For those who might not know, December is AIDS Awareness month. And today, December 1st, is World AIDS Day. It’s important that we continue to help raise awareness for HIV and AIDS, because throughout the history of the virus, many people have been unwilling to discuss it openly. And this enduring secrecy has led to enduring stigma, allowing countless new infections. In fact, 20% of people in the United States currently living with HIV don't know that they even have it.
It makes sense that when people are hesitant to talk about HIV and other STI’s, they are able to flourish in our communities. After all, if testing and treatment is not included as part of our sex education, how are we meant to know their importance? The stigma that began as bigotry has become a weapon in HIV’s continual spread. As a certified sexual health resource, we here at As You Like It know that the best way to stop both stigma and transmission is through normalizing talking about and testing for HIV and other STI’s.
And make no mistake, STI’s are a part of the human experience! At least 1 in 4 people will contract an STI at some point in their life, so testing positive is more common than you might think. Testing positive for an STI isn’t a reflection of someone’s hygiene, worth, or history, despite what rude misguided people might say. STI’s can happen to anyone who is currently or has ever been sexually active, as well as people who have been sexually assaulted. And transmission can occur no matter your age, sexuality, gender, lifestyle, or the kind of sex you have. Sometimes you do everything ‘right’ and still get an STI, and that isn't your fault.
So how can we protect ourselves and our partner/s from STI’s? Well, through a robust system of honest communication, safer sex practices, and, of course, frequent testing. Using a combination of these habits, most new STI transmissions can actually be prevented, stopping both spread and stigma in their tracks.
Build Safer Sex Habits
The good news is that while no form of sex (except masturbation) is entirely free of risk for spreading STI’s, there are always steps you can take to have safer sex when partner/s are involved. Most STI’s transmit via either skin-to-skin contact, or sharing fluids. This is why barrier methods, like condoms (internal and external), dental dams, gloves, and these amazing wearable Lorals underwear, are extremely common. Most barriers are designed to be single-use, quick, and convenient to add to almost any sexual act. And when used correctly, barriers can prevent up to 99% of STI transmission when having vaginal, anal, or oral sex.
Using a high-quality body-safe lubricant can also help minimize risk of STI transmission. If the sensitive tissues of our genitals or lips are exposed to large amounts of friction, they can experience microtears. Essentially tiny scratches or splits in the skin that are usually too small to even be felt, microtears can act as an entry point for viruses and bacteria to enter our bodies. But by creating a protective barrier over your skin, lubricant can limit friction and protect against microtears. Especially if you are going to have penetrative sex, consider adding a coating of your favorite lubricant — whether you think you strictly need it or not.
We can also make lifestyle choices that minimize our risks. Limiting our sexual partners to people that we feel comfortable talking about testing and safer sex practices with can seriously reduce the danger of STI transmission. We can also limit or avoid some higher-risk sexual behaviors, like unprotected vaginal or anal intercourse, or having sex while under the influence of drugs or alcohol.
Finally, an often left out part of STI prevention is trying to limit any nonsexual STI risk behaviors. Many STI’s can be transmitted by sharing needles, so using clean needles when using intravenous drugs or doing body modification is very important for lessening risk. Some STI’s, like pubic lice, can be transmitted by sharing towels or underwear, so it’s important to use caution and limit how often we share any unsanitized fabric that touches the genital area with other people. Oral herpes can be spread by sharing drinks, makeup, and more. Most people engage in some level of STI risk, even in their day-to-day life. All we can do is understand where the risks are, and minimize them wherever possible.
Why to Get Tested
Even with proper barrier use and frequent, careful risk assessment — even if we always do our best to err on the side of caution — it is still possible to get or transmit an STI. Some barriers do not cover the entire genital region, and barriers can break. And as imperfect humans, sometimes we may just choose to take greater risks. Which is why even if you practice safer sex practices to the letter, it’s equally important to get in the habit of frequent testing.
