We still have a long way to go in the ways that most of us discuss sex and sexual health. This was made painfully obvious recently when North Carolina rapper, DaBaby, made homophobic, misogynistic, and other insensitive remarks about sexual orientation, sexual practices, and sexually transmitted infections (STIs).
During the rapper's set at the Rolling Loud Miami music festival last month, he encouraged the crowd to publicly identify themselves if they had a negative HIV/AIDS test result, while simultaneously shaming women and gay men for their hygiene and sexual activity, respectively.
The response and consequences were swift, with the artist doubling down on his remarks, apologizing, and finally deleting an apology that had been posted to his Instagram account. He's been dropped from a number of upcoming festivals and other engagements where he was scheduled to perform, and other celebrities have weighed in to condemn his hurtful, uninformed and stigmatizing language.
Considering that the Centers for Disease Control and Prevention says that reported STIs in the United States have reached an all-time high for the sixth consecutive year, making sure that comments and conversations about sexual health are grounded in science and facts, rather than random beliefs and stereotypes, is even more important.
"To normalize STIs, we talk about sexual health. Sexual health is part of overall health and well being. So, getting diagnosed and treated for an STI is simply a way of taking care of your health," the American Sexual Health Association, a nonprofit advocating on behalf of people at risk for STIs, said in a statement. "That's why DaBaby's damaging, homophobic comments are so dangerous. They perpetuate harmful misinformation and reinforce stigma. At the very least, the resulting criticism and consequences for DaBaby suggest that we're making progress."
Phronie Jackson is executive director of W.A.L.K. Ward 5 Health Coalition in Washington, D.C., and assistant professor of health education at the University of the District of Columbia. She's directed local and national funding for HIV and AIDS prevention, awareness, and education programs, and has also presented her work multiple times during national and international conferences on STI prevention and stigma. Chris Harley is the president and CEO of SIECUS: Sex Ed for Social Change, an organization that works to advance sex education through advocacy and policy in order to help build increased equity that allows all people access to sex education, to be affirmed in their identities, and to have the power to make decisions about their own health, pleasure and wholeness. Jackson and Harley took some time to discuss this continued stigma around sexually transmitted infections, where it came from, and how to put an end to it. (This email interview has been edited for length and clarity. )
Q: How do DaBaby's statements perpetuate the stigma associated with STIs?
Harley: First, I just want to express love for your LGBTQ and genderqueer readers who may be reading the reaction to this. It's just really unfortunate that DaBaby's remarks perpetuate so much ignorance and fear around the LGBTQ community, and then lump that into also stigmatizing around STIs. I think that these comments were accurately labeled as homophobic, misogynistic and just plain ignorant. They perpetuate stigma by trying to shame people for their health status or sexual activities, which is both abhorrent and ridiculous, and perpetuates the reasons why STIs are not addressed in our society with a little bit more care and accuracy in terms of prevention.
Jackson: Anyone who has a platform for social influence, who makes derogatory or denigrating statements about people who are living with HIV - or any other kind of physical or mental illness, lifestyle, or sexual orientation - can perpetuate the stigma associated with it. So, society becomes desensitized to certain negative statements. We're less shocked and less appalled by these statements, and in some group settings, something may be said or done and no one reacts. Everybody's standing around thinking, "Am I the only one who thinks this is wrong, and none of these other folks do? I'm not going to say anything." However, other people in the group think it's wrong as well and also didn't say anything. A lot of times, these negative statements aren't challenged, and when they aren't challenged, they kind of become the social norm, leading to these kinds of negative statements definitely perpetuating stigma.
Q: Can you talk about where this stigma around STIs comes from?
Harley: I think it's really important for folks to realize that there is an agenda behind the stigmatizing of STIs. So, SIECUS produced a report earlier this year, " History of Sex Education," and when you look at that report, it talks about how the modern sex education movement has evolved over the past century but really started with the introduction of the social hygiene movement.
This was a middle-class reaction to a drop in marriage rates amidst a high rate of sex work and sexually transmitted disease. So, there was this moral alarm that was being raised, specifically as it related to White, Anglo-Saxon families. These social hygienists were trying to talk about and emphasize the dangers of sexual promiscuity, particularly as it related to White men, by using what were referred to as venereal diseases back then, to discourage people from going to sex workers and engaging in sexual activity outside of marriage. That all had links to the eugenics movement, where there was the fear that the Anglo-Saxon family was being destroyed, and it centered White, male sexuality and sexual freedom over the rights of others.
That has evolved over time. There was fearmongering that happened during World War I, where the effort to prevent sexual disease transmission in soldiers, used the branding of non-White women who were engaging in sex work activity near military installations, as being "impure" and "diseased." The AIDS epidemic brought all of this together again with STIs being treated as a danger and risk of sexual activity by non-Whites, and particularly by LGBTQ or gay men. So, I think when we hear the kind of language and hysteria around STIs today, we have to recognize that that it is a perpetuation of these different moments in time where STI rates may have been on the rise, but certainly the way that they were framed and talked about was through a very particular lens. Even today, when we hear of the abstinence-only movement, they are talking about sexual risk avoidance as a way to reframe their efforts, but it's still this echo of that social hygiene, AIDS hysteria of the past.
