer/LGBT, a belief that some of us struggle to put aside even after years or decades of living authentic gay lives.

Keeping that baggage in mind, I believe that there are two distinct, yet interconnected issues we as a community must work through.

First and foremost, we have to uncouple shame from the medical reality of contracting a sexually transmitted infection. This shame can spring from many places, including internalized homophobia, puritanical views of sex, and even the feeling of having “failed” at remaining STI negative. I recognize that this view is not universal within our community. After all, some people reason, if contracting an STI is seen as a shameful thing, surely that would encourage safe practices.

I’d argue instead however, that the air of shame around the topic of STIs can make reasonable conversations around risk and prevention more difficult than they should be. I cannot count how many young people I’ve talked to who’ve chosen to have unprotected sex out of a fear that their partner(s) would be offended by the (perceived) implications inherent in wanting to use protection. Likewise, all to often I hear variations on “I wouldn’t be involved with one of those sorts of people,” as an explanation for why protection or precautions simply aren’t necessary. When we build up a mythical image of the “kind” of person who contracts a sexually transmitted infection, it becomes easy to believe that the only precaution we need is to avoid being intimate with the “wrong” type.

Of course this cultural meme causes terrible harm to people who do have some form of STI. Even the language our community tends to use: “clean” for someone who is STI negative, with the implied antonym of “dirty” for someone who is positive, can be incredibly destructive. Moreover, we don’t tend to impose these same sorts of moral filters onto other illnesses, contagious or otherwise.

Which brings me to the second issue I wanted to address.

Due in no small part to a pervasive shame around the whole topic of STIs; rumors, misconceptions, and assumptions about the risks and spectrum of sexually transmitted infections remain rampant in and out of the LGBT community. Here is a short list of myths I find myself addressing at least four or five times a month:

  • The idea that sero-discordant people cannot safely have sex.
  • The belief that if someone contracts or develops symptoms of HSV1 or HSV2 it means that they have been promiscuous, unsafe, and duplicitous.
  • Even more disturbing: the belief that HSV posses a serious and potentially life-threatening/ending risk to an otherwise healthy person.
  • All sexually transmitted infections are incurable.
  • One can’t contract a sexually transmitted infection if it’s their first time being sexually active.
  • Condoms are ineffective at preventing the spread of HIV (thank George W. Bush and his friends for this one)
  • Receptive anal sex is the only way to contract HIV
  • HIV is only transmitted through homosexual sex (yes, people still really believe this)
  • For the sake of brevity, I’ll leaving out all the BDSM-related STI myths that I also encounter, but they are extensive

I’ve come to realize that as part of the Challenger generation, I was born into a narrow window during which there was good information and a will to educate youth about HIV, but before the doctrine of abstinence-only-education become pervasive.

This, combined with coming out young, while HIV was only really beginning to be tamed by modern drug cocktails, gave me advantages over the generations that followed mine both in terms of knowledge and particularly in openness of dialog. Of course, talking about sex for a living doesn’t hurt either.

Many young people have only the barest knowledge of HIV, and none at all of other STIs. In the lack of proper knowledge, half-truths and assumptions get taken as fact, as they always have.

For instance, as far as I can tell, the belief that HSV can kill an otherwise healthy person exists solely because the virus is often transmitted sexually, and people have been taught that sex kills. This rather than being provided with detailed information on the spectrum of risk and how to have a healthy sexual life as safely as possible.

Of course, nothing I’m saying here is new. But therein lies the issue facing our community: we’ve been having these conversations for so long, it’s hard to imagine that we still need to.

The fact that we do should be a sign that we’re doing something wrong.

Please don’t imagine that I’m suggesting that we take a laissez-faire attitude towards STIs or safe sex. The reality is that sexually transmitted infections range from the annoying to the seriously life-threatening, and with the growth of anti-biotic resistant strains of familiar illnesses, our level of care and concern should only be increasing.

At the same time, the risk of contracting an illness cannot continue to be a wedge with which an attitude of shame around our sexual desires are driven home. For very understandable reasons, the HIV/AIDS crisis fostered an element of sexual puritanism within the gay community that does not universally serve us well. After all, sexual promiscuity and adventurism is a natural facet of the human condition. We must find better ways to educate people about STI realities, and engage in productive dialogs about informed and risk-aware sexual behavior.

To get there though, we first have to shift how we think about and discuss sexually transmitted infections back foremost into the medical realm, hence the earlier thought exercise around the Rhinovirus.

There should be no more shame in contracting HSV, HPV, HIV, Gonorrhea, etc, than there is in any other preventable medical condition. I’m not saying we should remove the concept of personal responsibility, but when a smoker develops lung cancer we don’t call them dirty; and when a skier breaks their arm we may tsk at them, after all skiing carries the risk of injury, but we don’t assail their character, tell them they deserved what happened, or imply that their skiing injury reflects poorly on their worth as a person.

Especially not if we’re out on the slopes every weekend too.

POTD 2/1/12 Some Straight Talk on STDs from (the ever awesome) Mollena

Over on her blog, Mollena has written an excellent post about her experience being diagnosed as HSV positive. Perhaps more important than the excellent information she provides about the incidence of HSV 1 & 2 in the U.S., she also talks very openly about the emotional impact of being diagnosed with an STI, even one as ubiquitous and generally harmless to people with reasonably strong immune systems as HSV.

note: Mollena is all-around pretty damn awesome and a kick-ass presenter, even if she does intimidate the hell out me