American Board of Sexology Forums Articles in Clinical Sexology Help Your Clients Reduce STI Stigma by Starting with Yourself

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  • Dr. James Walker
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    November 29th, 2021
    Reposted from Sex Coach U by Julia Satterlee

    Sexually Transmitted Infections (STIs) might not be the sexiest topic in sexology, but as a sex coach, you can help make it a more sex-positive, pleasure-inclusive topic. Given how common these infections are, you’re almost certain to have clients who have acquired an STI, and perhaps you currently have or have had an STI, too. It’s important to not only know the basics, but also to check your own internalized shame around this topic, so that you can better serve your clients. STI stigma is a far bigger problem than the diagnosis itself.

    Your client might be dealing with having recently tested positive for an STI. They might be managing an ongoing (viral) infection and the stigma that often accompanies that. Or maybe they are just wanting to make sure they’re having sex-positive talks with partners about STIs & safer sex practices.

    We know life isn’t over if you’ve tested positive for a STI, but we want to make sure our clients are equipped to have a fulfilling sex life, regardless of their STI status. That includes being empowered and clear about their own boundaries and navigating safer sex practices. Informed, enthusiastic consent between partners is sexy!

    STI Stigma is the killer, not STIs
    While yes, STIs may cause health problems, especially if untreated for long periods of time, the most harmful aspect for many people is the stigma that goes along with them. We receive so many sneaky negative messages from peers, school, and popular media. These messages become ingrained in our minds because they’re constantly reinforced by everything from the terms we use (like saying “clean” to mean you haven’t tested positive for a STI) to graphics used by prevention specialists.

    I can remember being trained as a sex educator when I was in high school. The messages we were taught to share with our peers were fear-based and shame-based . Even though our education was supposed to be fact-based (and some of it was), it still included things like the “sexual exposure chart,” which showed how many people you would (potentially) be sexually “exposed to” for each additional partner you had over your lifetime. The numbers went up exponentially, so if you have 10 partners in your lifetime and each of those people have 10 partners, you could be “exposed to” 1,023 people, in theory.

    There was no clear explanation of what it meant to be sexually “exposed” to many people, but it was clearly intended to make you feel dirty about having multiple partners in your life, under the guise of STI prevention or explanation of “risks.”

    Imagine acting this way about someone getting the flu. Normally, we might ask how they’re managing and whether they need anything. “Should I drop off some soup? How are you healing?” Right?

    We don’t say, “You got the flu? You probably deserve it! What were you doing, anyway? I bet you were out breathing air with other people, sharing your germs with them. That’s so gross and irresponsible of you to catch the flu. You’re not clean anymore, so now no one will ever love you.” Yet that’s exactly how some people think and talk about STIs, and your clients have likely internalized a bit of those messages, too.

    If the culprit behind STI stigma is negative, shame-based, and fear-based beliefs about sex, then to beat the stigma, for ourselves and our clients, we have to take a good look at where we’re holding these beliefs. We can examine where we might need to do some work to reframe and get in line with the values we truly want to uphold around sexuality. Your worth is not measured by your STI status, and you can help your clients to internalize that message instead.

    The best place to start in deconstructing these negative messages is with sex positive education. Learning what’s scientifically accurate can help dislodge some of those beliefs and begin to break the stigma.

    The Basics: STI Transmission, Testing, and Treatment

    While STIs can be bacterial, viral, or parasitic, all STIs are infections that can be treated and managed. In other words, it’s not the end of the world to acquire a STI, no matter which infection it is. Your life is not over, and neither is your love life or sex life.

    The CDC estimates that one in four people in the U.S. has an STI on any given day. At least one in six people has genital herpes simplex virus (HSV). According to the CDC, “(Human Papillomavirus) is so common that almost every person who is sexually-active will get HPV at some time in their life if they don’t get the HPV vaccine.” (CDC data on HPV)

    Yet when I worked as a public health educator I would sometimes talk with people who were considering suicide, either because they’d just been diagnosed with an STI, or even because they suspected they had something like herpes.

    In general, STIs can be transmitted through oral, anal, and vaginal sex with a person who has an infection. Some STIs can also be transmitted through skin-to-skin contact with mucus membranes, and some through blood.

    Chlamydia, gonorrhea and syphilis are the common bacterial infections that most people have heard of. They’re pretty straightforward in terms of treatment with antibiotics, except in cases of antibiotic resistance. These are also pretty straightforward in terms of testing—they will usually show up on a test within a very short period of time after exposure.

    Testing positive for a bacterial STI does still bring up shame for many people, but because it clears completely with treatment, it doesn’t present quite the same challenges for the future as the three H’s—HIV, HSV, and HPV.

    Treatment and prevention options exist for these viral STIs. While HIV was once tragically fatal to so many people, now we have PrEP for HIV prevention, and highly effective medication for HIV treatment. There are vaccines for Human Papillomavirus (HPV) and Hepatitis B. There are antivirals that reduce outbreaks and transmission risk of herpes simplex virus (HSV).

