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Abstract
Stigma refers to socially undesirable attributes of individuals or groups, associated with isolation, rejection, and discrimination. Stigma is an essential contributor in the causal web of sexually transmitted infections (STIs) that flourish within the global context of inequities associated with STIs: social class, race/ethnicity, immigration status, gender, gender expression, and sexual orientation [1]. Public health capacity to address the diverse pathogens associated with STIs – including HIV – has been astoundingly transformed by the basic, clinical, and translational sciences advances of the past half-century. Paradoxically, despite great strides in capacity to understand, detect, and treat, STIs remain key indicators of global health inequity that have worsened in recent years [2]. Our great knowledge of STIs fails its worldwide potential largely because of deeply engrained sexual, and STI-related stigma [3]. Stigma is often amplified by public health policies and clinical procedures that reproduce cultural, social, and structural production of stigma, separating people into sexual and behavioral categories (enforced by social power, often through threat of violence) associated with disapproval, rejection, and exclusion that reflect the global epidemiology of STIs [4]. Stigma causes many people to avoid seeking STI-related services because of experiences such as discrimination, indifference, and overt hostility in health care setting. World-wide barriers to a full range of reproductive health services (for example, restricted access to STI testing for new immigrants), criminalization of sexual behaviors associated with STI transmission (for example, commercial sex work or same-sex sexual relationships), and restriction of access to evidence-based information and services (for example, abstinence-only-until-marriage sexuality education for young people) illustrate ways stigma is created and maintained in health care settings. Global STI prevention and control efforts require – in addition to effective public health infrastructures and the technologies needed for diagnosis and treatment – renewed commitment to systematic programmatic approaches to prevent or reduce STI-related stigma
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