In an era when smart phones have become a necessity and anything can be acquired online, it’s no surprise that that public health measures in the United States are going technological. According to a recent article in the Baltimore Sun, public health officials in cities such as Baltimore, Denver and Philadelphia have implemented the use of a website that supplies free in-home testing kits for the most commonly reported STDs. According to the article, up to half of young people will get a sexually transmitted disease by the time that they are 25; with access to testing kits online, the idea is that technologically-savvy twenty-somethings will be able to order a gonorrhea exam in between emails. This, presumably, will incite an increase in the number of young people who know their STD status. The real advantage of ordering these tests online, however, is not just convenience; teens and young adults will most likely utilize this online service to avoid the stigma and embarrassment that goes along with being tested for and having STDs.
While sexual education in the United States has improved markedly in the last half century, the majority of Americans are still not comfortable talking about sex. What’s more, even though 20% of Americans are currently living with an STD, there is a stigma that surrounds the acquisition of sexually transmitted infections. Many Americans would hesitate to admit that they have ever had an STD, because in American culture it connotes promiscuity and recklessness. In reality, even sex with a regular and trusted partner could end in the contraction of an STD, and some diseases are not preventable even with the use of condoms. This stigma, however, permeates sexual culture in the Unites States and prevents people from getting properly tested for diseases that they might be at risk for.
What struck me about this realization is the resemblance that this issue has to the problem of HIV/AIDS prevalence in Botswana. While Botswana has decent hospitals and adequate resources to combat the disease, government officials run into problems persuading citizens to get HIV tests. Because of the powerful stigma that surrounds HIV/AIDS in the country, people in Botswana would rather die of AIDS than face the social death that accompanies an openly positive status. And since testing clinics are few and far between, it is nearly impossible to conceal; everyone in a patients’ respective village is likely to know if they are receiving the free ARVs that the government provides. Many Westerners may look at this situation and lament the obstinacy of the citizens of Botswana – how could they choose their social well being over their biological health? The truth is, Americans are not nearly as comfortable as we’d like to think we are with knowing or disclosing our own statuses when it comes to STDs, and the situation is similar in many parts of the world.
So why the stigma around STDs? For one, getting tested for STDs is an open admittance to having sex, which, in many cultures, is not something that is socially acceptable to discuss. It is also oftentimes something that is associated with having multiple partners, which is also frowned upon in many societies. The point is, whether you’re in small-town America or Gaborone, Botswana, chances are that you are not going to want to admit to having an STD for fear of public embarrassment. This stigma, therefore, is an issue that public health officials everywhere must address before the world of public health can even begin to get a handle on the global AIDS crisis.