“All Adventurous Women Do”

HBO's GirlsOn the third episode of HBO’s new series, Girls, the protagonist Hannah (played by creator Lena Dunham) is diagnosed with human papilloma virus (HPV). Distraught, she tells her best friend, who replies with the most revolutionary phrase ever uttered on television regarding STI stigma: “All adventurous women do.”

STI stigma is not difficult to understand. Since STIs are sexually transmitted, they’re easy to interpret as punishment for promiscuity. People with STIs are often characterized as slutty, dirty, trashy, or stupid and reckless. And when someone is diagnosed with HPV–no matter how confident she is in her choices, no matter how careful she is–she’s faced with the crushing weight of this stigma. She must try her darndest not to internalize it–not to believe that she is being punished for her sexuality, not to believe that she brought this upon herself, or that this viral infection is indicative of poor moral character. This is extremely difficult because no one has prepared her for this, and she will almost certainly go through it alone.

Since HPV and STIs are treated as a shameful secret, we don’t ever talk about what the process of diagnosis and its aftermath is like, and as a result, we never hear what it was like for someone else. We each have to figure out how to cope on our own, in silence, without the comfort or guidance of those who have been there and can understand. There are no celebrity spokespeople for HPV. No star athlete role models. And so very few narratives in television, film, or literature.

It’s rare to see STIs on television. Rather, it’s rare to see STIs on television outside of medical and crime dramas where STIs are used as a “who done it” plot device to reveal some unexpected twist regarding infidelity or some otherwise inappropriate sexual behavior. It’s rare to see a character simply living with an STI–getting diagnosed, experiencing treatment, navigating relationships, and dealing with shame and stigma in every day life. It’s rare, but it shouldn’t be.

HPV is the most common STI in the United States. The CDC approximates that 20 million Americans currently have HPV, with six million new infections occurring each year. (For reference, 20 million people is roughly the population of Beijing, New York state, and the entire country of Australia.) The CDC estimates that 50% of sexually active Americans (men and women) will contract HPV at some point in their lives, although the American Social Health Association thinks it’s closer to 75-80%. For women, the rates are even higher: the CDC estimates that, by the age of 50, at least 80% of women will have acquired sexually transmitted HPV.

So, if at least 50% of Americans will one day have the experience of being diagnosed with HPV, shouldn’t we be doing something to prepare them for that moment so that the bottom doesn’t drop out from under them? Shouldn’t we let them know that this is a shared experience and that they don’t have to feel so alone? Shouldn’t we be working to combat stigma at the social level so that we can reduce the emotional damage it inflicts?

Writing HPV and other STIs into television narratives is a great way to challenge and combat stigma. Especially when the character is able to make peace with the diagnosis, providing a model for the rest of us.

“All adventurous women do.”

In that one glorious sentence, Girls let us know that HPV is common and that instead of a being a sign of poor character, it’s a mark of an adventurous spirit. This one line erases the stigma and reframes HPV as something normal, even positive. “All adventurous women do” allows Lena Dunham’s character Hannah to own the diagnosis, to embrace it, to wear it as a badge of honor. And it teaches the rest of us–all of us girls who have felt the waves of shame and guilt crashing on top of us, suffocating us–that we are okay. That HPV, much like traveler’s diarrhea, is just another part of the experience of being an adventurous woman in the 21st Century.

We’re coming to vaccinate your children: the moral case for compulsory HPV vaccination

Are there moral grounds for compulsory HPV vaccination? Joseph E. Balog, PhD, MSHYG, certainly thinks so. In an article in the April 2009 issue of the American Journal of Public Health, Balog concludes that compulsory HPV vaccination is not only morally justified, it’s a social justice issue.

Some are opposed to compulsory HPV vaccination because they are concerned that vaccinating teens for an STI could be seen as condoning or encouraging sexual activity, undermining abstinence messages and providing a false sense of security about protection from STIs. The scientific community is also skeptical of compulsory vaccination, arguing that the mortality rates of cervical cancer are too low to be considered an “imminent harm” and that the benefits might not outweigh the financial costs, as well as the costs to individual liberty.

Balog argues the “rightness” or “wrongness” of compulsory HPV vaccination should be determined by key ethical principles: whether vaccination would reduce harm to individuals and society, and whether vaccination would produce benefits that are at least as good as the alternatives for prevention of death and disease.

HPV meets the standards for compulsory vaccination
In addressing the concern that mortality rates of cervical cancer are too low to be considered an “imminent harm,” Balog argues that HPV still meets the precedent set by other diseases for which we mandate vaccination, such as polio and measles.  The risk of a fatal outcome from HPV is relatively low, but it is still comprable to that of polio or measles.  The HPV vaccine fits comfortably within the precedent already set for compulsory vaccination.

Eradicating disease trumps the preservation of social ideas
Balog rightly points out that the conservative folks who oppose HPV vaccination because they believe it might promote sexual behavior are more concerned with upholding moral values than they are with preventing real, physical harm. From a public health perspective, prevention of harm is the first priority, especially considering the fact that the types of prevention offered as alternatives to vaccination (abstinence) have been been studied and proven to be ineffective. As Balog argues, it would be wrong to deny teens a real solution in order to uphold a symbolic ideal.

A child’s human rights override parental rights
The law generally respects and protects parental rights over their children. But when it comes to the health and safety of the child, the state may sometimes step in. When it comes to child vaccinations, the state generally upholds the child’s right to healthcare. Since the health threat of HPV affects the child directly and the parent only indirectly, the right of the child to receive the vaccine outweighs parental autonomy. We don’t often think of it this way, but from Balog’s point of view, access to preventative healthcare, like vaccination, is a human right. Of course, any compulsory vaccination program must follow the legal precedent that includes the right of states to allow individuals with medical, religious, and philosophical objections to opt-out. A compulsory HPV vaccine would, of course, include these exceptions.