    With viral STIs, testing can be slightly more complicated. HIV can take up to three months to show up on a test after exposure. Herpes is usually not tested unless you have symptoms, even if you go to the doctor and ask for “testing for everything.” There isn’t even a test for HPV for people with a penis. If you have a vulva and live in the U.S., you’re not tested for HPV until you’re over 30 or you receive an abnormal pap result.

    HPV can be confusing because there are so many strands. Only some are harmful, and of those, the strand either causes genital warts (which is a skin condition without other ill effects) or can potentially lead to cancer. Even though HPV is viral and it’s possible to carry it forever, some people do clear the infection on their own. Warts can be treated, and pap smear testing monitors for cervical cell changes, which can then be treated.

    With HSV, if you’re not having symptoms, you can still get a blood test for both HSV type 1 and HSV type 2. While they’re often called oral herpes and genital herpes, HSV1 is often transmitted to genitals during oral sex when someone has a cold sore (which is herpes). HSV2 can also be transmitted to the mouth, although that is less common. The blood test checks for antibodies in your body, so you can’t know from the blood test whether HSV is oral, genital, or both, if you haven’t had an outbreak.

    Both HSV and HPV are transmitted by skin-to-skin contact, so barrier methods help but they’re not 100% effective, even with perfect use. Both of these infections can also be present in the body for long periods of time and then suddenly present symptoms, so it can be difficult or impossible sometimes to know who transmitted the infection to whom, and when.

    Helping clients get from “yuck” to “yes” about STI conversations
    Why bother to be informed about all those basic details? Because you want your clients to be able to talk with a partner about testing and protection without the shame that keeps so many people silent. You want to empower your clients to make sex-positive and informed decisions about what type of protection will work best for them and their partner(s) in whatever circumstances.

    You want your client who is living with an STI to still feel fabulous about themselves, their bodies, their capacity for pleasure, and their relationships. So how can you help your clients get to this place of fabulousness?

    First, help them have “the talk” with potential partners. At a minimum, it’s a good idea to discuss most recent testing results and current STI status with a potential partner. For a suggestion of a more elaborate, sex-positive outline for the talk, check out a suggestion here. Your client could script or practice the conversation with you first.

    If your client has a positive STI status, help them figure out how to disclose their status in a way that is sex-positive and self-positive. It’s really common for people who have been recently diagnosed with an STI to approach disclosure from a timid and self-deprecating stance, where they are already expecting rejection. Just like when talking to children about sexuality, taking a calm, matter-of-fact approach to this conversation is usually best. Humor can make things easier, and some people have even found a way to make this talk part of their foreplay.

    Whether they are disclosing for the first time or they already have a disclosure but they don’t feel great about it, help them decide on the details. This includes what facts they want to share, as well as how they want to share it—the wording, the tone, where, what format (in person or over text or on the phone), when, at what point in getting to know someone. How can they add some humor or playfulness to the conversation, if that appeals to them?

    Encourage them to rehearse it with you if they want to. There are many great resources online that talk about herpes disclosure in particular, including this one.

    Remind your client that their status is only one small part of their relationship, so there’s no need to make it a bigger deal than it is. It’s also worth noting that STIs are so common, it’s very possible their potential partner has tested positive for one, or at least has some other experience with ex-partners, friends, or family members who have tested positive.

    You can also refer them to a sex-positive support group—online or in person—for people living with their STI, and to other empowering resources, such as podcasts. (One of my favorites for herpes is this one.) Another great resource is the STI Project.

    You can help your clients by first helping yourself. Start by noticing, rejecting, and replacing these hidden, deeply ingrained, sex-negative messages that might show up when we talk about STIs. In fact, turn your attention inward for a moment and reflect on how you felt when you first started reading this piece.

    If you’ve already done the self-work to excavate and eliminate your own STI stigma, congratulations! You’re now ready to help your clients do the same.

    As a sex coach, you can an amazing opportunity to help your clients release STI stigma through accurate sex education. You can then guide them in how to have open, sex-positive, destigmatizing discussions with potential partners about STIs, whether they’re disclosing a positive status or not.

    If your client has a positive STI status, first you can assist them in reframe what this infection means in their life. And you can show them how to de-shame their relationship to their bodies and themselves. Then you get to help them figure out how to have empowering disclosure conversations with existing or potential partners.

    STI stigma can be eradicated, through the patient and compassionate re-educating of ourselves and our clients. We all deserve to enjoy sexual pleasure and loving, supportive relationships, no matter our STI status.

    About the Author: Julia Satterlee

    Julia is a graduate of Sex Coach U currently living in Savannah, Georgia. She holds a BA in Sociology and a BA in Spanish and is a member of the World Association of Sex Coaches. She first became involved in both sex education work and social justice activism as a teenager, and has been passionate about human rights ever since. With strong roots in peer education and adult education models of teaching, Julia brings her zest for learning to everything she does. As a student advisor for SCU, she has the great privilege to accompany people along part of their journey into sexology. In her coaching practice, her focus is on helping women to identify their own spark and helping parents to rediscover their sexual selves. She leads workshops in addition to coaching individuals and couples. You can find more about her work at juliasatterlee.com.

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