Sexuality-Related Risks are Judged more Harshly than Comparable Health Risks

ABSTRACT

Objectives: In three studies, the authors examined the extent to which STIs and sexual behavior were perceived negatively compared to objectively riskier behaviors. Methods: In Study 1, participants estimated the risk of death as a result of contracting HIV from one instance of unprotected sex (with a noninjection drug user) relative to the risk of death as a result of an automobile accident (a 300 mile drive). In Study 2a, participants read one of two vignettes, in which a target either unknowingly transmitted an STI (chlamydia) or a nonsexual disease (H1N1) to another person through a sexual encounter. In Study 2b, participants read one of 12 vignettes; the type of disease (chlamydia or H1N1), severity of the disease outcome (mild, moderate, or severe), and sex of transmitter (female or male) were manipulated. In Study 3, state-level public health and driving websites were coded for risk-reduction recommendations. Results: In Studies 1 and 2, participants rated the target who transmitted chlamydia more negatively than the target who transmitted H1N1; participants also perceived the target who transmitted chlamydia with a mild severity outcome (the sexual partner took antibiotics for one week) more negatively than the target who transmitted H1N1 with a severe outcome (the sexual partner died from contracting H1N1; Study 2). In Study 3, most state-level public health websites promoted safety through a recommendation that the public abstain from sex; no similar recommendations were provided on driving websites (an objectively riskier behavior). Conclusions: The stigmatization of STIs is beyond the degree of severity (relative to other diseases) and viewed as unjustifiably risky (relative to other risky activities).

KEYWORDS:

• Sexually transmitted infections
• stigma
• risky behavior
• decision making

Notes

1. These conditions were developed to provide the most stringent test of our hypotheses. There is a statistically greater chance of acquiring HIV than of dying from HIV. Therefore, it would be easier to support our predictions if we compared the probability of dying in a car crash to the probability of simply acquiring HIV, relative to the comparison we actually used (the probability of acquiring HIV and dying). Thus, we would expect our results to be even larger if we made a comparison between acquiring HIV and dying in a car crash. Moreover, we operationalized unprotected sex as a single act of sexual contact (intercourse) regardless of sex of partner (i.e., male-to-male, heterosexual male-to-female, and heterosexual female-to-male), consistent with the Centers for Disease Control's (2013) transmission categories of HIV from 2010. Our pilot testing indicated that the vast majority of people, when asked what “having sex” means, think of “sex” as heterosexual sexual intercourse; however, our estimates also include male-to-male sexual contact. Based on prior research (Sanders & Reinisch, 1999), if participants were not thinking of penile-vaginal intercourse (or anal intercourse), they were thinking of other noncoital activities. Noncoital activities would pose even less risk than sexual intercourse, meaning that, if anything, the results would be magnified if considering a broader scope of activities as “sex.”

2. In 2009, there was a total of 2,979,321,000,000 miles driven and 17,640 driver deaths (United States National Highway Traffic Safety Administration, 2009). The distance from Detroit, Michigan, to Chicago, Illinois, is approximately 300 miles. Assuming average U.S. road conditions, the probability of a (driver) death driving from Detroit to Chicago is 0.000001776 (calculation: 17,640/2,979,321,000,000 = x/300). According to the Centers for Disease Control (2013), there were a total of 899,600 individuals infected with HIV in the transmission categories of male-to-male sexual contact and heterosexual contact in 2010 (those in the injection drug use transmission categories were excluded from the current prevalence rate). Thus, the HIV prevalence among noninjection drugs users was 350.88 per 100,000 people (calculation: 899,600/256,384,408.60). Note, the U.S. population figure was garnered from census data for people over 13 years of age (U.S. Census Bureau, as cited in Centers for Disease Control, 2013). Infectivity of HIV is not the same across individuals and situations; according to the Centers for Disease Control and Prevention (2013), the rate of HIV transmission in 2010 was 4.15 per 100 persons living with HIV in 2010. Thus, the estimate of engaging in one instance of unprotected sex and contracting HIV is 0.0001456152 (calculation: 350.88/100,000 x 0.0415). To date, there is no figure available of the fatality rate of HIV/AID-related causes among those infected (for instance, the CDC provides the total number of deaths among those infected with HIV, but the causes are unknown). According to Rodger and colleagues (2013), among 3,280 well-controlled HIV-infected adults who were noninjection drug users (in SMART and ESPRIT clinical trials), 2 out of the total 62 deaths were attributed to AIDs-related causes (observed in 12,357 person-years of eligible follow-up). Note, the authors acknowledged that the ascertainment of HIV/AIDs-related deaths may be an underestimate. Moreover, we understand that not all individuals infected with HIV seek and adhere to treatment; however, this estimate of HIV/AIDs-related deaths (which did not include injection drug users) was the most accurate mortality rate we could locate. Thus, the probability of dying from HIV/AIDs (i.e., a HIV/AIDs-related cause) from acquiring HIV from one instance of unprotected sex with a noninjection drug user is 0.000000088789756088682 (calculation: 0.0001456152 x 0.0006097560975). Taken together, the estimate for driver fatality (for a 300 mile trip) divided by the estimate of (HIV/AIDs-related) fatality from one instance of unprotected sexual intercourse with a noninjection drug user is0.000001776/0.000000088789756088682 = 20.003207, or, approximately 20.