Compulsory vaccination is a social justice issue
I’m not sure if you’ve seen the ads for Gardasil (the first HPV vaccine on the market), but they are clearly directed to white, middle class women. The reality is, however, that there are huge racial and economic inequalities in rates of cervical cancer and cervical cancer screenings. In the US, incidence of cervical cancer is 50% higher among African American women and 66% higher in Latina women than in white women. While they have the greatest risk, these groups are the least likely to receive cervical cancer screenings (PAP smears) and are also the least likely to get vaccinated. A voluntary vaccination program does not guarantee universal access; the vaccine is prohibitively expensive without health insurance coverage. Public health professionals understand that mandates are not only the most effective way to ensure that the disadvantaged women have access to the vaccine, but also the most effective means of protecting these women from cervical cancer.

Just like children faced the threat of polio in the 1950s, our adolescents are in need of protection against HPV and the array of cancers it can cause. Withholding that protection is unethical, and supporting abstinence as an alternative is both unrealistic and ineffective. But making the HPV vaccine available on a voluntary basis is not enough. It is only with a compulsory vaccination program that all adolescents, regardless of their parent’s values, race, socio-economic background or insurance status, will have real access to the vaccine. Then, and only then, will cervical cancer prevention reach the groups that really need it.

Genital Herpes (part 6): Conclusions

This is the final post in my series on genital herpes.  We we have discussed the fact that genital herpes is the most stigmatized STIeven more so than HIV. We know that herpes jokes are overwhelmingly common and popular, and that anyone offended or hurt by those jokes is silenced by the risk of exposure.  We know that people with genital herpes are thought to be sluts, cheaters, and liars.  We know that people with herpes are described as lepers, monsters, or “dirty.” We also know from listening to people’s stories that it is a traumatizing and unbearable experience to find out you have herpes, but that after a few years, you go on with your life and it’s not so bad.  All of this leads me to the conclusion that dealing with herpes stigma is the worst part about having genital herpes.  In other words, the emotional effects of herpes stigma are much worse than the physical effects of the STI. I have even heard that some doctors advise against getting tested for herpes because if you aren’t having symptoms, the the risk of emotional devastation from a false positive is worse than the risk of delaying the diagnosis.

We may not be able to cure herpes, but we can certainly work to reduce stigma associated with it and make the experience of a herpes diagnosis less emotionally devastating.  So why aren’t more people trying to do this?

If that’s true, then why don’t messages about genital herpes from sexual health professionals fail to address the pervasive stigmas associated with the disease?  Instead of talking about the genital herpes we know from jokes, monster metaphors, Google image searches, and celebrity divorce scandals, health organizations give us dry fact sheets and statistics.  The genital herpes described in those fact sheets doesn’t feel like the same genital herpes we laugh at, recoil from, or vilify in pop culture. One explanation is that health communicators avoid acknowledging stigmas and negative metaphors associated with genital herpes in their messaging in order to remain neutral or non-judgmental.  It is also possible, however, that health communicators do not wish to reduce stigma because framing genital herpes as “ no big deal,” or “ nothing to fear,” could have negative consequences for prevention efforts because people will care less about being cautious. There may even be perceived incentive to cultivate and encourage stigma in order to “scare” people into practicing safer sex.

Some health resources do address stigma, however. Perhaps the best example of a health resource that acknowledges and addresses the stigma of genital herpes well is the American Social Health Association. The ASHA Herpes Resource Center features personal narratives, hotlines, and support groups, with the same prominence as factual information about the STI.  They understand that the emotional devastation of genital herpes is as much a part of the experience of the STI as the physical symptoms, and just as important to treat. The ASHA’ s approach could serve as a helpful model for health providers, educators and communicators.  The health education community needs to take an approach that not only encourages prevention, but also discourages further stigmatization of the disease.  The medical community needs to take an approach that treats not only the physical symptoms of genital herpes, but the social and emotional effects of the disease as well. And as for individuals, we all need to step up and do our part to get educated and put a stop to this pointless discrimination.

I have spent a lot of time really thinking about genital herpes this month because I’ve been writing a paper on it for school.  Most of us, though, don’t spend a lot of time thinking about genital herpes, or how many of our friends might be dealing with the shameful secret and how our careless jokes might make them feel.  And since sex is like Russian Roulette and any one of us might wind up with genital herpes, helping to fight the stigma, shame, and fear of the disease will help make the diagnosis less emotionally devastating when/if it happens to us, or our friends or partner.

So here are some things you can do:

  • Add “people with STIs, including herpes” to your mental list of groups that face discrimination (like GLBT folks, people with disabilities, women, Muslim Americans, African Americans, Latino Americans, etc). Recognize their struggle and support them when you see discrimination happening.
  • Take a stand against herpes jokes that would make someone who has it feel ashamed or uncomfortable.  Step in and say, “Dude, that’s not funny.  How would you feel?”
  • Pay attention to language.  Pay attention to metaphors like “monster,” “leper,” and “dirty” or “clean.” Try to stop using them yourself, and try to get your friends to stop as well.
  • Pay attention to stereotypes.  Correct people when they try to say that being a slut means you probably have herpes, or that people with herpes are liars and cheaters.
  • Tell your story.  If you have herpes, it may be too scary or too risky to “come out” about having herpes in public or to your friends and family.  But you can share your story anonymously either online or using a pen name.  Share your experience to help dispel the myths about herpes, and to let others know that they are not alone and that herpes is not the end of the world.
  • If you’re in college, investigate your health center and on campus sex ed resources.  Pay attention to how they talk about herpes and whether or not their approach is reinforcing or rejecting stigma.  If you don’t like what you see, try to change it.

