‘Clean’ or ‘dirty?’: Why sex educators say we need to change how we talk about STIs

Sexually transmitted infections (STIs) are more common than you think.

Yet despite the fact that half of all new STI cases in the U.S. are found in young adults ages 15 to 24, according to the Centers for Disease Control and Prevention (CDC)— and positive cases have reached an all-time high for the sixth year in a row — there are still many who find the topic too taboo and shameful to discuss.

As a consequence, STIs such as herpes, chlamydia, HPV and gonorrhea are routinely surrounded by stigmatizing language, such as when someone refers to people as “clean” if they test negative, which implies that they're somehow “dirty” if they test positive for an STI. This type of rhetoric, say experts, only diminishes a person's self-worth and affects healthy views on sex and our bodies.

“Culturally, we are taught to fear human sexuality and the expression of that sexuality. That fear leads to poor education and the stigmatization of anything that is related to our sexuality, such as STIs,” argues Jenelle Marie Pierce, board president of the STI Project, an organization that aims to destigmatize STIs through sex education, and spokesperson for the dating site Positive Singles.

Pierce tells Yahoo Life that this is why “language is so important” when talking about STIs and human sexuality because language “has the power to entirely change someone's perception of themselves by either generating shame or eliminating it.”

Pierce adds: Until we understand and accept that human sexuality is a component of overall health and wellness, a lack of comprehensive and inclusive education will persist — and STI stigma will continue to cause harm.

What drives STI stigma?

Stigma around STIs stems from a combination of sociological, psychological and ideological factors that people absorb at a young age — from family, friends, the media and religious organizations — that can be difficult to let go of later in life.

According to Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, using morality as the basis to label someone as “clean” or “unclean” is a tale as old as time — dating back thousands of years — with moral crusaders who “blamed a person’s behavior” for contracting infectious diseases, like leprosy.

“This was seen as evidence that a person was engaged in some type of immoral behavior,” Adalja tells Yahoo Life. These views, he argues, gave religious and political leaders precedence in deciding what behaviors are and aren’t deemed “moral” under the aegis of a puritanical code.

That code, he notes, encouraged people to believe that sex is “only meant as a tool for procreation rather than for pleasure.” But it also serves another purpose: to distort the ownership we have in our own bodies and how we think about sex in general — which includes viewing STIs as “punishment” for having “impure” sex or going against anything that challenges the “moral code.”

Historically, that moral code has bled into all facets of life, including how we educate young people about sex in America.

"STI stigma terminology comes from the idea that sex in and of itself is 'dirty,'" says Julia Bennett, senior director of digital education and learning strategy at Planned Parenthood. "STI shame and stigma is really rooted in the broader shame and stigma our culture has around sex and sexuality in general. This is counterproductive to the progress we're trying to make in public health around encouraging people to get tested, to talk about their status and to practice safer sex."

The impact of STI stigma

Words are powerful, says Pierce, who began using TikTok in 2020 to chronicle her personal history with genital herpes (there were more than 570,000 new cases of genital herpes in 2018 alone, according to the CDC) as a way to help others combat stigma and “sexual shame.”

“Everyone has experienced something that brought them shame in their life,” she says. “Sexual shame is interesting because it's different from regular shame in that it makes people feel bad, unworthy and less than as a whole. When you ask someone how they feel about an embarrassing moment, they might recall the event and cringe and feel shame around their actions during that event, but they don't internalize that shame and project it onto their whole selves.”

In contrast, Pierce explains, when someone experiences sexual shame, they might label themselves as a “bad person” and think they’re unworthy of love because they were intimate with another person. That in itself has a profound psychological impact and can negatively affect a person's overall self-worth and ability to advocate for themselves.

Contrary to popular belief, stigma doesn’t impact only those with an STI. For people who have an STI and don’t know it (especially if they have no symptoms), the fear and stigma can deter them from getting tested and treated, thus creating opportunities to unknowingly transmit the STI to others.

“The stigma surrounding STIs is really harmful to everyone,” Bennett says, noting that it can also impact the relationships we have with our significant others — especially if one person is positive and the other is negative. “Stigma can change the way you have and hold relationships with people, which isn't always necessarily bad in the long run, but the stigma can really be isolating,” she explains.

