The Silent Infection
By Lily Dupuis, with additional reporting from Abbie Riglin
Stigma means that the effects of sexually transmitted infections are more than just physical
There is an unspoken barrier to accessing proper sexual and reproductive health – stigma. With a plethora of social negativity around sex, finding the courage to get tested for STIs is no easy feat.
David Aveline, a professor of sociology at Mount Royal University, has researched human sexuality and the unique intersections of stigma for most of his career. He says that often people fear judgement when it comes to sex because of negative social perceptions.
Aveline explains that, for many people, having a close relationship with their family doctors can actually be a deterrent to wanting to get tested.
“A lot of people go to doctors that they've gone to all their lives. If you've known your doctor for 20 years, well, they're trained not to judge you, but you often think that there is a judgement somewhere.”
This is something that Tyra Sanderson, a twenty-something Calgarian who values getting tested for STIs, says they can relate to.
“I had a family doctor who I'd been with since I was a child. I never really felt super comfortable talking to her about my sexual health,” explains Sanderson.
“I think it's because I was worried about being judged. When you've [built that] relationship, and they have that history of your medical information, it does feel like there's some level of judgement.”
Aveline emphasizes the importance of STI clinics, as many people are more likely to use those services for more anonymity.
“I can remember during the throes of the AIDS crisis, there were clinics that did not ask your name, they assigned you a number,” he says. “It was completely anonymous.”
He says that the desire for anonymity is linked to embarrassment and a culture of shame around sexual expression.
“People feel that they've morally failed somehow. Even though you may think that there's nothing wrong with recreational sex or ‘hooking up,’ you know that other people do.”
"I had a family doctor who I'd been with since I was a child. I never really felt super comfortable talking to her about my sexual health. I think it's because I was worried about being judged."
Photo supplied by Tyra Sanderson
The Problem with Moralizing Healthcare
Aveline says that throughout periods of sexual liberation, societal shame has always been present, warping public attitudes towards sex.
Even though someone may be sex positive, that doesn’t mean everyone will be accepting towards STIs, something that Aveline says is severely impacting social ideologies towards sex.
“The idea that we're all supposed to be in this wonderful monogamous relationship, and if we're not, we’re supposed to be trying to find one, and waiting [to have sex] until we do… Well, casual sex has a stigma to it, and you can take lots of precautions, you can use condoms and everything else, but still, people will judge you,” he says.
This thought is echoed by Nolan Hill, gay men’s health specialist at the Calgary Centre for Sexuality.
“I think we are really bad about talking about sex in the first place. We're already not talking about sex and sexuality because it's considered a taboo topic,” he says.
But the taboo nature of sexuality does more harm than some might realize. Hill also explains that stigma reinforces a lack of engagement with the healthcare system.
“It's meant to be kept very private, and while sexuality is an individual and private matter that people are allowed to make those decisions about, that silence and that lack of willingness to talk about things just keeps things from being discussed, particularly when it comes to talking with healthcare providers.”
In 2021, a total of 22,531 STI/HIV cases were reported in Alberta. While there are many people getting tested for STIs, there are also many who still aren’t.
Video by Abbie Riglin and Astrid Cunanan
STIs & Shame: It's a Blame-Game
The conversation around STI increases can also become further complicated by searching for a cause. Aveline explains that, throughout history, society has always sought out communities to blame when things go wrong.
“The history of disasters and crises is the history of blaming other people,” he says.
The conversation of culturally-specific and community-focused care is a complex issue in the healthcare system. Aveline reflects on a graduate research project he worked on years ago that focused on sex workers who were also intravenous drug users. He explains that often underserved communities are not given the care they need due to various factors, but often due to a socioeconomic class divide between those who are in positions to provide professional support and those seeking it.
“There's a disconnect in class between [the people who need help] and the people who are committed to helping.”
This cultural disconnect results in further othering and underserving of various communities, informing the desire for more culturally-specific care.
And Alberta's healthcare system is not immune to discrimination, either.
Unfortunately, even though Sanderson is an advocate for safe sex and frequent STI testing, stigma isn't something they've overcome. Sanderson still believes that there is a culture of shame surrounding testing, and it even appears in interactions with medical professionals working within STI clinics.
“I've had friends who have gotten tested and have had really negative interactions with healthcare professionals treating them like they did something wrong or behaved in [an irresponsible] way.”
Most of Sanderson’s experiences with sexual health services in Calgary have been positive, save for one in particular.
Sanderson reflects upon a situation where they thought that they were dealing with a urinary tract infection (UTI) but wanted to get tested to be certain.
Sanderson says that, upon arrival at the STI clinic, they were greeted by a nurse who wanted them to disclose their reason for the appointment, despite having booked one in advance.
“The nurse asked, ‘why are you here?’ and I thought, well, I don't really want to announce that in the middle of a waiting room.”
Unfortunately, Sanderson said that the nurse was insistent that they share the reason for their visit.