If you have other ideas, please share them in the comments.

When I started this series, I talked about how I was uncomfortable with the idea of blogging about this and forever associating myself with genital herpes. I knew that everyone would be wondering if I had it, because why else would I write about it? Well, I’m not going to tell you if I have it.  But it’s interesting to think about – if I did, would that change how you felt about what you read?  If I didn’t, would it change it in a different way? I don’t know.  What I do know is that most people aren’t comfortable enough to speak out about herpes awareness, but I am and I did it.  And my world did not come crashing down.

I hope that this, in some way, gives others the courage to speak out and make a difference. Because when almost 25% of the population is demonized for having a virus, well, it’s just unnecessary. People with herpes are not sluts. They are not monsters. They are not predators. They are not dirty.  They are just people, and like anyone else with a disease, they deserve respect and compassion. After all, any one of us could end up with herpes. And when that happens, my friend, the joke’s on you.

Genital Herpes (part 5): Talking bout the herp

We hear illness narratives all the time.  We invite cancer survivors onto talk shows to tell their stories.  We read memoirs written by people struggling with mental illness or disability.  These narratives are told for a number of reasons: to help one make sense of his/her/hir illness; to assert control over one’s illness; to transform one’s identity; to justify one’s medical and life decisions; and perhaps most importantly, to build community. Telling our stories of illness helps us relate to one another – to know that we aren’t going through this alone.  Because they provide such an important function in our society (support, hope, community, love, strength, etc) these types of illness narratives are an increasingly popular vehicle for discourse about health and illness in popular culture.  But what about people with herpes?  We don’t hear their stories in the mainstream media.

If you want to hear stories about what it’s like to have genital herpes, you need to go online.  Due to the extreme stigma associated with the STI, the “community” of people living with genital herpes exists only on the internet, where they can connect anonymously through blogs and online forums. There are even dating sites where people with herpes and other STIs can find matches who understand.  It is not hard to imagine that before the internet, genital herpes was a much more isolating experience.

When you have genital herpes, you have the same reasons for sharing your story as anyone else.  Telling your story helps you make sense of what happened (“why me?”); deal with the loss of control over your body; your transforming identity (becoming a stigmatized/tainted member of society); the decisions you now have to make, like telling a sexual partner; and most importantly, it helps create a community where you can find support and connect with others going through the same thing.

There are two distinctive types of stories people tell about having herpes – those that internalize the horrible stigma surrounding the disease, and those that reject it.  The first type that internalize stigma (I am dirty, I am a whore, I am a monster) are pretty upsetting.  When people believe all that negative stigma about people with herpes to be true about themselves, their experience sounds unbearable.  These stories use the same metaphors we talked about earlier. An online forum user wrote: “ I woke up today feeling so empty, alone, rejected & depressed!! … I’m not angry at the person who gave it to me, yet. It’s[sic] my fault.” Another wrote: “ This thing has taken me away from myself… all I’ve been thinking about is being gone. Dead … I just don’t see how I’ll ever be happy again.”  These stories are heartbreaking and make it sound like getting genital herpes is the end of the world.  And isn’t that what we are all so afraid of?

The good news is that the majority of stories like this come from people who have been recently diagnosed with genital herpes. Narratives from people who have had the virus for a number of years, however, are much more positive.  Instead of internalizing all the stigmas and metaphors about herpes, they reject them.  They tell their stories with the goal of helping others feel okay about having herpes.  These stories are there – just like stories about surviving cancer – to help folks realize that herpes doesn’t have to be the end of your life.  In fact, it’s really not that big a deal at all!

These stories often begin by remembering what it was like when they first found out they had genital herpes.  A forum user wrote: “ I remember the devastation. I thought it was the end of the world; I quit eating and lost about 5 pounds in two days. I thought I was the most disgusting, gross, infected, worthless piece of trash in the world.”  But then he goes on to explain how, with time, he came to regard herpes as something totally manageable: “ I came to realize that, as far as living with it, it’s just like dandruff, psoriasis or some other skin disease for the most part; it breaks out, I get uncomfortable, and it heals in time …. It’s really not a big deal once you learn how to handle it.” Actually, a lot of people living with genital herpes think of it like a skin condition. Another forum user wrote: “This skin condition (personally I really see it as that) is only as big and frightening as you allow it to be.”

In these narratives, people with herpes reject the idea that they are sluts or “dirty.” A forum user made this pretty clear when she wrote “People who take a shower are clean. Those who have herpes are NOT DIRTY.”  In this interview on the Tyra Banks Show (a rare case where someone with herpes shared her story on TV!), Michelle Landry made it clear that she wasn’t any of those negative stereotypes.

Many people share their stories as a conscious effort to encourage those who do not yet
have an STI to protect themselves and to provide support for those who do.  On Sex Etc., Holly Becker wrote: “So, think about my story when you’re having sex. Ask your future partners the hard questions, too … And think about my story when you hear that someone has an STD. Most likely, if they have one, they are scared and lonely, and could use a friend.” An anonymous message post reads: “I hope my words and experience with this can help others learn to be OK with themselves after being diagnosed with this. Life does go on and you can be happy!!!”  More great stories like this can be found at the ASHA Herpes Resource Center.