Jackson: In my experience, stigmas associated with STIs originate from beliefs around sex. That's a big, taboo topic - you get an STI because you've had sex. For most people, sex and sexuality are not discussed at home, it's not discussed within the family, and most importantly, it's not talked about as a natural act, a part of life. It's learned about from peers, and usually with inaccurate information and ideas not based on facts.
You also have these institutions, such as religious institutions, that preach that sexuality that's not heterosexual is wrong, it's not acceptable, it's not "of God." In school, the only thing your teachers might teach about sex is abstinence: "Don't do it, don't have it, it's taboo. If you do it, you're promiscuous." So, the framing is that STIs come from doing this forbidden thing, and if you have an STI, you've been caught doing this forbidden thing.
That brings about stigma, which manifests socially and psychologically. Socially, there's judgment toward individuals who have STIs; they're judged and blamed, and it goes back to sex being "taboo." Psychologically, sometimes individuals with STIs are ashamed because they've contracted this infection that they got because they believe they were doing something that they shouldn't have been doing. It's all learned, psychological and social. The stigma can come from the individuals with STIs, sometimes it can come from health care providers, and certainly from society. It all really relates back to sex, and sex has always been the big, pink elephant in the room.
Q: What are some of the potential dangers, or consequences, of this continued stigma?
Harley: I think that the biggest danger of this kind of conflation and stigma is that it labels certain people and certain sexual activity, as being riskier or more susceptible to disease than others. When people are labeled this way, it puts them at risk of being attacked or isolated, or otherwise unprotected because of either an actual or perceived affiliation with a particular group. When sexual activity is labeled this way, it puts more people at risk because it de-centers the kind of proactive protection, communication and relationship building that is needed to protect against infections. It creates this kind of false sense of safety where folks are like, "OK, I'm just not engaging in that behavior, so I'm fine," and that's not actually true. I think that this kind of ignorance and reductionism really happens because we're not comfortable talking about sex with young people. We have to be able to talk about these topics from a comprehensive, medically accurate, evidence-based, inclusive approach. That means that we can, in fact, talk about STIs and sex without using scare tactics, or shaming young people or anybody who gets an STI. I think that what was most harmful about DaBaby's remarks is that there was this lumping of STIs and LGBTQ members of our communities, which is so dangerous because we know that LGBTQ individuals are at heightened risk for attacks or abuse. There's no reason to perpetuate that kind of harm when the information being repeated is obviously false.
Jackson: A potential impact of continuing stigmas around STIs can be labeled as social and psychological, in that it can have an individual impact, it can impact target groups, and it can impact entire communities and populations. At the individual level, if the individual is so concerned about the stigmas around STIs, they may not seek treatment and the infection can get worse, leading to potential transmission to others. Entire groups of people can also be stigmatized or labeled, related to STIs. At a targeted group level, people who were contracting HIV and AIDS experienced a stigma with being labeled "bad people" doing "awful acts." Then, at a community or population level, continuing the stigma will certainly bring about hate and discrimination.
Q: What are some ways that the language used to discuss STIs contributes to their stigma? I'm thinking of discussions about who's "clean," and what that indirectly implies about those on the other side of that coin?
Harley: I think what's most important is that we have to start by being fact-based. So much of what we see in abstinence-based sex education programs really tries to scare young people from engaging in any kind of sexual activity by showing them graphic and alarming pictures of extremely infected genitalia. That's alarmism. We have to recognize that sensationalism is not reality, but it does contribute to this immediate fear that people have when we're talking about STIs.
I think that we also think about STIs with this sense of permanence; that if someone is infected, that they're perpetually infected, and that creates a fear around touching or associating with anyone who may have an infection. With most STIs, though, if they're treated like any other bacterial infection, with proper treatment and proper care, most individuals will be fine and free of infection after a period of time.
Yes, we do need to stop the use of descriptions like "clean" to describe a negative test result, but more than that, I think we just have to realize that we can treat our sexual health the same way we treat other health issues, by engaging in proactive, preventative health care practices.
Jackson: Absolutely. If someone tests for an STI, and their test comes back negative and they don't have it, they are often told that they're "clean." So, the person who tests for STIs and their test is positive, are considered just the opposite of that. They're "dirty," they're "nasty." We have to really watch the language that we use around STIs. We don't want to use "clean," we want to say that they tested negative for an STI. The person who tested positive? We want to say that, that they tested positive. A sexually transmitted infection is a health condition, and with other health conditions - cancer, diabetes, hypertension - we don't say that "your test came back clean"; we say that you have cancer, you are pre-diabetic, your blood pressure is high. There is not a positive-negative connotation in the sense of being "clean" or "dirty." It's either positive, you have it, or negative and you don't. That's what we really have to start to think about because the more we talk about it from that standpoint (of negative connotations and stigma), the more we are going to discourage people from getting tested when they may possibly have an infection, and then they may continue to transmit it.