The only way to know for sure if you have an STI is to get tested. If you develop symptoms, such as itching, burning sensations, or strange lumps or sores in the genital area, then you should be tested as soon as possible. But most STI’s, most of the time, do not actually show symptoms. Which means that if you’re sexually active and haven’t been tested, you could have an STI even if you feel entirely fine. Many STI’s can be present for years without a person even knowing they’re there. And of course, if we don’t know our status, we can’t treat the infection, or protect our partner/s.
How often you should get tested depends on your lifestyle, and everyone’s lifestyle is different. For people who are in a monogamous relationship or who rarely engage in higher-risk activities or have new partners, it may be sufficient to include STI screening as a part of your annual physical exam. However, for people with multiple partners, who use recreational drugs, or who engage in higher-risk sexual acts frequently, it is wise to be tested more often.
In an ideal world, we would be able to get tested before each new sexual partner. After all, arming ourselves with up-to-date information is the best way to keep ourselves and our partner/s safe and healthy. And remember, getting tested often doesn’t make you “dirty” — it makes you smart!
How to Get Tested
You can usually get STI screening from your regular healthcare provider. However, if you do not have a regular healthcare provider, or they do not provide STI screening, we have several incredible resources here in Oregon that offer free or low-cost testing, such as the HIV Alliance and Planned Parenthood. To find a testing facility near you, check out the HIV Alliance’s Testing Resources. You will usually have to make an appointment requesting an STI screening and traveling to a clinic, although both of these organizations sometimes host free screening events outside of their offices. We suggest following them on social media to keep an eye out for convenient events near you!
Don’t be afraid to ask questions of your doctor or clinician! STI screening will involve different testing depending on where you go. HIV testing is often included separately from other tests, like chlamydia and gonorrhea. In addition, some STI’s require specific timing in order to get accurate results; it’s extremely difficult to test accurately for Herpes without an active sore, for example. If you want to get all the tests that are available to you, we recommend asking for a “full STI panel.”
STI screening often consists of a few simple tests that can be done via swab sample, urine sample, blood sample, or physical exam. Some may cause brief discomfort, such as a blood draw, but most should not be very painful. If you have a vulva, a swab test will be similar to a pap smear. If you have a penis, the swab will often be inserted into your urethra. Depending on your sexual history, you may also receive a swab in the throat and/or rectum. If you have any symptoms, relay those to your clinician at the appointment.
Some tests may offer immediate results, but most will require the samples to be sent to a lab and analyzed. How long you will have to wait depends on the lab, not your healthcare provider or clinic. No one likes waiting for results, and it’s ok if you feel nervous and anxious. But remember, by getting tested, you’ve already done the biggest thing you can do to care for your sexual health. And that’s pretty awesome of you, if we do say so ourselves!
What Happens If You Test Positive
Sometimes, when those results come in, you discover that you do indeed have an STI. And while getting that positive test can be really difficult for a lot of reasons, it’s important to remember that you’re not alone. As we said before, up to 1 in 4 people will contract an STI at some point in their lifetime. Getting sick is a normal part of being a human. We don’t let getting a cold affect our self-worth, after all! Getting an STI has no reflection on your value as a person, and it doesn’t make you “dirty” or “bad” in any way.
It also doesn’t mean that you have to live the rest of your life as a leper, shunned from society. Most STI’s can be treated or managed, and many people with STI’s are able to go on living their lives after making a treatment plan. Once you receive that positive diagnosis, take a moment to center yourself and think about how to move forwards with self-love. After checking in with yourself, the first thing you should do is reach out to your healthcare provider or clinic. Ask what treatments are available, and how they work. Be sure to ask about cautions with mixing medications, and if your partner or partners should also be treated at the same time. Sometimes, you will need to abstain from sex during the treatment process. It’s important to listen to all the rules of treatment to ensure that you get the proper care.
Your healthcare provider will also talk to you about the specifics of your particular STI, including any long-term concerns or care plans. While some STI’s are curable, others such as herpes and HIV, are not. However, despite enduring stigma, the truth is that with access to medication, those who are HIV positive can live long healthy lives, protect their partners from infection, and even reduce their viral load to undetectable levels.