Some people find the experience of opening up and talking about having herpes as liberating. In an interview about his book Monsters, Ken Dahl said, “ I’ ve got nothing to lose now, and it’ s really liberating. Now I kind of want to do it for everything else in life, because no one can make fun of me. What can they say that I haven’ t already said?”  Christopher Scipio, author of Making Peace With Herpes (2006), has become an advocate for this:

Instead of being imprisoned by this disease, I decided to free myself. I am nolonger afraid of saying the word and letting people know that I am one of “ them.”I have herpes, but herpes doesn’ t have me … I am at peace with my place in this world, and I have discovered the joy of encouraging others to liberate themselves from the stigma.

If you try, you can find plenty of stories about having herpes that really convince you that hey, this isn’t the end of the world.  Thanks to condoms and suppressive therapy (drugs like Valtrex), you can still have a healthy sex life with herpes.  The drugs also help suppress breakouts and make them less severe when they do happen.  Herpes will not kill you, and doesn’t really have any serious complications or health risks (except you might need to get a C-section to avoid passing it to your baby).  All in all, it’s a relatively mild condition that is totally manageable.

Sounds to me like dealing with the stigma and shame of herpes is a lot worse than dealing with the disease itself.  Is it really worth the agony?  We’re going to hash it out in Part 6, the conclusion of this series on genital herpes.  Stay tuned!

For more in the series:

Part 1: This is a post about genital herpes

Part 2: Actually, genital herpes IS a joke

Part 3: More than 51 million Americans are cheaters and whores, apparently

Part 4: Herpes makes you dirty and also a monster

Genital Herpes (part 4): Herpes makes you dirty and also a monster

Genital herpes stigma is largely constructed and reinforced through metaphor. The dominant herpes metaphors are drawn from the aesthetically repugnant nature of its symptoms (the way herpes lesions look) and liken carriers to “ monsters” or “ lepers.”

The most dreaded are those that seem like mutations into animality (the leper’ s “lion face”) or a kind of rot (as in syphilis). Underlying some of the moral judgments attached to disease are aesthetic judgments about the beautiful and the ugly, the clean and the unclean, the familiar or the alien and uncanny…What counts more than the amount of disfigurement is that it reflects underlying, ongoing changes, the dissolution of the person.

Susan Sontag, Illness as Metaphor and AIDS and its Metaphors

Considering the graphic and grotesque nature of genital herpes images on the internet, it is not difficult to explain why leprosy is a common metaphor for genital herpes. On Yahoo Answers, a user asks, “ Do you ever get over feeling like a leper?” On another forum, a user wrote: “ I feel like a leper. Who’ s going to accept me like this?” Christopher Scipio, author of Making Peace with Herpes, calls himself a “ modern day leper.”

The thing is, leprosy is actually a real disease that people today still suffer from.  Though it is uncommon in the U.S., the World Health Organization (WHO) estimated that between 2 and 3 million people were permanently disabled because of leprosy in 1995. We now know that leprosy, or Hansen’s Disease, is neither sexually transmitted nor highly infectious after treatment. Approximately 95% of people are naturally immune, and people with Hansen’s Disease are no longer infectious after as little as 2 weeks of treatment.  Also, it’s totally curable (when you have the resources).  Hansen’s Disease is probably the most stigmatized illness in the history of illness, and by associating it with genital herpes – one of the most stigmatized illnesses in contemporary western culture – the metaphor mutually harms sufferers of both herpes and leprosy, and sets back the goal of destigmatization for both diseases.

Another prevalent metaphor for genital herpes is the monster metaphor. It is often used to describe the virus itself, i.e., “ the herpes monster,” or by people with genital herpes to describe themselves, i.e., “ I am a monster.” In an online forum, one user wrote: “ The herpes monster has destroyed my life.” On Yahoo Answers, a user writes: “ I feel like a monster.” Another user wrote: “ I’m a monster and I don’ t deserve living.”

Let’s just back up a second. This is a monster:

These are people who could have genital herpes:

There is a difference.

The monster metaphor is central to Ken Dahl’ s aptly named graphic novel, Monsters. The novel is a groundbreaking, semi-autobiographical narrative about the experience of contracting herpes. Despite the fact that the protagonist’ s experience is primarily concerned with oral herpes, I’m including it here because it provides a powerful, illustrative, and in-depth examination of the experience of living with herpes, one that is rarely found in literature.

As is obvious from the title, the monster metaphor is pervasive throughout the novel, both in the text and illustrations: “Sometimes I feel like my body’ s been taken over by a parasitic monster, and sex is now just this monster’ s way of finding new hosts to infect.” Text like this is accompanied by vivid imagery of the protagonist encapsulated in giant, grotesque blobs of sores and pustules.

“Let’ s face it: nobody wants to fuck a monster… and become a monster themselves,” Dahl writes.  In a panel where the protagonist is drawn as Dracula hiding from an angry mob under a bridge, he writes: “ But look at it from the monster’ s point of view. You just want what everyone else wants – acceptance; affection; inclusion… and of course survival. Just for that, your life has to be a gauntlet of pretty faces recoiling in horror.”

Implicit in the monster metaphor are feelings about genital herpes as a manifestation of evil. Susan Sontag wrote: “Feelings about evil are projected onto a disease. And the disease (so enriched with meanings) is projected onto the world.”  As a result of this projection of evil, people with genital herpes are sometimes considered predators or dangerous to the community at large. This is the notion behind the awful, humiliating, privacy-violating and wholly unnecessary STD Carriers Disease Control Prevention Services website. The site hosts a STI carrier “ registry” where users can report people with STIs (including their names and locations) to a public database reminiscent of the National Sex Offender Registry. This website is an unfortunate example of how the monster metaphor and its connection to “ evil” can lead to fear, or even persecution, of people with genital herpes and other STIs.

