The term “STD” (sexually transmitted disease) is increasingly replaced by “STI” (sexually transmitted infections). Is this change (which started as early as the late 1990s) a matter of political correctness? An effort to reduce stigma affiliated with disease? Or are there real distinctions between infection and disease, hence adopting a more medically accurate term?
The correct answer: all of the above.
In the days before “STDs” there was only “venereal diseases”, and sex workers were the culprits. Image from the DailyMail.co.uk
Usage can be confusing because the medical distinctions between infection, illness, disorder and disease often overlap. In general, however, “infection” is only considered an illness or disease when symptoms occur. Many sexually transmitted bacteria and viruses are contagious without causing symptoms (or may have asymptomatic periods). Just a handful of these include chlamydia, gonorrhea, herpes simplex, HPV, hepatitis and HIV.
Most STIs are treatable. Some strands of HPV can be wiped out by the immune system alone (but not always). But some STIs are not curable, like herpes and HIV (as of today). Contrary to popular confusion, it is not correct to differentiate STIs as “curable” and STDs as “incurable”.
The major distinction is that all STDs are caused by infections. However, not all infections develop into illness or disease. Also, a disease is always associated with symptoms; an infection is not so consistent.
Does this mean it’s wrong to use “STD” in the twenty first century? I would argue no. In many instances, STI and STD are used interchangeably and refer to the same thing.
Why I Say “STI”
I think it boils down to semantics and meaning. Some people feel that dropping the word “disease” only reinforces stigma. Why not just face the fear head on? The more we speak of “disease” the more normalized it becomes, right? Well, not necessarily. “STD” eventually replaced the more euphemistic term “venereal disease” by the 1980s, yet stigma firmly remains.
Personally, I prefer the term STI for two reasons. Firstly, “STI” is a broader term thus more inclusive. Secondly, using the term STI helps raise awareness that physical symptoms are not a reliable way to determine your status. A person can be infected with no symptoms and pass on the infection to others without having a disease.
Serious point here: According to the CDC, 1 in 5 people who are living with HIV today in the United States do not know their status (CDC 2013). In fact, people who do not experience symptoms and/or are not tested are the ones most likely to pass on infection to others. There are serious consequences when STIs are left unknown and untreated. It increases the risk of infection for other STIs and disease. In short, ignorance (RE: stigma) of getting tested and assuming you won’t get an STI is the greatest cause of infection.
The fabulous sex educator, Andrea Renae (@theandrearenae), recommends the Judgement Free Health Care Providers directory, which is inclusive of LGBT and Queer people, Asexuals, Demisexuals, Polyamorous relationships, sex workers and people living with HIV. There is also the safer sex video Pleasure Rush initiative (NSFW) by GALAEI.
The Daily Mail and MSN Now published an exhibit of 1940s sexual health posters raising awareness about the spread of gonorrhea and syphilis. What’s striking is the way these images packaged moral stigma. Women, particularly sex workers, “loose” women and “victory gals” were portrayed as the sinful source of venereal disease. Copying war-style propaganda, some posters depicted sexualized women as the enemy for comrades to brave against. Like this one displaying an assembly line of blonde temptresses- all the same; all out to fuck you and your country.
WWII Public Service Announcement. After condoms are finally made legal in the USA Army. Image from the DailyMail.co.uk
Loose equals Loaded with disease! Read STI stigma. Image sourced from the DailyMail.co.uk
Many campaigns, like this one, used fear tactics and warned soldiers not to be fooled by the attraction of “loose” women- for they are not what they seem.
And, of course, we won’t mention the risks of unprotected sex for men who have sex with men, because that doesn’t exist in the armed forces (sarcasm).
Another aspect to put into perspective is the history of condom stigma, especially in the United States during the first World War. These PSAs were made just after condoms became legalized and issued to the Armed Forces.
But during the First World War, the reality of STIs dealt with differently. It was widely believed that venereal disease was the price one paid for sinful choices.
Thus, the American Social Hygiene Association objected to issuing condoms to soldiers- so during the First World War, they weren’t. In fact, since 1873, the U.S. government illegalized any advertisement of contraceptives. That same set of laws also banned the sale of condoms and allowed for condoms to be confiscation from personal mail in up to thirty states (Collier, 2007).
It wasn’t until World War II that the use of condom became prominent among both European and American soldiers. Keep in mind that condom technology at the time was not regulated and the pleasure factor was close to nil. Lubricant wasn’t invented until 1957. Defective latex and breakage rates were high. It wasn’t until the 1960s that North America and most of Europe established a quality standard controls for manufacturers to follow (Perera 2004).
