SMART HEALTH

Confronting Stigma

Reducing shame around STIs promotes better sexual health.

Much of our exposure to the shame and stigma of our sexual behavior begins before we even fully understand what sex is. As children, we are rarely taught in a nonjudgmental way about the functioning of our bodies. We may have been taught to avoid touching ourselves, and perhaps we were even discouraged from examining our bodies in the mirror. Abstinence-based educational programs and a pervasive lack of sex positivity in our school systems reinforce the overall sense that sex is something that we should be ashamed of and not discuss openly.

These messages are magnified even further for LGBTQ individuals. Parents and families sometimes struggle with talking openly about queer identity, so discussing the nuts and bolts of sex with LGBTQ kids can be even more of a challenge.

Schools are no better for LGBTQ youth, since ‘How to have queer sex’ is definitely not an approved topic in health class. Additionally, anti-LGBTQ messaging from religious organizations and discriminatory legislation all create an environment of intolerance, making it even more difficult to initiate honest dialogue about sex and sexuality.

The Consequences of STI Stigma

Without proper instruction about the mechanics of sexual activity, queer people are oftentimes forced to find information on the Internet—all without explanation, context, or nuance. Learning—or rather, not learning—about sex from the Internet can negatively impact and complicate one’s understanding of what constitutes queer sexual activity.

But perhaps worse than not knowing what to do in the bedroom is the implicit message that LGBTQ people receive about their sexual desires: Queer sex is on the fringe, abnormal, and beyond discussion. Queer sex is unworthy of consideration because it is immoral or unnatural, and not procreative. We learn to be quiet and secretive about our sexual desires.

It is no surprise, then, that LGBTQ people with sexually transmitted infections (STIs) are routinely stigmatized in this repressive environment.

Dismantling Stigma against STIs

It is vitally important that we reduce the stigma surrounding STIs. Stigma prevents people from getting tested for STIs and notifying partners about their exposure to an STI. Stigma drives much of the reluctance to share health information with family or friends. Stigma discourages people from seeking treatment and adhering to live-saving medication regimens.

Claiming your queer identity can be a liberating step in releasing personal shame related to sex. Begin by looking at your own sense of internalized sexual shame. For example, are there sexual activities that you tell yourself you’re not going to do because they might make you less masculine, or too feminine? Too “dirty” and unclean? What negative judgments do you carry about your past and present sexual behaviors?

Because shame is a driving factor in the development of stigma, when you work to release your negative feelings and hang-ups about sex, you create a space to be who you really are, regardless of your health status. Freeing yourself from worrying about the opinions of others regarding your sexual identity is not only emotionally and psychologically healthy, but it also reduces many internalized negative feelings within the LGBTQ community.

Get tested. Frequent testing is a big part of reducing personal stigma and shame. By testing for STIs, you acknowledge that any sexually active person can get an STI. You are also promoting the idea that STIs are treat-

able conditions. Negative outcomes are much less likely to happen when you are receiving competent medical care.

The language you use also makes a difference, so it’s important to be thoughtful about the way you talk about STIs with friends and family. Be careful to avoid language that suggests the superiority of someone who is not infected. It is important to challenge the stigmatizing hierarchy between those who do and do not have STIs.

When friends make negative comments or statements about people with STIs, you can challenge their language and misconceptions about sexual health. Queer activism begins within our network of family and friends.

If you encounter negative STI messaging in the media or from our trusted institutions, consider responding with direct feedback that calls out these sources of STI shaming.

Sexual Health beyond STIs

Reducing stigma related to STIs is an important part of encouraging queer folks to seek out supportive healthcare resources, regardless of their STI status.

Routine appointments with a primary-care provider play a crucial role in maintaining good health. Getting a complete physical exam and a laboratory blood-work evaluation is an important first step. LGBTQ people tend to experience more frequent chronic medical conditions because of the disparities in healthcare delivery, so routine STI, cholesterol, and colonoscopy screenings, mammograms and pap smears (for women), and prostate exams (for men) are essential.

Curiosity and exploration are natural parts of your sexual development. Cultivating deeper insights into your sexual self can ground you while confronting the societal factors that unfairly stigmatize LGBTQ sexuality.

“REDUCING STIGMA RELATED TO AN STI IS AN IMPORTANT PART OF ENCOURAGING QUEER FOLKS TO SEEK OUT SUPPORTIVE HEALTHCARE RESOURCES, REGARDLESS OF THEIR STI STATUS.”

Daryl Shorter, MD, is a Diplomate of the American Board of Psychiatry and Neurology and is board certified in both general and addiction psychiatry. His clinical practice focuses on veteran care, and he lectures widely on LGBTQ mental health.

IMPORTANT FACTS FOR BIKTARVY®

This is only a brief summary of important information about BIKTARVY and does not replace talking to your healthcare provider about your condition and your treatment.

(bik-TAR-vee)

MOST IMPORTANT INFORMATION ABOUT BIKTARVY BIKTARVY may cause serious side e ects, including:

 Worsening of hepatitis B (HBV) infection. Your healthcare provider will test you for HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking

BIKTARVY without first talking to your healthcare provider, as they will need to check your health regularly for several months, and may give you HBV medicine.

ABOUT BIKTARVY

BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults and children who weigh at least 55 pounds. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS.

Do NOT take BIKTARVY if you also take a medicine that contains:

 dofetilide  rifampin  any other medicines to treat HIV-1

BEFORE TAKING BIKTARVY Tell your healthcare provider if you:

 Have or have had any kidney or liver problems, including hepatitis infection.  Have any other health problems.  Are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby.

Tell your healthcare provider if you become pregnant while taking BIKTARVY.  Are breastfeeding (nursing) or plan to breastfeed.

Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

Tell your healthcare provider about all the medicines you take:

 Keep a list that includes all prescription and over-thecounter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.  BIKTARVY and other medicines may a ect each other.

Ask your healthcare provider and pharmacist about medicines that interact with BIKTARVY, and ask if it is safe to take BIKTARVY with all your other medicines.

POSSIBLE SIDE EFFECTS OF BIKTARVY BIKTARVY may cause serious side e ects, including:

 Those in the “Most Important Information About

BIKTARVY” section.  Changes in your immune system. Your immune system may get stronger and begin to fight infections that may have been hidden in your body. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY.  Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY.  Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.  Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.  The most common side e ects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%). These are not all the possible side e ects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.

Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY. HOW TO TAKE BIKTARVY

Take BIKTARVY 1 time each day with or without food.

GET MORE INFORMATION

 This is only a brief summary of important information about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more.  Go to BIKTARVY.com or call 1-800-GILEAD-5  If you need help paying for your medicine, visit BIKTARVY.com for program information.

BIKTARVY, the BIKTARVY Logo, GILEAD, the GILEAD Logo, KEEP CREATING, and LOVE WHAT’S INSIDE are trademarks of Gilead Sciences, Inc., or its related companies. Version date: February 2021 © 2021 Gilead Sciences, Inc. All rights reserved. BVYC0370 04/21