STI-related Stigma and Shame

Women and men in many different types of relationships and with different levels of sexual experience contract sexually transmitted infections (STIs). Nonetheless, there is stigma, called STI-related stigma, associated with having an STI. STI-related stigma refers to the association of STIs with people with undesirable characteristics, such as “promiscuity” or being “dirty” and such stigma is one of the greatest barriers to seeking appropriate health care. In addition, individuals who have STIs often report feeling considerable shame, guilt, and embarrassment and worry about other people rejecting them. My former graduate student, Lyndsay Foster, and I conducted a series of studies investigating factors associated with STI-related stigma and the sexual well-being of individuals who have a STI diagnosis. This program of research has been published in the four manuscripts listed below.

The first study explored the extent to which attitudes, education, and knowledge are associated with STI-related stigma and shame. We used the attribution-value model of prejudice (AVM; Crandall & Martinez, 1996) to guide this work. According to this model, negative attitudes develop when a stigmatized group is assumed to be responsible for having characteristics that conflict with one's values. Consistent with the AVM, we found that conservative sexual attitudes and authoritarianism were more important than was knowledge about STIs in predicting STI-related stigma and shame. 

We also conducted an experiment to examine the effects of features of the illness and characteristics of the observer on individuals’ tendency to stigmatize individuals with STIs. We found that people with more conservative sexual attitudes were more likely to blame individuals for having a STI; they also associated more negative affect with having a STI. Further, having herpes (an incurable STI) was associated with more stigma and shame than was having chlamydia (a curable STI). Consistent with the AVM, participants judged a peer more negatively if their STI was acquired through controllable compared to “accidental” factors (i.e., a condom breaking).

As her dissertation research, Lyndsay examined the sexual well-being of individuals who have been diagnosed with an STI. This research examined differences between people who had had or had not had a STI diagnosis in terms of their sexual behavior, sexual concerns and problems, and sexual thoughts and feelings. Overall, participants with a STI history reported high sexual well-being. Although there were some differences between individuals with and without a STI diagnosis, the size of these differences was small. This suggests that being diagnosed with an STI does not routinely have a negative impact on sexual well-being. Nonetheless, participants with a STI diagnosis reported being somewhat less sexually satisfied and were more likely ot have experienced a distressing sexual problem than those without a STI history.  

Finally, we examined factors associated with better sexual well-being among individuals with an STI diagnosis. Individuals who more strongly agreed with stigmatizing stereotypes about people with STIs, felt more shame about their diagnosis, and reported experiencing more negative reactions from others due to their STI reported poorer sexual well-being. In addition, individuals with more severe symptoms reported poorer sexual well-being.

Publication based on this work:

Foster, L. R., & Byers, E. S. (2014). Predictors of the sexual well-being of individuals diagnosed with herpes and human papillomavirus. Archives of Sexual Behavior. Online before print DOI: 10.1007/s10508-014-0388-x

Foster, L. R., & Byers, E. S. (2013). Comparison of the sexual well-being of individuals with and without a herpes and/or human papillomavirus infection diagnosis. International Journal of Sexual Health, 25,148–162. DOI:10.1080/19317611.2012.739596

Foster, L. R., & Byers, E. S. (2013). Stigmatization of individuals with sexually transmitted infections (STIs): Effects of observer and illness characteristics. Journal of Applied Social Psychology, 43(S1), E141-E152. DOI: 10.111/JASP.12036  

Foster, L. R., &  Byers, E. S. (2008). Predictors of stigma and shame related to sexually transmitted infections: Attitudes, education, and knowledge. Canadian Journal of Human Sexuality, 17,193-202.