Read here for more on the foible history of condoms and other contraceptives.
Visit the Daily Mail and MSN to view more WWII sexual disease propaganda.
This post is written by Tashia Amenerio, founder of the non-profit HPV Awakening. She writes from her personal experience why she is pushing for HPV be reportable- meaning sexual partners must legally inform each other of their status- and why she urges you to sign the petition to get the FDA to approve HPV testing for men.
Graph from the CDC. Fourteen million will become newly infected with HPV this year. This means that almost every sexually active person in the US will acquire HPV at some point in their lives.
When diagnosed with HPV, life as you know it is over. You face disturbing contradictions within the medical community . On the one hand, there are those who describe it as “this generation’s AIDS”. On the other side, you are faced with medical “experts” who don’t know their head from a hole in the ground and tell you that HPV is nothing to worry about.
Here is the kicker: Most HPV strands, like most cold or flu strands, really don’t do much of anything but chill out in your body having a viral party of genome development. The issue(s) arise when you get people who are knowingly infecting others with cancer causing strands- a crime of which I’m personally all too well aware. And then you have others who are unknowingly transmitting the STI. A major reason for this is because it is not standard practice to get tested for HPV- and there are no official tests made publicly available for males- despite the fact that HPV is the most prevalent STI in North America right now.
So What Can We Do?
Well, I started a nonprofit HPV Awakening Inc. I lecture all over the Florida and have done a few media interviews. I sit here now writing you about my experiences and I’ve launched a petition that needs 100,000 signatures by May 28th, 2013, so that it can go to the White House to get HPV male testing approved by the FDA. Sign the petition.
I have contacted several local media stations and sites. And I have tried moving my civil court case Tashia Ameneiro vs. Zamil Xavier Lopez to a criminal one in order to have the state acknowledge the fact that HPV cancer strands should be taken as serious as AIDS/HIV strands.
The Miami Dade DA has kindly informed me that, well, HPV isn’t mentioned in the Florida statute at all. Thus they can’t help me. This is in spite of the fact that my case is backed with the full support from the local police department that filed my report (Miami Gardens), and they are willing to facilitate the investigative work!
So here is where you the reader come in. What can you do? Well, if you have ever been diagnosed or know someone that has been- I can relate. It sucks and it isn’t easy. And fun (insert EXTREME sarcasm) questions and situations follow diagnosis.
From Why Me? To What I Will Do About It!
In my case, I had been a virgin with no sexual experience prior to my ex, so I didn’t have to go through the questioning phase of Who? But I did have to go through the constant questioning phase of Why? After I received my diagnosis and contacted my ex he kindly informed me that he had known but since it hadn’t directly impacted me he hadn’t cared.
But that wasn’t the only “Why”. The “Why me?” phase kicked in and it kicked in for several of my friends too. Because once you get sick, it isn’t just you. It’s you and those that care about you, or who know you in a caring light- family, acquaintances, associates, co-workers and strangers you disclose to- that are impacted.
I remember one conversation in particular with a friend of mine that went through a bad life phase (attempted suicide and was a bug chaser at one point in time) sitting on the stairs while we shared a smoke (a short lived habit I picked-up during that “Why be and Why bother” phase). He was crying because he couldn’t understand how “Good people like [me], who never do anything risky end up getting sick and people like [him], who have tried every way possible to be ill and die didn’t.” Easy answer: “I don’t know what a ‘good’ person is, but sometimes Shit Just Happens.” It is a matter of what you do with the situation that counts.
I finished the cigarette and realized that some habits aren’t worth starting or maintaining just to stay wallowing in self-pity.
For those of you that are still reading, I say Yay! Thank you in sharing in my past misery. It really does love company.
Please sign the petition to get HPV male testing approved by the FDA. Go to We The People to sign.
The US faces an HPV epidemic, yet there is still little known about the virus. A Florida-based grassroots organization, HPV Awakening, is fighting to expand research about the virus to provide resources for treatment and prevention. Public awareness is in desperate need of an energy boost.
HPV is the most prevalent and rapidly spreading STI in the USA according to a February 2013 report (PDF) by the CDC (Center for Disease Control and Prevention). Based on the most recent data on STIs in 2008, the report finds approximately 80 million Americans are infected with some form of HPV- which makes up 71% of all STI infections in the country. And it is spreading fast, as most people with HPV do not know they are infected. Fourteen million will become newly infected this year. This means that almost every sexually active person in the US (regardless of sexual orientation, number of partners, age, income, etc.) will acquire HPV at some point in their lives. In other words, we are officially in an HPV crisis.
