Fact, prevention, stereotypes and social stigma  

According to the World Health Centre’s report from 2005, annually around “333 million new cases of curable STIs occur worldwide, with the highest rates among 20-24 year olds, followed by 15-19 year olds.  One in 20 young people is believed to contract an STI each year, excluding HIV and other viral infections.  A minority of adolescents have access to any acceptable and affordable STI services.” (WHO, 2005 http://www.who.int/maternal_child_adolescent/documents/9241562889/en/).  

These trends do not seem to be reversing - the 2016 report claims that there are 357 million new STIs acquired every year (WHO, 2016 http://www.who.int/en/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis).

According to statistics, more and more teenagers experience their first sexual intercourse at the age of 15, more than half without protection. Out of fear for getting pregnant, they choose anal and oral sex.  Worryingly, their main source of information about sex is not sex education at school, but the Internet.

Sadly, Poland - as in many countries steeped in conservative catholicism - there is no ‘sex education’ at school. In Poland, the subject is called ‘Life in a family’ (loose translation), where students essentially learn that (paraphrasing the Bible) a woman’s body is a garden for man’s seed. In addition, the subject is often run by people not qualified to do so, such as priests or librarians. This is why young Polish people come to believe that anal or oral sex is not sex - you do not lose your virginity, and you cannot get pregnant.  In the eyes of their ‘teachers’, it does not count as ‘real sex’.  
 
The need for educating youngsters and preventing venereal diseases is a motto for such organisations as Ponton (a group of sex educators) led by Agata Kozłowska. Unfortunately, such groups work only in Warsaw. They realised that the program implemented in schools does not match reality - teenagers do not get any answers to the questions they have, or to concerns that bother them. According to Kozłowska, the results is that problems relating to sexual health are becoming bigger: venereal diseases and teenage pregnancies are the result of the message that sexuality is something bad. The virginal membrane has become a "sanctity" which should be kept until the wedding day.

Another problem is the omission of the existence of a sexual orientation other than heterosexuality, and the presentation of the "a boy and a girl is a normal family" model as the only obligatory and "right" path to follow. It is not surprising, then, that homophobia, transphobia or sexual violence are increasingly frequent phenomena (Newsweek 26.09.2018).
 
According to the World Health Organisation, and as confirmed by numerous researchers, sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are a not only a personal matter but public health and political issue. They still carry considerable mortality and morbidity and are a high economic burden. The number of these infections continues to rise, and although all sexually active individuals are potentially at risk of contracting an STI and may feel stigmatised as a result, it is heterosexual women and homosexuals who are particularly at risk of being stigmatised due to the entrenched gender norms and stereotypes associated with these infections (hivinsite.ucsf.edu › Home › Public/Patient › Basics).
 
FACT SHEET: STIs
 
Sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs) or venereal diseases (VD) are diseases that are passed on from one person to another through sexual contact - the infection can be passed on through vaginal intercourse, oral sex, and anal sex. Some sexually transmitted infections can spread through the use of unsterilized drug needles, from mother to baby during childbirth, or breast-feeding, and blood transfusions.
Examples of sexually transmitted diseases include: chlamydia, chancroid, crabs (pubic lice), genital herpes,genital warts,hepatitis B,HIVand AIDS, HPV, trichomoniasis (parasitic infection),molluscum contagiosum, pelvic inflammatory disease (PID), syphilis, gonorrhea, trichomoniasis (trich).
The WHO estimates that, worldwide, there are more than 1 million new STDs acquired each day. People aged 15-24 acquire half of all new STDs, and 1 in 4 sexually active adolescent females has an STD, such as human papillomavirus or chlamydia. Compared with older adults, individuals aged 15-24 have a higher risk of getting STDs
Source: WHO, 2016.

FACT SHEET: Prevention of sexually transmitted infections

Have "safe sex" - for each sexual act, use a new latex condom, whether it be oral, vaginal, or anal sex. Avoid using an oil-based lubricant, such as petroleum jelly when using a latex condom. Non-barrier forms of contraception, such as oral contraceptives or intrauterine devices, do nothing to protect people from sexually transmitted infections.
Abstain - abstaining from any sexual act is probably the most effective way to avoid becoming infected with an STD.
Be faithful to one uninfected partner - be in a long-term relationship with a person who is not infected, and remain faithful.
Vaccinations - there are vaccinations that can protect from eventually developing some types of cancer caused by two STIs - the HPV (human papillomavirus) and Hepatitis B vaccines.
Check for infections - before sexual intercourse with a new partner, check that the partner and yourself have no STIs.
Drink alcohol in moderation - people who are drunk are more likely to engage in risky behavior. Avoid using some recreational drugs, which may also affect judgment.
Explain you want safe sex - before engaging in any sexual act with a new partner, make it clear that you would only consider safe sex.
Education - parents, schools, and society in general need to teach children about the importance of safe sex, and explain how to prevent becoming infected with an STI.