Q: Are there ways that language can be used to dismantle this stigma? What would that look like in practice? And how would that shift in language help to end the continued stigma? How should we be talking about STIs and sexual health, in general, in order to put an end to this?
Harley: We have a blog post that we wrote with The STI Project, focused on how to have positive conversations around STIs. To paraphrase some of the things that were addressed within that, were changing how we have conversations around sexual health. We should be talking about our bodies and genitalia earlier and more often with kids, so that we are using the proper names of genitalia, versus calling it something like a "hooha"; this helps eliminate this taboo and this strangeness that we have with our own bodies. It's a practice of being more open about our bodies and our sexual and reproductive health. If we can shift the way we approach that, it helps set up a practice of encouraging young people to engage in self-care, have open communications with their sexual partners, and prioritize preventative health care so that they can remain safe and healthy.
It's also important to use person-centered language, so that we can move away from using more stigmatizing language. Focusing on the person and not on the infection. A lot of times, the way STIs are talked about can emphasize the infection rather than the human being, which then leads to that kind of derogatory or stereotyping language and social discrimination. When we use language that's more medically accurate, it helps to alleviate that kind of blame and it helps us to recognize that human beings are more than just their infection status.
Then, I think it's also really important to remember that STIs are really common. We are seeing that the rates of STIs have been going up. It's fine to point to numbers and statistics when talking about STIs, but I think it's also helpful and encouraging to then tell the personal stories behind some of those statistics, to humanize them a little bit more. I think that destigmatizing them shows that it's not just particular communities that are being impacted by STIs, or a particular sexual activity that's the cause of an STI increase; it can be far more diverse and nuanced than that. There are plenty of people who contracted an infection after their first time having sex. That happens, and it's not anybody's fault, but it goes back to recognizing that we are not doing a good enough job about encouraging open communication.
Jackson: Earlier, when I was talking about my work and how I've presented for the Centers for Disease Control and Prevention, they have a conference called the STD Prevention Conference. I think we have to start right there, with considering changing that language from the top, from using the word "disease" to instead using "sexually transmitted infection." We want to focus on preventing the illness and treating the illness.
In thinking about HIV, a lot of times you will hear "Oh, that person's HIV-positive" or "That person has full-blown AIDS." I cringe when I hear that because the person is living with HIV/AIDS, they are living with that illness, they are not that illness. That illness is something that they have and that can be treated, like any other health condition. We have to really consider how we're describing individuals who have these illnesses and make sure that we're focused on how we can prevent the illness, and how we can treat the illness.
Q: What are some other ways to combat this particular shame and stigma related to STIs, so that we aren't continuing in the use of the kinds of stereotypes and language that DaBaby chose to engage in?
Harley: I think that it comes down to just being less fearful about sex, generally, and to reiterate the point that STIs happen because we are not comfortable talking to our partners about our sexual health history, engaging in safer sex practices, and relationship preferences. The first step is to encourage folks to have more open and honest conversations around these topics with their sexual partners and within social circles. And, talking about sexual health and STIs in ways that are sex-positive and affirming, and empowering folks to feel in control of their own sexual health.
I think it's important to call out somebody who speaks about STIs in ways that are stigmatizing or inaccurate, to rebut that with facts. I think it's important to show empathy toward folks who are scared of contracting an infection, or who have an infection. And, I think it's important for us to create space for folks to make sexual health decisions that are right for them, so that, hopefully, folks like DaBaby are forced to rethink their ill-informed notions and can engage in a little self-reflection and some learning, and shift their behavior. Anyone can get an STI and nearly everyone can treat and overcome those STIs. Having an STI is nothing to be ashamed of, it's nothing to be alarmist about, but we can do a better job of supporting each other and talking about safer sex in order to prevent STI outbreaks. (For people looking for a starting point in more open and informed communication about sex and sexual health, Harley recommends the following podcasts: " Sluts and Scholars," " Sexually Liberated Woman," " The Sex Ed of Black Folk," and " Sex Nerd Sandra.")
Jackson: I'm a firm believer in awareness and education. There's a lot of ignorance around sexually transmitted infections, so we have to make people aware of what they are and educate them. If we can remove some of the ignorance, give people better knowledge of these illnesses, then we can start to bust some of the myths and remove some of the stigmas around it.
If you go to your doctor and you get your work-up, you get tested for cholesterol and you get your glucose levels tested; testing for STIs should also be part of that process. If it's automatically there, then it's a normal part of your health care routine and helps break down the stigma. When the results come back, your physician can talk to you about it just like they'd talk to you about your A1C levels (blood sugar) being high. They can tell you if you have gonorrhea, syphilis or chlamydia, and talk to you about how it should be treated and what you can do moving forward to prevent it. We just have to normalize it, so that it isn't seen as permanent, and if it's contracted, we want to treat it and make the person well. I think that is huge.
We just need to understand that health is simply health, and that's what we need to focus on. It doesn't matter if it's sexual health, mental health, physical health, it's health. We have to look at individuals holistically and be concerned with the entire person; not with one type of health, but to consider it all and make sure that everybody is well and at their optimal health.