On Safe Sex and Stigma: Where Morality Skews the message

This was a twitter thread that I posted on my personal Twitter account. Thought I share it here too.

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I guess this whole conversation on #SafeSex and #Stigma is timely given the announcement of the antibiotic resistance of gonorrhoea. I saw a twitter thread that made me uneasy because it suggested that the safe sex ‘narrative’ stigmatizes testing and those with STIs. I was in agreement with the first part which was that it is ridiculous that stigma exists in the first place, given that you can get infected even from your monogamous partner. There is a reason why there are ads in DC Metro encouraging people to get tested, even if the are in relationships.

STIs are transmitted regardless of your relationship status. However, the thread was arguing for getting rid of the safe sex narrative, since the safe sex narrative stigmatizes testing for STIs, and this is where I disagree. That argument is like saying advocating for the HPV vaccine stigmatizes testing for HPV, or using Prep stigmatizes testing for HIV. The framework of safe “safer” sex acknowledges that people engage in risky behaviors all the time. The purpose of the safe sex framework and its prevention strategies are aimed at risk reduction. All the prevention strategies and interventions are focused on reducing risk. They bring agency and place the onus of prevention on all the partners involved, but it also allows for particular circumstances that people might be involved in: can’t negotiate condom use, social/cultural beliefs regarding sexual behaviours, etc.

The framework itself is not inherently stigmatizing: it does not dictate which behaviors are “better” or more socially acceptable. Safer sex does not penalize you if you did get an STI, it just points out what behaviors will (statistically) put you at less risk, and how to minimise the risk of passing that STI to current and future partners. Same way that advocating and educating you to avoid a diet high in red meats is not stigmatising/blaming those with heart problems since health is multifaceted. The interventions are telling you how to minimize that risk. Where is the stigma here? Your auntie/uncle who is spouting some respectability politics BS? How is that the fault of the safe sex framework? Google “Just World Hypothesis”. Why throw away the framework when people are just reaching for their own morality regarding sexual behaviors?

One last example: social and reproductive health scientists who work in family planning still advocate for abortion as part of reproductive justice and reproductive choice, even in places where people don’t think abortion should be legal or acceptable, e.g. many states in the US, and many other countries. We don’t care that you think abortion is wrong or right, we are advocating for it regardless as part of reproductive health. If people choose to stigmatise those who choose to abort, that is another issue related to what is socially acceptable. Those social/cultural/moral beliefs mean that we have to tailor the interventions, not abandon the education and advocacy efforts regarding abortion. Same goes to Safe Sex.

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