Why This Matters : The Intersection of Race, STI's and Mental Health

Article Written by: Priscilla María, Mental Health Advocate and Writer

Sexually transmitted infections (STIs) are incredibly common and most people do not know they have one. For instance, 20 million new cases of STIs occur annually and only 12% of sexually-active youth aged 15 to 24 were tested in the last year. It is important to note that the most common symptom of STIs is no symptom. Additionally, STIs can be transmitted in a single instance and through a variety of ways such as intimate touching, kissing and intravenous drug use. In other words, STIs being tied to promiscuity, carelessness and sex work are inaccurate because STIs can be contracted despite condom use, without sex and within a monogamous relationship. Furthermore, STI stigma does not consider survivors of sexual violation that contracted an STI through a nonconsensual encounter.

An examination of herpes and the human papillomavirus (HPV), two of the most common STIs, puts into perspective how unfounded and harmful STI stigma is. For starters, both herpes and HPV are not included in routine STI screenings; herpes screening is expensive, sometimes inaccurate and does not influence sexual behaviors. Similarly unhelpful, HPV screening tests do not exist for men and only women over 30 are routinely screened for HPV. Additionally, both herpes and HPV can be transmitted regardless of proper condom usage.

According to the CDC, “HPV is so common that almost every person who is sexually-active will get HPV at some time in their life.” The good news is that HPV typically “clears” on its own, however, it does carry the potential to cause cancers. On the other hand, herpes is incurable. Herpes simplex virus type 1 (HSV-1) occurs in as many as 1 in 2 American adults and the herpes simplex virus type 2 (HSV-2) occurs in 1 in 8 Americans ages 14 to 49. Fortunately, herpes does not harm the immune system or fertility, it is not fatal, it does not become cancer, and it is rare for adults to have health problems from herpes with the exception of during pregnancy. In fact, herpes is less threatening to one's health than diabetes, a chronic condition that carries the risk of blindness and kidney failure. Yet, diabetes is not socially condemned like herpes is despite lifestyle being a factor in both diagnoses. Ultimately, although some STIs are incurable, no STI is unmanageable or precludes someone from having an active sex life.

There is a complex relationship between mental health and sexual health. Although close to 90% of people living with herpes do not know they have it, those that have been diagnosed are twice as likely to be depressed than adults who have not been diagnosed. Additionally a study conducted by Courtney Brame, founder of Something Positive for Positive People, found that 50% of participants experienced suicide ideation after a positive HSV diagnosis and that the mental health of individuals living with herpes greatly improves by having a support system. Overall, individuals with a mental illness are at an increased risk of contracting an STI for such reasons as: impaired autonomy, increased impulsivity, and increased vulnerability to forcible sex. For instance, individuals living with a psychiatric illness are 10 to 20 times more likely to contract HIV than the general population.

STI stigma needs to be eliminated. This stigma is founded in misogyny, racism, sexual repression and heteronormativity. From queer Black men having less access to PrEp medication to hypersexualized representations in the media, sexual health remains a social justice issue for Black people. Not only do Black people have less access to competent sexual health education, but most sexual health classes do not focus on subjects that are relevant to the Black community such as: consent, trauma, cultural expectations and setting boundaries.

Black youth are more likely to receive abstinence-only education than white youth are. This type of sex education has been proven to be very ineffective and is highly inappropriate for populations of color that disproportionately experience STIs, teen pregnancies and sexual traumas. For instance, Black men are 6.6 times more likely to get chlamydia, 8.9 times more likely to get gonorrhea and 4.5 more likely to get syphilis than white men are. Additionally, abstinence-only education tends to be scientifically flawed, reinforce gender stereotypes and be heteronormative. According to the CDC, “research has clearly shown that the most effective programs [to prevent the spread of HIV/AIDS] are comprehensive ones that include a focus on delaying sexual behavior and provide information on how sexually active young people can protect themselves.”

Sex remains a very taboo topic across many cultures. Whispers surrounding reproductive health need to be transformed into open dialogues that empower Black youth to make informed, responsible decisions. Additionally, measures must be taken to curtail gaps in access to sexual education, STI screenings and reproductive health resources. As taught by activist and sexuality educator Ericka Hart, sex positivity is the end of STI stigma and racism. Sex positivity is also self-care and ensuring that our mental health and sexual health are in harmony.