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Taking the STI Out of Stigma

Campus | March 7, 2016

During my sophomore year, I went home for spring break and had my annual gynecology exam. I decided to get tested for Sexually Transmitted Infections (STIs), not expecting positive results. A few days later, I received a call from my nurse practitioner—I had tested positive for chlamydia. I panicked. How do I get rid of it? What does this mean for my health? And the worst part, how do I tell my partner that I have an STI? I was soothed when I learned that the treatment was to take two antibiotic pills, just once. I took the pills, and sucked it up enough to text my partner and tell him he should get tested.

As soon as I was healthy and back on campus, I started telling my friends that I had chlamydia. My confession was met with frequent shock and occasional disgust. Faced with these reactions, I started to wonder how many people at Tufts had STIs. I felt isolated and alone, but I was sure that on a campus of 5,177 students I could not have been the only one who had this experience.

STIs are quite common in the United States. According to the Centers for Disease Control and Prevention, there are 110 million cases of STIs in the United States, 50 percent of which are diagnosed among 15 to 24 year olds. Twenty million new cases are diagnosed annually. The most common STIs include Human Papilloma Virus (HPV), Herpes Simplex Virus, Trichomoniasis, and Chlamydia.

In an anonymous survey of 312 Tufts Students, nearly all STIs highlighted by the CDC were accounted for. The only exception was HIV, which Health Services reports is present at Tufts as well.

Thirty-three percent of survey respondents said they knew someone who had an STI at Tufts. Yet, only 7 percent said they had tested positive for an STI. While the survey results only represent a fraction of the Tufts population, I was nonetheless surprised by this finding, as I expected that it would reflect the United States prevalence. It is important to note that only 57 percent of the students who responded had been tested for STIs. Those who had not been tested may well have had STIs and not even known it.

Even more revealing, however, were the personal testimonials of Tufts students who had contracted an STI. The comments received from the survey indicate how traumatic contracting an STI can be.

One particularly poignant comment made by a senior stated, “[genital herpes] really grossed me out. I had very visible, painful sores. It was so nerve-wracking to get, and tell the guys that I had slept with that I had it…especially because there were a few of them. Mostly, I didn’t feel like myself. I’m very sexual, I love sex and having the herpes bomb fall on me was pretty devastating. Not only painful, but I truly hated my body. Like I was invaded by an alien.”

As this senior explained, STIs can be physically painful and distressing. Beyond the physical ailments of STIs are the psychological challenges of feeling alone and embarrassed.

A few students who tested positive explained that they were hesitant to tell their friends at Tufts because of the stigma associated with STIs. As one student explained, “I felt it was my fault since I did not use protection.” One student said he felt “slutty” and “dirty” upon receiving a diagnosis. A student with genital herpes said she avoided disclosing her diagnosis to her friends because herpes “has such a strong negative connotation because it’s incurable.” A first-year student explained that if she were diagnosed, she would “be embarrassed to tell anyone because I wouldn’t know how they’d look at me. Friends already joke about having something if their lips are chapped or if they have an allergic reaction to something, so I wouldn’t know how to seriously be able to tell anyone that I had an STI.” These responses exemplify how the perception that STIs are gross and incurable can negatively impact those diagnosed.

The survey also revealed that some students are reluctant to get tested at Tufts Health Services. Only 20 percent of responders who had been tested for STIs used Health Services.

The most frequent reasoning for not going to Health Services was that the cost of getting tested at Health Services without Tufts Student Health Insurance is “prohibitively expensive.” It is easier for students to wait to see a healthcare provider that accepts their insurance, allowing time to potentially transmit the STI to other partners or for an STI to worsen. One senior said, “I went [to Health Services] the other day to ask for a price estimate for various STI tests and had a really hard time. The person whom I talked to (in the billing office) couldn’t tell me how much tests cost…she called other people to find out what kinds of tests were administered.”

Other students had too much trouble making an appointment, or were concerned that their parents would find out about their tests. Carolyn Schwartz, a nurse practitioner at Health Services, provided more insight into the testing process at Health Services. When asked about how she addresses STIs with students, Schwartz said, “we have a conversation about what [a positive test] means, and how [the STI is] treated, and then we try to talk about their risk—once you have an STI, your risk for future STIs is greater. We try to talk about barriers and condom use in a non-judgmental way. I think that a lot of the stigma and shame comes from people feeling like ‘I should’ve used a barrier, I should’ve used a condom’…and maybe they have some self-judgment about that.” Schwartz hopes to help students understand that STIs are more common than some students may think.

In response to concerns about the prices of testing at Health Services, Schwartz said that she occasionally recommends that students without Tufts Student Health Insurance wait to see their healthcare provider at home unless they are showing symptoms, in which case treatment is imperative. She emphasized that there are free clinics in the Medford/Somerville area that provide testing as well.

Students without Tufts Student Health Insurance can get tested without their parents finding out. After a test, Health Services will add a bill to the student’s tuition titled “Health Services Fee.” If the student wishes to send this to insurance, the insurance company may ask specifically what the charge was for; due to privacy laws, however, Health Services cannot disclose to parents the exact reasons behind fees without the student’s consent.

Schwartz emphasized that when it comes to STIs, “knowledge is power and shaming anyone for anything medical…makes people not want to talk about it. But the more we talk about it, the less shame that’s out there.”