Self-harm is also a real concern, adds Adalja, especially for those who test positive for chronic infections once deemed untreatable — like HIV. But thanks to modern advances in medications, people living with HIV who are on medication and considered “undetectable” (whereby no virus is detected in their blood) live long and healthy lives without the possibility of transmitting the virus to others.

However, the stigma continues to act as a barrier to real progress, despite advances in medication and efforts from activists to change the way we educate young people about STI testing, treatment and prevention.

“One of the biggest barriers to overcome is not projecting our own internalized shame and morality onto others,” says Pierce. “I see this happen in the medical field all of the time by practitioners who mean well but who are offering advice and suggestions that are not practical or relevant to the individual they are treating. We have to take into account that everyone is coming from unique circumstances and many people are facing health disparities and inequities that impact their sexual agency.”

How can we eliminate the stigma?

The first step is to not be afraid to have uncomfortable, honest conversations — and, more important, to realize that not everyone has access to healthy, comprehensive sex education. We can do a very basic thing, sex educators argue — we can update our language.

“People-first language is key: putting someone's personhood before their diagnosis or status,” Pierce explains. “For example, 'someone who has an STI' as opposed to an 'STI-positive person.' It seems like a small nuance, but it's worth the effort because we want to showcase how people are not defined by the things they have or the things they do.”

This also has the potential of disrupting what Bennett describes as an unspoken hierarchy around STIs. Labeling someone as an “STI-positive person" creates a harmful notion that only "a certain kind" of person will receive a positive STI diagnosis.

“Sex education in this country, unfortunately, is completely inequitable,” adds Bennett. “One thing that we're really striving toward is having more access to sex education that is inclusive, that is medically accurate and that really gives people the skills and tools they need to navigate sex and relationships throughout their lives.”

Bennett adds: A big piece of that is to take the shame away when discussing STIs by articulating that STIs are a “potential outcome of having sex” and that “there are ways to prevent them” through safer sex practices — instead of teaching an “abstinence only” approach.

“STI prevention does not have to be this sort of sex-negative separate thing in sex education. It can actually be really well-complemented with a sex-positive or pleasure-centered approach,” explains Bennett. “Practicing safer sex, for example like using condoms, can actually enhance your sex life. It does not have to decrease the quality of your sex life because practicing safer sex can help reduce your anxiety and any worries related to getting STIs or even unintended pregnancy, depending on the sex you're having. It can help you really focus on what you're trying to do with your partner, which is to have a pleasurable, intimate, enjoyable experience.”

Another component is to avoid focusing on directives and absolutes when discussing STIs and sexual health; don't tell people what they should and shouldn’t be doing with their bodies, says Pierce.

“Telling someone that they should always — ‘should’ being the directive and ‘always’ being the absolute — use a condom alienates people and doesn't meet them where they are,” says Pierce. “We need to understand that everyone gets to make their own choices about their sexual health practices and it's our job to provide them with the most comprehensive information that will empower them to make the decisions that are right for them and their partners.”

That has proven successful in the past, says Adalja, who notes that when health educators use “direct and explicit” language about treatment and prevention, rather than make the message “all about a person’s individual choices,” it’s more likely to change someone’s behavior.

“When you are actually honest and remove all the stigma and puritanical bias, then people are actually receptive and you can actually gain traction in whatever you're trying to control," he says.

For parents: Create a shame-free zone

Experts recommend that parents have age-appropriate conversations with their kids about their bodies, consent and how to advocate for themselves in relationships early.

"The best advice for parents is to have ongoing conversations. It's not just a simple 'birds and the bees' conversation," Pierce says, who also notes the importance of using the correct names for body parts to help "instill that bodies are not shameful." Pierce says: "Making sure we encourage our children to ask before touching someone and that they can also say no to being touched teaches about consent."

It's also OK to say you don't know the answer and to get back to your kids after doing a little research, she says. "We are all human, learning and growing and taking a pause to consider your answer shows the vulnerability that is necessary to build strong, trusting relationships," says Pierce.

Resources such as Planned Parenthood's Chat/Text and Chatea/Textea programs can also help parents answer questions about sexual health. (You can text “PPNOW” or “AHORA” to be connected with a trained educator for answers in English or Spanish.)

Honesty is key to creating for young people a healthy perspective around sex and their bodies, notes Adalja.

"It shouldn't be something that's talked about in whispers," he says. "Obviously, it should be age appropriate when parents have those conversations, but it's basic human physiology and we shouldn't feel uncomfortable to talk about it."

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