Sounds pretty serious, eh? In most cases, HPV will go away by itself before it causes any health problems- particularly in young people. The problem is that there are many variations and strains of HPV- 40 of which are related to cancer- and there remains much unknown medically about the virus and how to detect it.
For example, there is no certain way to tell who will develop health problems from HPV and who will not. For men, there is currently no FDA-approved HPV test, which means that men who have clear STI screenings with negative results should not consider themselves HPV-free or at zero-risk. The only form of testing a male can have is through an anal pap smear (used to check for anal cancer), and only if he has been the recipient of anal sex, not directly as a method to check for HPV. For women, there are test to directly detect the virus, but they are not mandatory- you still have to specifically ask for them, despite how prevalent HPV is in the USA. In 2009, the FDA approved DNA testing for HPV yet blood donations and samples are not screened.
What is HPV? Human Papillomavirus is an infection of the skin and mucous membranes. There are over 100 strains of HPV of which 40 are identified as sexually transmitted infections. It is often called “genital warts”, because when a strain causes warts (not all do) and symptoms are visible it appears as tiny cauliflower-like clusters on the genitals. These HPV types can also infect the mouth and throat. Other strains are cancerous and some are a direct cause of cervical, anal, and oral cancer. On average, about 15,000 women get diagnosed yearly with cervical cancer and about 80% of these cases are cause by HPV.
In most cases, HPV shows no symptoms yet remains highly contagious, and unfortunately, condoms do not offer 100% protection. However, they are by far safer than going without protection. It is generally stated by health organizations that condoms provide approximately 70% protection against HPV.
How does it spread? Penetrative sex or exposure to bodily fluids, like semen, is not needed to contract HPV. It is transmittable by skin-to-skin contact during oral, vaginal, anal, and manual sex. It is most commonly transmitted from direct genital-to-genital contact (touching two sets of genitals together without a protective barrier). Some strains can be transmitted from kissing.
The CDC recently reported that HPV is contactable from mother to child through vaginal birth. Yet there is still much unknown about the virus. For example, the only studies released for HPV cases in children are from oral cancer cases. As the non-profit organization, HPV Awakening points out, no information has been released about whether or not children are being examined for anal, cervical or other cancers caused by HPV.
How is it diagnosed? HPV is detected from examination of warts and from tissue samples taken during a gynecological or urological exam. For women, a PAP smear does not test for the virus itself, but may detect precancerous condition that are caused by HPV. There are DNA tests that can be done with or without a PAP smear. These tests can determine if the type of HPV is a high-risk stain. For men, there is currently no FDA-approved HPV test, which means that men who have clear STI screenings with negative results should not consider themselves HPV-free or at zero-risk.
Is it curable or treatable? No. Warts can be removed. However, the virus may still remain in the body and can be transmitted to partners, and/or cause long-term health problems like cervical cancer.
Unfortunately, neither public awareness nor medical understanding of HPV matches these severely high statistics. Few people, both teens and adults, think about how a condom is only 70% effective against the virus or that a clear STI screening does not indicate that they are HPV-free. Blood banks do not screen for HPV.
And HPV is considered a “none-reportable” STI. This means that the US government and the CDC do not feel that individuals have a legal obligation to be informed by a partner that they have had a history of or currently have an “active” case of HPV.
Yet rather than acknowledging our unfamiliarity and unawareness of HPV we, the general public, continue to reinforce great social stigma with being diagnosed with an STI. And thus, the ignorance continues. This is precisely why the non-profit group HPV Awakening exists: to educate the general public and push for more investment in medical research.
HPV Awakening Inc.: was founded by Tashia Ameneiro shortly after she was diagnosed with HPV at 25 years old. She contracted the virus from her first sexual partner who had known he was a carrier but did not tell her. It wasn’t long after that Tashia found herself trying to coop with a severe lack of public resources compounded with social stigma for being diagnosed with an STI. The impact of being diagnosed led her and her friends (Virginia Pena and Yvette Rodriguez) to launch HPV Awakening- A nonprofit to counteract social stigma through public education.
The Miami-based organization is the first established non-profit in North America to address general HPV that is not limited to one cancer form or another caused by HPV. They run workshops, lectures, and info booths at universities, schools and community events to raise public awareness about HPV and how to protect one self. They have partnered with major community-based organizations, such as the Village South/WestCare – Project IMPACT, hosting the First Cervical Cancer Day at FIU in January 2013 to provide a wide range of free health information to the public. HPV Awakening has also partnered with several student organizations such as VOX, WSSA (Women’s Studies Student Association), The Vagina Monologues, and One Billion Rising.
