“I’m clean, and I assume you are, too,” my then-boyfriend said to me before we had sex for the first time. This sentence is the way many people inquire whether their about-to-be sex
partners have any sexually transmitted infections (STIs), an unfortunate use of language that dates back to the early years of the HIV/AIDS crisis.
Despite using a metaphor (“clean”) to soften his language, this sentence was blunt, and gave me intense nausea and anxiety. It was a physical response: my shoulders tightened. I had to stop myself from grabbing my stomach. I had this gut reaction even though I had practiced this conversation in therapy many times.
I had to practice it, because I have genital herpes.
“I’m not dirty,” I replied as I momentarily considered lying, “and I have herpes.” People socialized as female who know they have STIs are accustomed to society's view of us as “dirty,” but this metaphor--of being “clean”-- for disease refers to morality, not to infection. Medicine doesn’t deal in “clean” or “dirty;” rather, doctors and scientists speak of infection and contagion, and the former terms are not intrinsically related to the latter terms. The link between STIs and “unclean” comes from the association with this type of infection with sexual activity.
The idea that having an STI means being "contaminated" is out-dated and harmful. If we de-stigmatized STIs, then maybe there wouldn't be crushing shame at the other side of a diagnosis. Such shame is well documented, and is known to be a driving force preventing people from even being tested.
The association of these infections with sexuality–an essential aspect of our identities that is still the object of attack from social conservatives–is the primary reason that this handful of infections are treated differently from, say, strep throat, a bacterial infection that one gets just through “bad luck.”
The context of a global pandemic is a perfect time to destigmatize STIs
Why? Because we are constantly discussing contagion and the morality of “protection” in the form of social distancing and mask-wearing. One common subject of discussion is safe sexual activity during the pandemic, within the context of spreading COVID-19. New York State has officially recommended glory holes to prevent transmission of the coronavirus. This form of sexual activity is, however, largely practiced by people who have penises. We should expand this conversation and drive a much-needed cultural shift that aims to normalize sexual desire, for those of all genders and genital-expression.
Sexually transmitted infections such as HPV, chlamydia, and trichomoniasis are caused by viruses, bacteria, and parasites, just like diseases that are contracted by breathing or by consuming a spoiled food item. These microscopic organisms are oblivious to notions of morality-- the body itself is morally-neutral. COVID-19 is a perfect example because it infects people in all walks of life, whether they engage in risky behaviors or not–although people who take risks are more likely to contract it.
People who claimed that the pandemic was a “hoax” have died of the virus, as have people who took every possible precaution to avoid it. No matter how much we fear coronavirus or ignore the possibility of contracting it, our control over our fate is limited. Those same principles apply to STIs, too, but this type of infection also carries a stigma that coronavirus does not have. In my painfully broad experience of sharing with boyfriends, friends, and acquaintances that I have herpes, people on all points of the political spectrum think I’m a “slut.”
This differs from the morality debate attached to COVID-19 because in the United States moral judgements about coronavirus vary based on one’s political ideology. While these ideologies have some basis in similar thought, there's a moralism to one that doesn't perfectly extend to the other.
STIs are the object of stigma because puritanical notions about sexuality, especially sexuality for folks socialized as female, pushed by conservatives --and not effectively countered by liberals--dominate our conceptions of what it means to be a sexual being. This problem has a long history. Women who expressed sexual agency used to find themselves incarcerated in asylums alongside patients with severe mental illnesses.
Sometimes the state went even further than “mere” institutionalization. Carrie Buck, an inmate in an asylum who was the plaintiff in the case Buck v. Bell was forcibly sterilized because she was allegedly promiscuous (she was actually a victim/survivor of rape), a “defect” for which she was deemed “feebleminded.”
While gender is a social construction, gendered violence has often been used as a tool to keep certain populations under control. Oppressive ideas about sex apply harshly to people who identify as women and girls, while largely ignoring men’s desires, since people widely believe that men “need” sex and women must therefore control their own desires and act as sexual gatekeepers.
Men, in fact, may be shamed for their lack of sexual experience, while women and girls face the impossible double-bind of male pressure to have sex and slut-shaming once they do. Fetishizing female “virginity,” otherwise known by the more insidious term “purity,” damages women’s self-image. If a woman is not “pure” then she is “impure” or “dirty,” and, the demeaning logic goes, what can constitute greater evidence of such foulness than an STI?
Genital herpes, usually caused by Herpes Simplex Virus II (HSV2), is the most potent example of this problem because it is, in most cases, a harmless infection, even if it is occasionally uncomfortable. The virus is a variant of the germ that usually causes cold sores (known as Herpes Simplex Virus I), which infects up to 80 percent of American adults. Still, these viruses are treated differently;most people don’t even use the word “herpes” to refer to the blisters that occur on the face, opting instead for “cold sores” is used instead to differentiate. HSV2 causes similar sores on the genitalia, which can be extremely painful, especially upon the first outbreak.
