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The Impact of Social Stigmas on Sexual Health Seeking Behavior: a Review of Literature McNair Scholars Research Journal Volume 13 Issue 1 Article 11 2020 The Impact of Social Stigmas on Sexual Health Seeking Behavior: A Review of Literature Jason O. Talley [email protected] Follow this and additional works at: https://commons.emich.edu/mcnair Recommended Citation Talley, Jason O. (2020) "The Impact of Social Stigmas on Sexual Health Seeking Behavior: A Review of Literature," McNair Scholars Research Journal: Vol. 13 : Iss. 1 , Article 11. Available at: https://commons.emich.edu/mcnair/vol13/iss1/11 This Article is brought to you for free and open access by the McNair Scholars Program at DigitalCommons@EMU. It has been accepted for inclusion in McNair Scholars Research Journal by an authorized editor of DigitalCommons@EMU. For more information, please contact [email protected]. Talley: The Impact of Social Stigmas on Sexual Health Seeking Behavior: A The Impact of Social Stigmas on Sexual Health Seeking Behavior: A Review of Literature Jason O. Talley Dr. Jefrey Schulz and Dr. Joan Cowdery, Mentors ABSTRACT Studies show a meaningful association between STI/HIV-related stigmas and low adherence to routine STI testing (Morris et al., 2014; Hull et al., 2017). Tese studies also show that healthcare workers help to facilitate a culture of stigmas among coworkers and patients. According to a national survey, only 16.6% of women and 6.1% of men who partic- ipated in the survey had been tested in the last 12 months (Cufe et al., 2016). Low rates of STI testing contribute to the spread of chlamydia, gonorrhea, HIV, and syphilis (Big-Ideas-HIV-STIs.pdf, n.d.). Te moti- vation for this literature review is to examine how STI and HIV-related stigmas infuence sexual health seeking behaviors and sexual health out- comes for patients aged 18 to 24. Tis paper also examines how health- care providers and clinicians perpetuate stigmas among patient popula- tions and what kinds of sex education programming have been efective in improving sexual health behavior. LITERATURE REVIEW Introduction Te scope of this review. Continuous increases in Sexual- ly Transmitted Infections (STI) and Human Immunodefciency Virus (HIV) rates over the last fve years are undeniable. In 2018, consolidated incidence cases of chlamydia, gonorrhea, and all stages of syphilis totaled 2,419,774 (Centers for Disease Control and Prevention [CDC], 2019d). Te CDC estimated that in 2017 the costs related to congenital syphi- lis were over $12 million (National Academy of Public Administration, 2019). Te widespread implementation of abstinence-only education has encouraged further stigmatization of sexual health (Kirby, 2008). Re- 123 Published by DigitalCommons@EMU, 2020 1 McNair Scholars Research Journal, Vol. 13 [2020], Iss. 1, Art. 11 Jason O. Talley search has confrmed that abstinence-only education produces no mean- ingful impact on participants’ understanding of STI/HIV transmission, and in some cases, has increased participants’ chances of being exposed to or transmitting an STI (Hogben et al., 2010; Santelli et al., 2017). Te gap in STI/HIV knowledge created by abstinence-only education has in- creased stigmas among Adolescent Young Adults (AYAs). It is well doc- umented that stigmas create signifcant barriers for individuals seeking sexual health treatment and related services. Studies have shown a link between a person’s knowledge of how STI/HIV are transmitted and lev- els of stigma. Tese studies found that as levels of STI/HIV knowledge wanes, stigmas increase (Kingori et al., 2017; Tornicrof et al., 2007; Yang et al., 2006). Data suggest that an increase in knowledge about STI/ HIV transmission, disease and infection severity, and risk-reduction be- haviors corresponds to declining levels of stigma. Similar gaps in knowledge have been found among healthcare pro- viders and medical students. Unless a student or clinician specializes in HIV prevention, treatment, and care, many healthcare workers (HCWs) do not receive STI/HIV training. Lacking training, many HCWs are un- equipped to meet the needs of their patients (Stringer et al., 2016). With- in healthcare facilities, STI/HIV stigmas negatively impact the quality of care, successful health outcomes, and accurate diagnoses and treatment (Nyblade et al., 2019). Tis review of literature examines possible caus- es of the STI and HIV epidemic, identifes sex education programs that have been successful in improving sexual health outcomes, and discusses the impact that STI/HIV-related stigmas have on sexual health-seeking behaviors and sexual health outcomes. Tis study also focuses on how healthcare providers and clinicians perpetuate stigmas about STI/HIV among patient populations. Gaining new insight on how these themes infuence the health outcomes for STI/HIV-positive patients is important because it may assist program planners in developing more efective stig- ma-reduction interventions. Keywords: STI, HIV, Stigma, Intervention, CDC, Sexual Health Education Databases: Elsevier, ResearchGate, Social