Another common metaphor in the discourse surrounding genital herpes is the idea that someone infected with HSV is “ dirty” and someone who is not infected is “ clean.” This metaphor is commonly used in reference to STIs and dates back to the nineteenth century. According to Sontag, “Specific diseases, such as cholera, as well as the state of being generally prone to illness, were thought to be caused by an ‘ infected’ (or ‘ foul’ ) atmosphere, effusions spontaneously generated from something unclean.”  Though we now understand that the cause of infection is due to viruses or bacteria rather than miasma, the dirty/clean metaphor is still pervasive. Today, the word “ dirty” also carries a sexual connotation, and for this reason, it is a popular metaphor for people who have genital herpes.

This language is all over the place. One forum user calls genital herpes her “dirty secret.” On Yahoo Answers a user writes: “my friend just told me she has genital herpes, now I can’t help but think she’s dirty.” Another forum user concerned that he might have contracted genital herpes writes: “The two women I slept with swear up and down they are clean.” In a routine called “The Herpes Myth,” stand-up comedian Courtney Cronin seems to differentiate between people who got it because they were victims (someone lied to them, etc) and those that go around spreading it willy-nilly because they are “dirty, disgusting pigs.”

Really? Let’s bring our friends back to demonstrate.


Which one is the victim, and which one is the dirty, disgusting pig? Hmmm…

The dirty metaphor is also used by rapper Immortal Technique in the song, Industrial Revolution: “My metaphors are dirty like herpes but harder to catch.” This example identifies another interesting use of metaphor in which herpes becomes a metaphor in and of itself. Susan Sontag wrote: “First the subjects of deepest dread (corruption, decay, pollution, anomie, weakness) are identified with the disease. The disease itself becomes a metaphor. Then, in the name of that disease (that is, using it as a metaphor), that horror is imposed on other things.” So, herpes is often used as a metaphor to describe something that “keeps coming back,” or “will not go away.” At her Comedy Central roast, comedian Joan Rivers closed with this metaphor: “ I plan to be around for the next hundred years just like herpes. When you least expect it, I will be there.”

(For the record, I am really upset that the only clip of Joan Rivers was put up by those awful, nasty, people behind the STD Carriers website. JERKS!)

You know, Joan has a point.  Herpes IS going to be around forever, and as you get older your chance of getting it only increases.  Do we really want to keep perpetuating these myths about people with herpes as dirty, scary monsters?  Forever?  Sure, maybe putting down those who have genital herpes is a way to make people without herpes feel better (“well, I know I’m not a slut or a monster or any of those bad things because I don’t have herpes!”) but the chances are high that those people will someday contract herpes and what then?  That’s when they – if not everybody – has to face the fact that after vehemently propagating and internalizing this stigma for years and years, they are now stuck inside a shitty social prison of their own making.  Who’s the monster now?

In case you missed them, check out:

Genital Herpes (part 3): More than 51 million Americans are cheaters and whores, apparently

Genital herpes occupies a uniquely stigmatized and shameful space in American culture.  STIs are always stigmatized due to the cultural and religious moralization of sexuality in America. They are often assumed to be the “consequence” of promiscuity. This stigma is so, unmistakably pervasive throughout American culture that I hardly need to give examples, but I will.

The entry on genital herpes in the Encyclopedia Dramatica, a satiric version of Wikipedia, reads: “ In fact, you get genital herpes because you are a whore.” Right wing blogger Melissa Clouthier writes: “Twice as many young adults ages 20 – 29 have herpes than did 20 years ago. This is a recurring tragedy for the sufferer and his partner–a consistent, unrelenting reminder of promiscuity that cannot be undone.”  These examples demonstrate the two different types of slut shaming going on: the former is simple, ignorant shaming for the purpose of “making a funny,” while the latter has a religious/political agenda behind it suggesting that herpes is the consequence of deviant sexual behavior.  (See how the Right capitalizes on ignorance and reinforces ignorance all at the same time?)

The connection between genital herpes and promiscuity is consistently made in film and TV as well. In Forgetting Sarah Marshall, the rock star Aldous Snow reveals to his girlfriend that he has genital herpes: “ Well, look, you know, I’ve not told you I’ve got genital herpes because it’s not inflamed at the moment.”  Here, genital herpes is used as a device to emphasize Snow’ s promiscuous, “ rock n’ roll” lifestyle. Stephen Colbert of the Colbert Report poked fun at the association between herpes and promiscuity with a story about oysters infected with a strain of herpes. Colbert called them “ oyster sluts,” asking, “ Come on oysters, have you never heard of protection?”

Perhaps the best recent pop culture example of the link between genital herpes and promiscuity in the American imagination is MTV’ s The Jersey Shore. After the first episode aired, one blogger called it “ The Real World with herpes,” implying that the show was comparable to The Real World, another MTV reality show first broadcast in 1992, but with more promiscuity . In 2010, a Jersey Shore producer made headlines when she said “We hand [Valtrex] out like M& Ms. ‘Hey kids, it’s time for Valtrex!’ It’s like a herpes nest. They’re all in there mixing it up.” The cast of the Jersey Shore denied this allegation in an attempt to avoid the stigma of genital herpes. In later episodes, however, cast members make herpes jokes themselves, categorizing certain women as promiscuous or “ tainted” in a humorous way. In doing so, they become both victims and propagators of this stigma, thus strengthening the association between genital herpes and promiscuity.