Regardless of the severity of the symptoms of disease--and other STIs can be more harmful, especially if untreated--many people view folks who have or have had STIs as ‘damaged goods.’ And we know it. This view of us as “damaged” is the source of the tsunami of emotional trauma that can nearly drown us when we receive a diagnosis of an STI.
Telling our stories is not only therapeutic but educational for others, and since we’re already talking about disease every day, we should start getting personal about this issue.
I contracted herpes from a boyfriend with whom I was in a monogamous relationship (at least, that was my understanding). He gave me herpes for my twenty-fifth birthday. When I was diagnosed, I was so hysterical that my doctor wouldn’t let me leave the office until I made an appointment with a psychologist. One thought played on a loop in my head:
“Nice middle-class Jewish girls don’t get herpes. I'm disgusting.”
I stopped eating, and I didn’t sleep for nearly 72 hours. At that point I called my doctor and she immediately prescribed me Xanax for the panic attacks.
My personal story is not unique; and so my experiences highlight the need for society to change its collective feelings about STIs. My emotional trauma was not caused by the infection itself, but by my knowledge that many people would decide that I’m “dirty” because of it. I was afraid I would be alone for the rest of my life, because I was sure that no one would ever want me again. I didn’t go on a date for more than two years, despite the fact that I was young and attractive. When I finally had the courage to tell someone I was dating that I had herpes, his response was as terrible as I had feared:
“Maybe you should be more careful about who you sleep with.” Translation: “Maybe you should stop being a slut.”
With the knowledge I have now, I can say without hesitation that I would rather have herpes than most other infections because it is largely harmless. Genital herpes won’t damage my lungs or give me myocarditis like COVID-19. It doesn’t make me bleed out of my orifices like hemorrhagic fevers such as Ebola. It’s much less dangerous than seasonal flu. Without an active outbreak, the chances of transmitting the virus are extremely low, and apply only to a person with whom I’m having sex–meaning my husband, who understands this. And yet my life almost fell apart when I was diagnosed.
This situation has to change.
What if we lived in a world in which having an STI were treated no differently than having the flu or even a less serious infection like a common cold? How much emotional suffering could I have avoided? I often wonder where I would be now, because the depression and orthorexia that governed my life after my diagnosis impeded my ability to produce my best work in my doctoral program. Might I have the tenure-track faculty position that I once dreamed of?
We can all make small changes in our language and attitudes to help normalize STIs--while still trying to prevent transmission--and remove the unfounded moral stigma attached to these infections.
Here are action items we can immediately start doing in order to ignite a cultural shift on this issue.
- People should immediately cease asking others if they are “clean,” when what they mean is “Do you have any infections or physical limitations that I should know about before we have sex?”
- Language is important. Less stigma and more openness about STIs will likely decrease infection rates; shame is a powerful incentive to lie or avoid testing . Approaching the conversation in this way can also lay the foundation for an open and honest sexual relationship in which partners discuss STIs, as well as their sexual desires and boundaries.
- Making a difference in the everyday: Individuals should stop their friends and acquaintances if they make jokes or degrading comments about people with STIs, as one would do with a racist or misogynistic comment.
- How many of us have heard a bad joke about STIs? One might turn, for example, to Tiffany Haddish and Kevin Hart who made a supremely unfunny quip about herpes at the MTV Video Music Awards in 2018.
- Counter with facts. I’ve been subjected to many remarks about “sluts with herpes,” so I can suggest two impactful ways to respond to such remarks: “You know, ⅙ of American adults has herpes, so there’s a good chance you just called one of us a slut.”
- If that doesn’t work, try a personal approach. “I have herpes. Would you like to reconsider that comment?”
- People who have STIs need to start talking openly about their experiences.
- I thought I was alone when I was diagnosed with herpes, but eventually I started talking and found out that I had at least four friends who had herpes. Studies about diversity demonstrate that people who know an LGBTQ+ person are significantly more likely to be accepting of the queer community. While it’s not a perfect parallel, the same concept may apply here: the more people who know that they know someone with an STI, the more normalized--and thus less stigmatized--STIs will become.
- Use COVID-19 as an opportunity to spread information and awareness.
- COVID-19 has routinized the public discussion of symptoms, contagion, and treatment. We discuss infection rates and testing with our loved ones and our colleagues on a daily basis. This direct way of dealing with infection should be copied into how we address STIs, too.
We can and should talk about STIs so that we can expand people’s knowledge of the diseases and eliminate the stigma attached to these infections. The American essayist and activist Susan Sontag was correct in decrying the use of illness as metaphor, noting about tuberculosis and cancer, “the romantic idea that the disease expresses the character is invariably extended to assert that the character causes the disease.”
Many people continue to apply this flawed logic to STIs: they assume that the poor character of folks who engage in sexual activity demonstrates that they caused their own infection. That logic must disappear. If we separate moral judgment from sexual acts between or among consenting adults, we can make great progress toward viewing STIs as just another type of illness.