Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections

Abstract

Stigma has long accompanied sexually transmissible infections (STI) and hindered prevention and control efforts. It not only acts as a formidable barrier to STI testing, treatment and disclosure, but has a multitude of consequences for the health and quality of life of infected individuals. This review summarises the literature related to STI stigma and offers practical approaches to counter STI-associated stigma through multi-level efforts. Specifically, it describes the key sources that breed and perpetuate stigma, outlines how STI-associated stigma has been conceptualised and measured in the literature, documents the impact of stigma on infected and uninfected individuals, and summarises the stigma reduction strategies recommended in the literature. Gaps in the literature are identified and areas for further research are suggested, along with practical strategies for moving forward.

Sexually Transmitted Infection Related Stigma and Shame Among African American Male Youth: Implications for Testing Practices, Partner Notification, and Treatment

“…Through this investigation, we noted a significant trend: higher median (IQR) stigma and shame scores among participants who had never been tested for STI [stigma = 15 (9-17); shame = 17 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)], average stigma and shame scores among those who were tested and received a negative result [stigma = 11 (7)(8)(9)(10)(11)(12)(13)(14)(15); shame = 14.5 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)], and the lowest scores among those who tested and received a positive result for an STI [stigma = 8 (5-15); shame = 11 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)]. …”

“…The median and interquartile range (IQR) of the STIrelated stigma scale was 12 (7)(8)(9)(10)(11)(12)(13)(14)(15); median (IQR) of the STIrelated shame scale was 15 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Good global model-data fit was obtained with five items in the stigma dimension and six items in the shame dimension [v 2 (43) = 92.06, p £ 0.01; comparative fit index (CFI) = 0.97; root mean square error of approximation (RMSEA) = 0.10; weighted root mean square residual (WRMR) = 0.72]; 25 all factor loadings were strong in magnitude (see Table 1).…”

“…12 Our findings similarly showed stigma to be more associated than shame was with testing practices. This may be because stigma involves the (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) 14.5 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 11 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Test for trend a p £ 0.05; b p £ 0.01. IQR, interquartile range.…”

“…12 It has been proposed that marginalized groups can experience much higher levels of stigma because of a 'layered stigma' effect. 13 To date, a handful of studies have found an association between higher levels of STIrelated stigma and shame and failure to test for STIs among males and females. 12,14 Other investigators have noted a relationship between STI-related stigma and shame and prolonged care-seeking intervals 15,16 and reduced likelihood of discussing STIs with partners or health service workers.…”

“…12,14 Other investigators have noted a relationship between STI-related stigma and shame and prolonged care-seeking intervals 15,16 and reduced likelihood of discussing STIs with partners or health service workers. 13,[17][18][19] There has been limited research however, on the effect of STI-related stigma and shame on African American men, their STI testing practices, and the association between STI-related stigma and shame and partner treatment in this population.…”