About 1 in 5 or 1 in 6 people in the U.S. have genital herpes.  If the US population is 310,519,000 (all stats taken from Wikipedia), then that means there are over 51 million Americans with genital herpes right now.  That’s more people than there are Latino Americans (46.9 million) or African Americans (37.6 million).   What’s the likelihood that all of those people are “sluts,” or “deserved” to get herpes?

Genital herpes is often framed as physical evidence of infidelity. This Saturday Night Live parody (I couldn’t get the embed code to work, sorry!) of a Valtrex commercial plays with this stigma. In the sketch a husband (Alec Baldwin) and wife (Amy Poehler) are sitting together on a couch and it is obvious that the husband has been unfaithful. When the wife says that she finds it odd that a married couple with no history of STIs could have genital herpes, the husband replies: “But then I explained it, and that was the end of it, and there was no need to talk about it anymore.”  See how people with genital herpes are further stigmatized, not only as cheaters but as liars? The majority of Valtrex parodies play with the stigma of people with genital herpes as cheaters and liars in a similar way – perhaps suggesting that people believe using Valtrex is dishonest because it makes herpes easier to hide.

Lying about having genital herpes is also discussed in the context of celebrity divorces. For example, David Gest made headlines when he accused Liza Minnelli of giving him herpes inthe midst of their divorce. In an attempt to overturn a prenuptial agreement, DavidHasselhoff’ s ex-wife accused him of infecting her with genital herpes. In some cases, lying about genital herpes becomes a legal or criminal issue. In 2005, a woman sued NFL quarterback Michael Vick for negligence and battery for infecting her with herpes.

Celebrities often use their fame to help raise awareness for diseasesor health-related causes. (Think: Michael J. Fox for Parkinson’s Disease.)  When it comes to genital herpes, however, no celebrity would risk the stigma of association or exposure. As a result, the only time we hear about a celebrity having genital herpes is in the context of a scandalous rumor, bitter divorce, or lawsuit.  No one in their right mind would dare be open about having genital herpes, right?

Then, wait.  It’s not safe to be open about having genital herpes yet, you’re a liar and a cheater if you aren’t?  Seems like you’re damned if you do, damned if you don’t here.  It’s almost as if we want people with herpes to wear a scarlet “H” on their clothes so we know when to run away screaming. This seems a little much for a disease that is, in actuality, relatively mild condition with hardly any health complications that can be managed quite well with medication.

And speaking of running away screaming, my next post will discuss the different metaphors we use to talk about herpes and the people who have it.  *Read Part 4 here.* If you need to catch up, check out part 1 and part 2 of the series.

Genital Herpes (part 2): Actually, it IS a joke.

Ever notice that the only time we hear herpes mentioned in movies or on TV is when it’s the butt of a joke? Genital herpes is an easy target for humor because it is not fatal and the people who suffer from this STI are not usually considered victims. Unlike HIV/AIDS, genital herpes is a relatively mild condition that does not warrant the seriousness or sensitivity that society grants fatal illness. Instead, genital herpes is understood to be a punishment, or something you “ bring upon yourself.”  People with genital herpes aren’t though of as victims; they’re thought of as sluts, monsters, lepers, or just stupid.  When we combine these factors, people with genital herpes are obvious subjects for ridicule.

A quick search on the Internet Movie Database will reveal that the majority of the films and scripted TV shows that mention genital herpes are comedies. The Hangover features a classic herpes joke: “ What happens in Vegas, stays in Vegas. Except for herpes – that shit’ll come back with ya.”  Another common quip dubs genital herpes “ the gift that keeps on giving.”  Let’s not forget this one from Sue Sylvester on Glee: “You know, for me trophies are like herpes. You can try to get rid of them but they just keep coming. You know why? Sue Sylvester has hourly flair ups of burning itchy highly contagious talent.”

Herpes jokes are also common in stand-up comedy. In a routine called “ Herpes Facts,”comedian John Ramsey discusses a statistic from a Valtrex commercial:

The Valtrex commercial Ramsey refers to is part of an advertising campaign that marked thefirst time a herpes medication was advertised to a national audience, making the disease morevisible than it had ever been in the mainstream media. The commercials could have beengroundbreaking in their attempt to normalize the STI, but instead they became a popular vehiclefor the same sorts of stigmatizing jokes the ads were intended to diffuse. The huge number ofValtrex parodies on Youtube demonstrates just how entrenched genital herpes humor is in ourculture, and Valtrex’ s inability to overcome it.

On her talk show, Tyra Banks interviewed Michelle Landry, a woman with genital herpes, about how she felt when she was first diagnosed.  She responded: “ I was so shocked. Thinking back to that day, all I thought about was the jokes I’ d heard about herpes, the stigmas.” Tyra then commented on the profusion of herpes jokes in popular culture: “ Like we were talking about earlier, jokes, jokes, jokes… so many people have herpes that I bet a lot of people telling the jokes probably have it.”

So why are these jokes so popular?  And why isn’t anyone saying anything about how miserable it must be for people with genital herpes to hear them and have to laugh along in order to avoid detection?

The jokes generally go unchecked since those who find them offensive or cruel are silenced by the fear of association with genital herpes, or the fear of being exposed as having genital herpes.  Both outcomes carry the very real risks of shame, judgement, and rejection.

At the root of the “ herpes humor” phenomenon is the extreme stigmatization of genital herpes as a grotesque or disgusting indicator of promiscuity and infidelity.  Stay tuned for more on stigma in part 3 of this series.

