Public tolerance, private pain: Stigma and sexually transmitted infections in the American Deep South

Abstract

This pilot telephone survey sought to identify social barriers to treating sexually transmitted infections (STIs) in a socially conservative state (Alabama, USA). The sample consisted of 250 household residents aged 19–50 years, mostly African‐American and White, who were drawn from the general population. The participants reported that infected persons, per se, should not be stigmatized. However, almost half of respondents stated that they would seek revenge against a partner who infected them. Feelings of embarrassment negatively affected willingness to seek health care; almost half of the respondents stated that, if infected, they would delay treatment or not seek treatment at all. Differences in responses emerged in relation to ethnicity and religiosity, with African‐Americans and regular churchgoers being more likely than others to say they would delay or refuse treatment because of embarrassment. Gender differences also emerged: respondents reported that women would be more stigmatized than men if they were infected, even though men should be held responsible for spreading STIs. These findings suggest that stigma may be a compelling barrier to STI control in the American Deep South, and that ethnicity, gender and religiosity play an important role in attitudes toward treatment.

Acknowledgements

The research for this paper was supported by The University of Alabama at Birmingham Sexually Transmitted Diseases Clinical Research Center New Investigator Program, grant number 5U19AI38514‐07. Thanks to Patrick Cotter, Stanley L. Brodsky, Celia Lo and Danielle Williams for their editorial input, technical advice, and support in writing and researching this paper. Thanks also go to William C. Cockerham of the Center for Social Medicine and STDs at the University of Alabama‐Birmingham for facilitating the research.

Notes

Bronwen Lichtenstein is an assistant professor in the Department of Criminal Justice and the Institute of Rural Health Research at the University of Alabama, Tuscaloosa, USA. Edward W. Hook III is Professor of Medicine in the Division of Infectious Diseases at the University of Alabama, Birmingham, USA. Amit K. Sharma is a project officer for the Rural Medical Scholars Program in the Department of Community and Rural Medicine at the University of Alabama, Tuscaloosa, USA.

Additional information

Notes on contributors

Amit K. Sharma

Bronwen Lichtenstein is an assistant professor in the Department of Criminal Justice and the Institute of Rural Health Research at the University of Alabama, Tuscaloosa, USA. Edward W. Hook III is Professor of Medicine in the Division of Infectious Diseases at the University of Alabama, Birmingham, USA. Amit K. Sharma is a project officer for the Rural Medical Scholars Program in the Department of Community and Rural Medicine at the University of Alabama, Tuscaloosa, USA.