Along with improving public awareness, HPV Awakening is also putting pressure on the FDA and greater medical science community. They are pushing to make HPV caner strands “reportable” and get HPV male testing approved. They are also trying to expand medical and social research about the virus and the impact it has not only physically, but mentally and emotionally.
They need your support: As with all social causes, people’s support is essential to their survival. HPV Awakening functions through the hard work of just Tashia, her mother, and a few friends. They currently have no funding or sponsorship. All the things they have managed thus far have been done through their own pockets and free-time. They need support from everyone and have set up a donation bank on their website.
They desperately need funding for basic things like printing information pamphlets, free condoms to distribute, website management and sponsorship to attend relevant events like Gay Pride Fest- Miami Beach, AFO, and Exxxotica Expo.
They welcome any support. This includes actions as simple as sharing their facebook page or more involved help such as volunteering at their events and donating money to help them stay afloat.
A recent study by researchers at Stanford Medical School reveals that a large portion of young women are irresponsible in bed, meaning they ain’t protecting themselves. The year-long study collected data from 1,194 sexually active females aged 15 to 24 who visited Planned Parenthood clinics and were beginning contraceptive pills, patches, injections, or vaginal rings for the first time. At the beginning of the study, only 36 percent of participants consistently used the “dual method” (relying on both hormonal contraceptives and the condom), which meant that STI and STD protection was compromised. Getting pregnant seems to be the only risk to care about.
Surprised? To be honest, I wasn’t either as I know many friends whose first time using birth control was when they entered a relationship with someone they trust, and that trust included believing (hopefully, with medical proof) that neither person carried STIs.
However, it gets worse: The study found that over 50 percent of young women did not resume condom use after they discontinued hormonal contraceptives. That’s right, NO protection!
Less Youth are Using Condoms
Why is this happening? And how can prevention improve? According to Rachel Goldstein M.D., lead author of the study, the most influential factor of condom usage is the partner’s attitude toward condoms. When a woman did not know how her partner felt about condoms or knew that he felt they were “very important”, she was more likely to be a dual method user than when her partner thought condoms were “not at all important”. The researchers speculate that power imbalances within the relationship impact the woman’s ability to negotiate condom use. “It appears that her partner’s feelings may be more important than her perceived risk of a sexually transmitted infection or her own beliefs about dual method use,” said Goldstein. This is an important point of concern. There are many factors, including levels of mutual respect, emotional maturity, and self-esteem that need to be considered when counseling youth about healthy sex (Scarleteen offers great advice on negotiating condom use). Of course, the study concludes that more counseling is needed to accompany hormonal contraceptive treatment that emphasizes the risks of STIs and STDs.
However, I think this is only one piece in the very complicated puzzle of sexual relations. Plus, the research does not address why young women are not resuming condom use after discontinuing hormonal medication.
In fact, condoms are not very popular among young adults in general. According to the American Academy of Pediatrics and the Henry J. Kaiser Family Foundation, the rate of STIs in people 15-24 years old is exceptionally high. Two-thirds of all individuals who become infected with STIs in the United States are younger than 25 years old! The reason for this is because young people simply are not using condoms and other barriers consistently or correctly to protect themselves and their partners.
Condoms Miss the Limelight
Now, most teens in North America have been exposed to sex ed and know why condoms exist, but this is obviously not the only means to ensuring healthy sex lives. Indeed, sex pedagogy in North America is riddled with censorship (that’s a whole other post), and health counseling should accompany hormonal contraceptive use. Both these solutions, however, overlook a larger social problem. The social stigma which has developed around STIs and diseases has produced negative attitudes and ignorance towards safer sex. It’s fair to say that this negativity permeates in our popular culture.
Condoms and other safer sex practices have acquired an unsexy reputation from their very absence in romantic and steamy and sex positive representations. Pornography, films, romance novels, or how-to articles in popular magazines rarely represent the condom and how it can actually increase sensuality, not dull it. And this is something that needs to change because it limits our knowledge, attitude and imagination about what healthy sex can be.
This is not to say that viewers of media are passive recipients who are easily influenced by what is on TV. But media can be interpreted as a cultural artifact that reflects beliefs, attitudes, prejudices of the times. It is a matter of what sells, and unfortunately, the mainstream only works to reinforce the notion that safer sex is a chore.
One Solution: Safer Sex Porn!