Part 1: This is a post about genital herpes.

This is a post about genital herpes (part 1)

I have been MIA the past few weeks because I have been working on a paper for my grad program on genital herpes.  The paper is about the social representation of the disease – how genital herpes is discussed and framed in pop culture and the media, etc.  I have learned a lot writing this paper and I’m excited to share it with you.  Most of what I learned came from my research survey of blogs, film, TV shows, Youtube videos, online forums, images, and health communication theory texts.  But a lot of what I learned was more organic than that.  I learned a lot about the social perception of genital herpes just from the experience of writing a paper about genital herpes.  Let me explain what I mean.

I am a pretty open person and I like to be controversial.  That’s why it was strange to me that when I chose genital herpes as my paper topic, I was a little hesitant to share it with my classmates and the world, aka Facebook.  But being me, I did it anyway.  Dr. Anna Wald, a virologist at the University of Washington, told the New York Times, “ Herpes has a stigma attached to it that even H.I.V. doesn’ t have anymore.”  I think she’s right.  Recently, Mondo Guerra publicly announced his HIV positive status on Project Runway and there was an outpouring of tears, love, and empathy.  This would not be the case for anyone who openly revealed that they had genital herpes on TV.  Can you even imagine anyone doing that?  We assume that one would have to be crazy to share such a shameful, stigmatizing, and personally damaging secret.

I realized that I was uncomfortable associating myself with genital herpes.  Will people think I have it? Why else would someone write a paper about genital herpes and risk that association if they didn’t have it, right?  So I pressed on, putting myself at the center of an itty-bitty social experiment.  I told everyone about my paper on genital herpes.

For two weeks, my gchat and AIM away message read “herpes, herpes, herpes, herpes.”  I received the gamut of responses, from “you have herpes????” to “ewwww” to “I love the fact that you’re comfortable enough to leave herpes as your status message.”  I posted updates about my herpes paper to Facebook all the time.  Most of them got “likes” from classmates and my former sex counseling buddies from college.  In response to a status update noting that just about every Judd Apatow movie includes a herpes joke, a friend joked, “herpes is no joke.”

I wrote the majority of my paper in the Emerson College and Tufts Med School libraries.  I couldn’t help but wonder what someone would think if they checked my browser history to find a plethora of articles, info guides, and support forums about genital herpes.  I also was wary of judging eyes walking past that might catch a glimpse of “genital herpes” on my screen.  I even felt this way in the med school library, where real medical students were making powerpoints with much grosser-looking slides right next to me.  (Abdominal surgery pics? Yuck!)

I’m not exactly new to this feeling.  I spend a lot of time and energy talking and writing about STI prevention, not to mention about rights and respect for people who have STIs. I’m sure plenty of people have already wondered if I do this because I have an STI.  Hell, you’re probably wondering right now.  (Would it make me more credible as a sexual health writer if I did?  Less credible?  Would it change your opinion of me as a person?)

I’ll be completely honest.  When I started writing this post, I paused for a second because I realized that writing this post would forever associate my name with genital herpes in the annals of internet history.  Me and genital herpes, total Google search bffs.  (“Writing about herpes on the internet is like herpes, it will be there for life.”)  But I don’t shy away from things like this.  That’s kindof what I’m about.  Genital herpes is NOT A DIRTY WORD.  But think about it.  Genital herpes is so stigmatized that even a veteran sexual health blogger thought twice about writing about it.

In the next few days I’ll be sharing some more from my paper about genital herpes stigma, metaphors, “herpes humor,” and narratives.  Stay tuned, and take a second to think:  Would you be willing to speak out for genital herpes awareness, or openly support those with genital herpes?  Or would the risk of stigma-by-association be too great?

Read on to part 2 – Genital Herpes: Actually it IS a joke

True Blood Danger: The Health Risks of Vampire Sex

It was only a matter of time.

For the past couple years (thanks to Twilight and it’s R-rated cousin True Blood) the world has been seduced by the notion of vampire sex. After finishing season 3 of True Blood, I remember remarking to a friend, “I wonder if people are actually trying this?” Turns out, they are.

This MSNBC report identifies biting and licking each other’s blood as a new “teen fad.”

Teenagers obsessed with the “Twilight” vampire saga, or those simply fascinated with fangs, reportedly have been biting each other — hard – and then licking or sucking the blood.

It reports some important health risks of this behavior as well:

Such talk alarms medical experts, who warn about the dangers of blood-borne diseases such as hepatitis and HIV, as well as the risk of nasty infections. Typically, 10 to 15 percent of human bites wounds become infected.

“If you break the skin, your mouth is pretty dirty,” said Dr. Thomas Abshire, a pediatric blood and cancer specialist and spokesman for the American Academy of Pediatrics. “The human mouth flora is dirtier than a dog or cat’s.”

It doesn’t surprise me that people are doing this. In True Blood, we see blood sucking as a sexual act – one that heightens intimacy and pleasure. After watching 2 seasons of True Blood back to back, I cannot say it hadn’t occurred to me that this was something people might want to try.  Plenty of people are kinky, and considering the popularity of Twilight and True Blood, biting and blood has become sexualized – even fetishized. I agree that those who have been tempted to experiment with this should be aware of the health risks listed above. It looks like there may need to be a call for education about STI transmission through blood and biting, as well as information on keeping human bite wounds clean.