Sciences Citation In- dex, PsycINFO, CINAHL, CDC Community Health Improvement Navi- gator, PubMed Health, SEER, STD Communications Database. Factors Leading to STI Epidemic In 2017, infectious disease research showed that the ongoing STI epidemic in the U.S. has negatively impacted AYAs for the last three de- 124 https://commons.emich.edu/mcnair/vol13/iss1/11 2 Talley: The Impact of Social Stigmas on Sexual Health Seeking Behavior: A Te Impact of Social Stigmas on Sexual Health Seeking Behavior: A Review of Literature cades. AYAs make up approximately 27% of sexually active Americans, but they represent an alarming 50% of annually combined reported cas- es of chlamydia, herpes, HPV, HIV, gonorrhea, and all types of syphilis (Youth-sti-infographic.pdf, 2013). According to a 2019 press release from the CDC, since 2014 there has been an increase in the national incidence rate over the last fve years, including a 19% rise in the incidence of chla- mydia, a 63% rise in the incidence of gonorrhea, a 71% rise in the incidence of primary and secondary syphilis, and a 185% rise in the incidence of con- genital syphilis (CDC, 2019e). Despite the high prevalence of STIs among American populations, self-perceived susceptibility among women who have sex with men (WSM) aged 18 to 24 is low (Hickey & Cleland, 2013). In 2017, Aurora Research & Consulting conducted an indepen- dent survey on behalf of Quest Diagnostics. Te survey collected data from WSM aged 15 to 24 and their mothers to better understand the beliefs that young women have about sexual health. Of the 3,414 young women who participated in the survey, 56% reported that they were sex- ually active. Among those, only 39% said a condom was used during their most recent sexual encounter. Within the sampled population of young women (n = 3,414), less than one in four women had asked their clinician to administer an STI test. Sixty-two percent (62%) of respondents report- ed low levels of perceived susceptibility to STIs as a reason for not get- ting tested, despite high STI prevalence. Fify-fve percent (55%) reported they did not seek testing because they were asymptomatic, even though symptoms of STIs can be easily overlooked or are non-existent (Auro- ra Research & Consulting, 2017). Researchers identifed two strengths of this study: frst, the large sample size represented many diferent de- mographics; second, the survey was conducted by an outside company, which limited potential bias from Quest Diagnostic. Researchers also mentioned that the survey data was self-reported by the respondents. Tis is seen as a weakness because the survey asked sensitive questions regard- ing sexual behavior and health; respondents might have chosen answers that seemed more socially acceptable rather than responding truthfully. Sociological factors. Te causes of the STI epidemic are multifac- eted and will require coordinated solutions. Major factors that contrib- ute to this epidemic are sociological, biological, and cultural (Institute of Medicine (US) Committee on Prevention and Control of Sexually Trans- mitted Diseases, 1997). A possible sociological factor that could lead to the continuation of the STI/HIV epidemic is a shortage in STI/HIV pre- vention and treatment funding (CDC, 2017). State and local health de- partments play a vital role in providing prevention, screening, and testing 125 Published by DigitalCommons@EMU, 2020 3 McNair Scholars Research Journal, Vol. 13 [2020], Iss. 1, Art. 11 Jason O. Talley services to a community. Many of these services receive funding through the Ryan White HIV/AIDS program. Funding is appropriated annually by Congress, and in 2019 the program received about $2.3 billion (Kaiser Family Foundation, 2019). Te methods used to appropriate funds ofen miscalculate the true cost of providing HIV/AIDS services. Tat means that many public health organizations in underserved communities are unable to meet the healthcare needs of their patients. Tis leaves many people at risk of contracting or transmitting HIV to others in their com- munity (Kaiser Family Foundation, 2019). Biological factors. A common biological factor that contributes to high rates of infection is the asymptomatic characteristic of many STIs. STIs such as chlamydia, herpes, gonorrhea, syphilis, or human papillo- mavirus (HPV) ofen do not produce acute or noticeable symptoms. Te most reliable strategy to confrm a person’s sexual health status is to com- ply with sexual screening guidelines. Based on CDC guidelines for STI and HIV screening, it is recommended that people between the ages of 13 and 64 should be tested at least once in their life for HIV. Sexually-ac- tive women below the age of 25 should be tested for gonorrhea and chla- mydia once every year, and sexually-active women older than 25 should be screened yearly for gonorrhea and chlamydia, based on individual risk factors. All men should receive testing for syphilis, gonorrhea, and chlamydia once a year, and based on individual risk factors, they should be tested every three to six months.
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