STDS and Stigma


Sex is everywhere. Sex sells. But one of the implications of sexual liberation is the possibility of acquiring stds. Safer sex does not mean that there is no chance of getting an std. Condoms do not completely protect against stds like HPV (genital warts) and HSV (herpes). People like to use the word 'clean' to denote an std-free state, but this perpetuates stigma and misperception. Even careful, sexually responsible people, with good hygiene, who take care of themselves can acquire sexually transmitted diseases. Some people are unlucky enough to catch something their first time out, or within a long-term committed relationship - having an std doesn't necessarily mean that a person sleeps around.

When you think of cold sores, what is the commonsense approach or reaction of most people? When they have a sore, they abstain from kissing anyone or sharing cups, etc. We don't expect that all people with cold sores will tell every person they ever kiss that they have cold sores, and we don't expect them to wear condoms on their lips, even when they don't have a sore.

Cold sores are herpes. They are not significantly different from genital herpes. Even when a sore is not present, there is the possibility of asymptomatic shedding. It is estimated that somewhere from 50-80% of the population is affected by cold sores (HSV-1), and have the potential to pass HSV on, even when there are no visible symptoms. We do not require people with cold sores to inform any person they will kiss that they have herpes, but most people believe that those with genital herpes (HSV-2) must disclose to all potential partners. In some places, not disclosing can bring a threat of lawsuits.

Does this seem fair? Does it make sense?

HSV-1 and HSV-2 have been around for centuries, and it is really only since the 80s that genital herpes has been singled out as something really horrible that means your sexual life as you know it is over. In the 80s, a drug company created the stigma so that it could establish a market. Competing drug companies later continued to benefit from the original exploitation of prejudice and fears. At present, it is only in Western countries that antivirals are prescribed as suppressive therapy. In most countries, they are only prescribed for atypical/extreme symptoms.

When people request a full std panel from their doctor, HSV is not part of that. It has to be separately requested. One of the reasons for this could be that doctors know how devastating a herpes diagnosis is. Also, there are some false positives and negatives. It could also be they know that for the vast majority of people who have herpes, symptoms are extremely mild, or nonexistent. The first outbreak might be a bitch (if there ever is a first outbreak), but beyond that, for most people, it's no big deal. The stigma attached to the diagnosis is what is the problem, and is what leads to psychological devastation.

As for HPV - almost everyone has this or will at some point. It's why women are required to go for Pap smears regularly. There are (free) vaccines for young women, for some of the strains that are linked to cancer, but HPV remains a very common std worldwide.

If you are at a party or club, if you look around, out of every 20 women, 4-5 of those will have HSV-2, but only one will know she has it. The ones who don't know they have it can pass it on through asymptomatic shedding.

Is it fair to segregate people sexually, according to std status? Should these 'diseased' people date only other 'diseased' persons? What about 'what's on the inside' of a person? Does the std trump that?

With regular sex, over the course of a year in a given relationship, the chances of a partner who doesn't have genital herpes contracting it from one who does is approximately 3-4%, if the only measure taken to prevent transmission is abstinence from sex during an outbreak or prodromal symptoms (this is when there are no visible symptoms, but the person experiences itching or tingling - signs that there might be some shedding of the virus). If the couple use condoms, this risk is reduced a little. If the person with HSV takes antivirals, the risk is reduced, and if condoms and antivirals are used, the risk is very slight.

Plus, there is the possibility that the other would never exhibit symptoms, even if they did contract herpes - because this is how herpes presents for the majority who have it. Basically, the odds are pretty good.

The thing that most people have trouble with is the 'slight chance' issue. If there's any risk at all, a sexually responsible person will inform all potential partners, so that they can decide for themselves if they want to take the risk, or not. Yes, it would suck to be one of the very few who contracts herpes and goes on to develop horrible symptoms. But when the risk is so small, and when the vast majority of those who do have herpes either have no symptoms or have very mild symptoms is it really fair to make sexual pariahs out of all people who have herpes?

I contracted genital herpes at age 23. At that time, the consensus was that a person's life was over when they received such a diagnosis. The internet wasn't around at that time, and the info I received from healthcare professionals was ominous. I was also told in no uncertain terms that I was now expected to inform all potential sex partners.

People today are still told they must disclose. The problem with this is that because of the stigma attached to herpes, this could seriously limit their options, for no good reason. Most people, when faced with the choice: would you sleep with someone who has herpes? would probably opt not to. It is argued that if someone 'really loves you' they will see beyond the herpes to the person inside. But, not all people are ready to commit for the rest of their lives. Herpes is, for most people, a relatively benign skin condition that should not force their hands.

What about those who don't believe in lifelong monogamy or commitment? What about wanting to explore before making a commitment? Even though women might be more inclined to be commitment-oriented, there still might be many who fantasize about encounters in which glances are exchanged, but not many words, encounters which are remembered throughout life, but do not lead to marriage.

With a herpes diagnosis, all that should be over, forever?

The way it is handled by medical professions and public service announcements seems to be that if you have it, it is your responsibility to be careful. So, even in a long-term relationship, you should use condoms and take precautions. Forever. If you really love and care about someone, you will do this. It's your responsibility. I don't know.. it just seems so restrictive, when it comes to love and sex. You made a terrible mistake, but you can fix it by being on your best behaviour for the rest of your life, no exceptions! I guess I'd rather go without.

People who have herpes all too often feel 'less than'. Dirty, diseased, damaged. They might not feel deserving, they might experience guilt and shame, or a sense of hypervigilance - the feeling that they must always be aware, and always protect others from them and their horrible disease, so as not to ruin another life.

When it comes to casual sex partners, I don't think people with herpes should have to disclose. Casual sex is inherently risky, and both parties assume the risk when they don't get to know each other before having sex. The lack of complications is part of what casual sex represents. If people with cold sores don't have to tell the people they kiss they have herpes, I don't see why casual sex partners have to be informed that someone has genital herpes. The other person could have herpes already and not even know it, or could have something else. If it is important to people to know their partner's status, then they should ask to see test results. If people with herpes avoid sex when they have outbreaks or prodromal symptoms, and if they practice safer sex, I don't think they should have to 'warn' people they have herpes.

When it comes to long-term relationships, the issues are different. Do you tell prospective partners, and if you do, how long do you wait? Is there a possibility you will scare someone off if you tell them before they have had a chance to get to know you? Will it be harder on both of you if there is a rejection once both are already feeling attached? Because the stigma related to herpes is so extreme, how many people can be expected to rationally assess the information?

In a long-term relationship, it's practical if the other person can know. If there are times when an outbreak is occurring, it is easier to just tell your partner about it, rather than make up excuses as to why to avoid sex until it's over.

I have been 'out' regarding herpes for many years. What I mean by that is that the information has been available publicly, on my site. It has now been many years since any person has expressed sexual interest in me. Is this because I have herpes? Is it because I am physically or psychologically unattractive? Is it because I am getting older? Is it because a person who is obsessed with death and talks about suicide all the time isn't very much fun? Is it a combination of all these things? It doesn't seem likely that herpes is the biggest factor, but it does seem that because of the stigma attached to herpes, and the fact that although it's a pretty common std not very many people are willing to broadcast that they have it, it is unlikely it plays no part. People who are more connected to life and 'attractive' could hurt their dating chances if they admit to having herpes. And even though people want to believe 'love conquers all', it is possible that in many cases herpes becomes the deciding 'con' that prevents a relationship from moving forward.




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