But much of the MSNBC story annoys me. I highly doubt that teenagers are the only people who have tried, or are doing this. I also doubt that “These are kids who think they are real vampires,” as Dr. Orly Avitzur, the medical advisor to Consumers Union, the agency that publishes Consumer Reports magazine, stated. I agree with a student quoted in the piece who argued that biting is a common practice that has “gotten a bad rap because of this whole vampire thing. In reality… a lot of teens bite – and leave marks – for the thrill of it.” According to his statement, it sounds like biting is common, but licking or drinking blood is not. The MSNBC article suffers from the obvious sensationalism of the story, but does make a necessary point about health risks of biting and licking blood.

So how do we educate adventurous and curious folk about the health risks of playing vampire? Can we find a way to provide non-judgmental education without encouraging the behavior? And who’s responsibility is it to provide this education?

At the base level, we need to remind people that blood is dangerous; even if vampires cannot be infected with HIV or other STIs, (although in an early episode of True Blood, they reveal that vamps are susceptible to Hep D), humans can. Any time another person’s blood gets in your body, you are at risk for STIs like HIV – which, unlike vampires, is a very real threat.

Now, here’s a sex study that makes sense

After a dubious study from The Heritage Foundation nearly drove a friend of mine to insanity, it’s nice to see some conclusions based on actual research that account for and acknowledge socio-economic forces at work. In this study, researchers from the London School of Hygiene and Tropical Medicine (UK) analyzed data from 59 countries. They conclude that sexual health strategies must go beyond individual risk reduction and address social and economic determinants of behavior. (They also use funny spellings like “analyse” and “behaviour.”) (I’m allowed to make jokes because I lived there, ok? Sheesh.)

Here is the first part:

The analysis revealed the huge regional variation in sexual behaviour but also showed that there has been less change in behaviour over the past two decades than was thought:

  • There is no universal trend towards sex at a younger age. However, a shift towards later marriage in most countries has led to an increase in premarital sex, more so in developed countries and for men. Sexual activity in single people tends to be sporadic.
  • Most people are married (or live together in partnerships) and most sex happens in stable partnerships. Marriage does however not always safeguard sexual health.
  • Monogamy is the dominant pattern everywhere, but having had two or more sexual partners in the last year is more common for men and in industrialised countries.
  • Condom use has increased almost everywhere, but rates remain low in many developing countries.
  • School-based sex education improves awareness of risk and ways to reduce it. It increases the intention to practise safer sex and delays rather than hastens the onset of sexual activity.

So, contrary to certain bio-determinist beliefs, it seems as though we aren’t experiencing an “unprecedented rise in casual sex.” No universal trend towards sex at a younger age, either! Instead of looking at rates of “sex outside of wedlock” as evidence of moral decay, this study uses social logic to explain how premarital sex has increased while people aren’t having sex any younger: delay of marriage. And hey, they found that sex education actually “increases the intention to practise safer sex and delays rather than hastens the onset of sexual activity.” (We knew that, but it bears repeating!)

Regional variations in sexual behaviour do not correlate with sexual health status. Higher rates of partner change in industrialised countries are offset by higher levels of condom use and better access to treatment results in better health. The authors explored the main reasons for the variations:

  • Some of the variations can be explained by demographic and structural changes. The age structure and ratio of men to women in a population can limit or extend opportunities to form new partnerships.
  • There is a striking gender difference in sexual behaviour. Multiple partnerships are more common for men than for women. This is in line with a double standard in most societies that makes non-exclusive relationships more acceptable for men than for women.
  • Poverty, deprivation and unemployment work with gender inequity to promote partner change, multiple partners and unprotected sex.

Let’s talk about that “striking gender difference.” At first glance you might see this as support for the bio-determinist argument that men are just less monogamous and/or can’t keep it in their pants. But not so!  The authors make sure to first of all use the word “gender” and not “sex” to imply that this is not a XY/XX distinction, but a man/woman, “gender-as-a-social-construct” distinction. They point out, rightly so, that the data correlates with the double standard in most societies that makes non-exclusive relationships more acceptable for men than women (aka the “player” v. “slut” double standard). They also point to the influences of poverty, deprivation and unemployment on promoting partner change, multiple partners, and unprotected sex.

The authors highlight the need to base interventions on evidence rather than myths or moral stances. Approaches focusing exclusively on expectation of individual behaviour change are unlikely to produce substantial improvements in sexual health. Comprehensive multi-level behavioural interventions are needed that reflect the social context. These should attempt to modify social norms and tackle the structural factors that contribute to risky behaviour. Examples include mainstreaming HIV and sexual health in development projects; empowering sex workers through business and IT training; and integrating sexual health education into microfinance schemes. However, the success of these strategies requires decision-makers to accept the reality of sexual practices.

Wow.  I have shivers. Can we just read that again?

The authors highlight the need to base interventions on evidence rather than myths or moral stances. Damn straight!

Approaches focusing exclusively on expectation of individual behaviour change are unlikely to produce substantial improvements in sexual health. Comprehensive multi-level behavioural interventions are needed that reflect the social context. Amen!

These should attempt to modify social norms and tackle the structural factors that contribute to risky behaviour. Examples include mainstreaming HIV and sexual health in development projects; empowering sex workers through business and IT training; and integrating sexual health education into microfinance schemes. HELL YES!

However, the success of these strategies requires decision-makers to accept the reality of sexual practices. BAM.

And then, just when you thought this couldn’t get any better? They list and link to their sources and give an explanation of who funded the research. And guess what? It’s academic! Not a lobby group!

It’s work like this that gets me excited to begin my MA in Health Communications at Emerson next week. There is such a need for information about sexual health that serves not to moralize or control, but to actually reduce the spread of STDs based on the reality of sexual behavior and the social forces that influence it.