There are some who have sought to exert control over the representation of safer sex through alternative media. One honorable example is the 1990 video short, Current Flow, by Jean Carlomusto starring Annie Sprinkle and Joy Brown. This explicit video was made in response to Cosmopolitan magazine publishing a piece which erroneously claimed that virtually no females could contract HIV. The short is basically about a woman (Annie Sprinkle) masturbating on the couch with her vibrator. Suddenly her vibrator stops and we see a woman enter the room with a towel in one hand and a power cord in the other (not many battery-operated vibrators back then). The woman seductively crawls over Annie and rolls out from her towel dental dams, latex gloves, condoms and lube for the dildo. And the climax begins.
But this is not just any girl-on-girl porn, it also emphasizes “showing how”. For example, a close-up of Annie Sprinkle getting eaten-out shows how to use a dental dam. Another shot shows Joy Brown washing the dildo before it is her turn to use it on Annie. As Carlomusto writes,
“…in order to educate lesbians about safer sex we have to establish what it is. Saying, ‘use a dental dam’ is not the same as saying ‘use a condom’, since many women don’t know what a dental dam is” (1992: 82).
Current Flow is the first of it’s kind. Sexy and safe lesbian porn made by and for lesbians. It was made at a particular time during the HIV/AIDS crisis when the Centers for Disease Control refused to investigate data on woman-to-woman transmission of HIV. It was also a time when mass media and public health bureaucracies refused to produce explicit sex education or represent gay and lesbian sexuality. While the information today is made more available and inclusive of a wider public, we still do not see safe sex represented as often as we see sex in the media.
Safer sex should be not be limited to public health messages or HIV/AIDS activism. What would be powerful is normalization of safer sex in everyday media. Imagine music videos- the soft porn of daytime television- including condoms in a sexy, bootylicious way…
Dull Feeling in Bed Begins with Dull Attitude
You might think that the reason there are few representations of positive condoms in popular culture is simply because condoms are genuinely unfun and decrease pleasure. You might think that it is for this reason that younger people are using condoms less. I would argue that this belief is grounded more in attitude than it is in actual reality. Let me explain.
Some studies, such as “Sexual Pleasure and Condom Use” by Randolph et. al. (2007), have found that those who report sex with a condom as less pleasurable tend to be people who have not used condoms in a while or who don’t use them at all. They found that more men than women tend to believe condom use is less pleasurable even without actual experience. It is beliefs that influence experience with condoms and whether one wants to use them. It is true that many people reported that unprotected sex feels better than protected sex. Overall, people who are familiar with using condoms tend to report greater pleasure with protected sex than those who are likely to go without protection. As Heather Corinna at Scarleteen writes, “The more you use them, the more they feel good, and it’s people who don’t use them at all that tend to complain about them most.”
In other words, it is the attitude that one has towards condoms that greatly affects satisfaction. People who use condoms often do not express a decrease in overall pleasure because they learn what condoms suit them best and what ways they are most comfortable using them.
Know Your Condom
Which brings me to my next point. Part of the process of popularizing condoms is to increase understanding of the different types and ways of using them. Another study by Michael Reece and Debra Herbenick (2012) found that many people do not know how to use condoms properly and what can increase pleasure. For example, putting a drop of lube inside the condom before rolling it on can improve application and increase sensitivity. Also, the condom can be put on in sexy and tantalizing ways by you or your partner that make it a part of sex- not an interruption to it. Check out our post for some sexy tips on condom use.
Pediatrics and sex educators should know condoms too. Reece and Herbenick suggests that prevention providers can play a valuable role in alleviating negative perceptions of condoms by recommending different condoms made for specific needs. For example, for those men who feel condoms are too tight, a practitioner may recommend condoms which are designed with a more bulbous head or looser fit. The point is that there are hundreds of thousands of condom types out there and there needs to be more access and understating of choice and care.
If it’s true that sexual pleasure with a condom is all in the attitude than it is all the more important that there be representations of safe sex in pop media. How powerful would it be if Jake Gyllenhaal whipped out a condom during the famous sex scene in Broke Back Mountain!
What do you think? Would safer sex in the media help increase positive attitudes towards safe practices? What do you think should be done to get more youth practicing safer sex?
Source cited: Jean Carlomusto & Gregg Bordowitz (1992).“Do It! Safe Sex Porn for Girls and Boys Comes of Age.” A Leap in the Dark: AIDS, Arts and Contemporary Cultures. Allan Klusacek & Ken Morrison, eds. Montreal: Vehicule Press.