“In front of an entire waiting room of people, [I said], ‘I think I have a UTI,’” they explain. “It got really weird, and [the nurse] made me feel really bad and guilty about it, which is weird because UTIs aren't even just related to sex."
“That was a really gross and bad experience for me.”
Remembering the AIDS Crisis
Sanderson's story is a repercussion of the societal associations of sex and morality. Aveline explains that the association between STIs and moral failure is harming society.
The sociologist and professor not only researches and teaches about sexuality and queer studies, but he also lived through the AIDS epidemic of the 80s and 90s.
He explains that social attitudes towards members of the gay community during this time is a historical example of how stigmatized sexual health is and has always been.
“I remember, somewhere around 1982, somebody said to me, ‘Have you heard of the gay cancer?’” recalls Aveline. “I said, ‘What kind of shit is that? How can you get cancer just for being gay?’”
He even explains that the news media played a large role in sensationalizing the AIDS outbreak and victim-blaming people who caught HIV through sexual contact.
Aveline says that newspapers would report that women and children were “innocent victims” of HIV/AIDS, while gay men were being blamed for the outbreak.
“What is an innocent victim? Nobody wants to get AIDS. Nobody expects to get AIDS.”
Media Frenzy & Fear-Mongering
Frenzied conversations around STI awareness can be dangerous. Hill explains that fuelling fire with fire isn’t an effective way to get people involved in conversations surrounding their sexual and reproductive health.
Hill is a gay men’s health specialist and works with underrepresented communities in Calgary. Through his professional experience, he believes that stigma is the root of the problem when it comes to the syphilis outbreak and a reluctancy towards testing.
“Because it's attached to sexuality, people are really uncomfortable talking about it and they're very afraid of it. If we can normalize the occurrence of STBBIs as a potential outcome of, having sex with other people, I think we can help break down that stigma.”
Hill says that STI awareness messaging is a difficult sexual health promotion strategy to do effectively. He notes that, a lot of the time, awareness campaigns take an approach that further stigmatize STIs and “others” people who have contracted STIs.
“A lot of sexual health campaigns in the past have veered into that sort of shaming and stigma messaging, which can be really difficult to avoid, because it is often what's really catchy,” he notes.
“We hear so often that getting an STI is the worst thing that can happen to you.”
Hill says that, from a public health perspective, it's reasonable to not want people to get infections that are preventable and manageable, but unfortunately STI awareness campaigns often resort to shame and fear-based messaging to increase public attention.
However, Hill believes that there is hope, as society begins to shift towards a future of comprehensive sexual education and thoughtful awareness for STIs.
“I think the world is slowly shifting towards [promoting] sexual health without scaring people, even though sexual health is still so stigmatized.”
Not just about you
Judgement is naturally something people are afraid of, but Sanderson explains that getting tested is something that must be done, regardless of fear.
Sanderson says that sexual health is “not just about you” – it's also a sign of respect to your potential sexual partners.
“It's also about consent with your partners, and being open and honest,” they say.
“I want to make sure that I'm presenting accurate information about my sexual health if I'm getting involved with someone new, rather than just having no idea what's going on."
"I do think that that is a conversation that should be had with your sexual partners,” explains Sanderson. “That is an important part of the decision of whether or not you want to engage with someone physically.”
Unique Intersections of Stigma
While responsible decision making and frequent testing sounds simple in theory, it’s not always easy in practice. Syphilis, and STIs in general, face multiple intersections of stigma.
Aveline believes there are two specific intersections of stigma that contribute to STI negativity – infection and sexuality.
“If you have cancer, that's not your fault. You didn't do anything to get cancer and people know that, but at the same time, it stigmatizes you. People don't know what to say to you, they don't know how to act in front of you, and when you mention it, they get uncomfortable,” he says.
The barrier of being treated differently after having health issues becomes exacerbated when the cause is sexual activity.
“The second barrier is now that you got [an infection from having sex],” he explains. “That barrier is sort of a double whammy.”
Hill explains that normalizing sexuality, having open conversations about sex, and comprehensive sexual education is the only way to start tackling this unique stigma.
“I think we need to do a better job as a society talking about sex and sexuality more openly," says Hill.
You’re taking care of your own health, and that’s something to be really proud of.
Nolan Hill, Centre for Sexuality (on getting tested)
“For folks who are nervous about getting tested, it's important to honour that it can be a big step, it can be nerve racking, it is something that is not talked about and is maybe made to feel scary. Honour that that's a real experience, and honour that that's okay to feel that way,” says Hill.
The Centre for Sexuality specialist believes people can make a day out of getting tested to help ease nerves. He suggests booking an appointment, alone or with a friend, and after your trip to the clinic, rewarding yourself, a method he believes could incentivize STI testing.
“It's just important to know that you're actually taking really proactive steps to take care of your health,” he says.
“It's not something to be ashamed of that you're needing or wanting to get tested – it's actually a really positive aspect of taking care of your own health, and it's something to be really proud of.”