If you test positive, you should also reach out to any past partners that you may have transmitted an infection to. For example, if you tested negative six months ago, but have had four partners since then, you should speak to all four. That way, they can go get tested, and if necessary, treated, so that they don’t continue spreading the infection unknowingly to more people.
And, of course, if you’ve been diagnosed with an STI that will stick around for some time, like herpes or HIV, this is something that you will need to tell any potential future partners about before engaging in sex with them. Part of informed consent is having all the information, and everyone involved deserves to be able to accurately assess the risks they may be taking. Once everyone is fully aware, it’s a lot easier to make safer choices.
How to Talk About Your Status
When having these conversations, you may be met with a range of reactions from positive, negative, and everywhere in between. Try to remember that you are doing the right thing in giving your partner or partners the information, and how they react is not your responsibility. By communicating with them, you are keeping them and others safe. Anyone who was involved in the transmission of an STI may react with anger or upset, especially if dishonesty was involved. Try to leave room for feelings to come up, and break out those conflict resolution skills. Speak honestly, and remind yourself as many times as you need to that you are doing the right thing in engaging in responsible communication.
Some think that having conversations with your potential partner or partners about their status is rude or insulting, but this could not be further from the truth. In fact, by getting comfortable talking about your STI history and safer sex practices, you’re actually showing more care and compassion for your each other! If you’re reading this piece, it’s safe to assume that you are someone who doesn’t want to pass an STI to your partner/s. And while we can never entirely eliminate risk, transmission usually happens when either testing or communication are lacking.
People aren’t perfect. We know this. Some people may think that because they trust their partner, that they are at a lower risk for STI’s. But many people go without screenings, and therefore don’t really know their status. Others were never told the risks that go along with activities other than vaginal or anal intercourse. It’s also possible that even if your partner is being entirely honest with you, that someone in their past may have lied about their sexual history to them, or said they had been tested when they hadn’t. Many people avoid testing because they are afraid of what the results may say, thereby putting their partner/s at greater risk.
In addition, people who feel shame about their sexual activities are actually less likely to practice safer sex. We live in a society that teaches us to be ashamed of sex and pleasure. So it’s understandable that some may meet these feelings of shame with denial, rationalizing their actions as “not technically” sex. Others will hide their sexual history from their friends, family, or partners. But most kinds of sex — even open-mouthed kissing — carries some degree of risk. Being unable or unwilling to talk about the risks does not eliminate them, it only exacerbates them.
So get comfortable talking about it! We’re not saying that everyone in your life has to know every detail of your sex life. However, if you can’t be honest at least with yourself and your potential partner or partners, you are only putting yourself at greater risk of STI transmission. Of course, no one should pressure you to take risks you are not comfortable with. Safer sex includes more than just condoms and lube — it also requires open communication, healthy limits, and boundaries. Anyone who is hurt or gets defensive by requests for safer sex practices is likely not ready to have sex with another person in the first place.
Get Tested, End the Stigma
The most harmful thing about STI’s is often the stigma that comes with them. Our society often makes contracting an STI seem like the end of the world, but that is rarely the case. The moral binary that we are taught tells us that when something “bad” happens it is because we are ‘bad’ people, that something we have done has caused this to happen. But that just isn't true. We are all just people, and sometimes things just happen. What matters is how we respond to them.
The fear surrounding STI’s is pervasive, even as the sex positive movement pushes forward. But we believe that like most fear, this stigma stems from ignorance. By talking aloud about STI’s and the importance of getting tested, we can counter the shame. Armed with facts and accurate, up-to-date information, we will continue to fight back against social stigma that only allows STI’s to spread more easily in our communities.
And you can, too! Make a plan to get tested, practice talking about your status, and build safer sex habits to reduce your risk. Testing is both self care, and an important investment in your health. Because when you know your status, you can make better choices for yourself, protect your partner or partners, and help bring an end to STI stigma.
Acknowledgments
The statistics from this piece were sourced from S.E.X.: The All You Need To Know Sexuality Guide To Get You Through Your Teens And Twenties by Heather Corinna. We cannot recommend this incredible, all-inclusive resource highly enough for anyone who wants to know more about safer sex and STI’s.