Stereotypes
 
Historically STIs have been conceptualised simply as a medical/health dilemma for heterosexual men, yet have denoted immorality among women and deviance among homosexual individuals.
 
Although perceptions of sexuality are becoming broader and more accepting, women’s and LGBT people’s sexuality remains governed by traditional gender norms, that is why they continue to be subjected to oppressive and demeaning labels. Such a perception partly arises from STIs having a long historical association with female and gay prostitution, which is why women and homosexuals have been positioned as sources of STI infections and heterosexual men as victims of seductive, deviant and immoral behaviour of others.
 
As a result of these gendered stereotypes, women and homosexuals with STIs are still stigmatised and oppressed. In contrast, men who contract STI/s are not commonly subjected to demeaning labels, and having an STI is perceived to be a ‘normal’, albeit unwelcome, outcome of a man’s virility.
 
Stigma
 
Stigma is a phenomenon associated with many chronic health conditions, including leprosy, HIV/AIDS/STD, mental illness, epilepsy, disability and tuberculosis. Stigma has long been associated with sexually transmitted infections (STI).
 
The ancient Greeks came up with the term stigma to refer to bodily signs designed to expose something unusual and bad about the moral status of the signifier. Scientists define stigma as a form of deviance that leads others to judge an individual as ineligible to participate in social interaction. This is because of the perception of lack of proficiency to interact with society which is influenced by the person’s dangerousness and unpredictability. Stigma is a “collection of negative attitudes, beliefs, thoughts, and behaviors that influence the individual, or the general public, to fear, reject, avoid, be prejudiced and discriminate people.” (Gary, 2005: 980).
 
Stigma is a social construct and it seriously impacts patients and families alike. Stigmatized persons are regarded as people who have lost social value and are “spoiled” forever. It could be conceived as a rational construct which can be changed according to time and society (Florez, 2008). Stigma is a serious problem and a barrier for achieving life-goals for those with mental illness or sexually transmitted disease.
 
Unfortunately the myths and stereotypes of these diseases often lead to stigma. Stigma creates fear and negative attitude towards the stigmatized in society. It affects the whole society and impacts the lives of the stigmatized, leading to the internalization of a sense of low self-esteem, social rejection, discrimination, isolation and finally to withdrawal and therefore of aggravation of the disease itself. Stigma is a serious obstruction for the wellbeing of the person who faces such an experience.
 
Gender differences among individuals diagnosed with an STI have been identified. In numerous researches, women diagnosed with chlamydia feared being stigmatised and judged by others; they also perceived themselves negatively and felt ashamed, which reflected their own negative views of individuals who contract STI/s (Mills, Daker-White, Graham, & Campbell, 2006). This caused many women to conceal their diagnosis from others, yet the male participants did not fear stigmatisation, or perceive themselves negatively (Mills et al., 2006).
 
Social stigma is at the point of epidemics regarding people infected with HIV virus. Stigma and discrimination are manifested in many ways, for instance in health care settings, barring people from accessing health services or enjoying quality health care. Some people living with HIV are shunned by family, peers and the wider community, while others face poor treatment in educational and work settings, erosion of their rights, and psychological damage. These all limit access to HIV testing, treatment and other HIV services.
 
According to HIV Stigma Index, in 2015, more than 70 countries were using the HIV Stigma Index, more than 1,400 people living with HIV had been trained as interviewers, and over 70,000 people with HIV have been interviewed. Findings from 50 countries indicate that roughly one in every eight people living with HIV is being denied health services because of stigma and discrimination (http://www.stigmaindex.org/).
 
ECDC Special Report from 2017 claims that people with HIV are increasingly marginalised, not only from society, but from the services they need to protect themselves from HIV. For example, in 2016, 60% of countries in the European Economic Area reported that health care professionals’ negative and discriminatory attitudes towards men who have sex with men and people who inject drugs hampered the provision of adequate HIV prevention services for these groups (https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/Status-of-HIV-response-in-EU-EEA-2016-30-jan-2017.pdf).

There are plenty of forums, blogs and websites (eg. https://www.teensource.org/) where young people ask questions to the doctors and educators – these are a great resource of ideas.

1. How does your health affect your sexual relationships? 
2. How do your sexual relationships affect your health? 
3. How can you protect yourself from venereal diseases?  What different methods exist? 
4. Could you get a venereal disease by visiting a public swimming pool or by using a public toilet?
5. How big is the risk of contracting diseases during oral or anal sex? 
6. What is the most common STD among teenagers today?
7. What can happen if an STD goes undetected?
8. If you have a disease and you have a child, can the child get infected?

Some more practical questions, which you can adapt for your country/school:

1. Where can I test for venereal diseases for free?
2. If you suspect you have an STD, can need to get yourself checked out.  Can you go to the doctor for treatment without your parents finding out?
3. What organisations or groups offer information on STDs and details on health care options? 

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