Attitudes about sexual disclosure and perceptions of stigma and shame

Abstract

Objectives: To determine the association between stigma and shame about having a sexually transmitted disease and adolescents' past STD related care seeking; between stigma, shame, and perceptions about disclosure of sexual behaviours to a doctor or nurse; and whether the association of stigma, shame, and care seeking was moderated by perceptions about disclosure. Methods: A household sample of 142 sexually active African-American youths, 13-19 years old, was questioned about STD related stigma (alpha = 0.89), STD related shame (alpha = 0.90), and perceptions about disclosure of sexual behaviours to a doctor or nurse (alpha = 0.81). Results: Among females, stigma was associated with increased anticipation of negative reactions to disclosure of sexual behaviours to a doctor or nurse (odds ratio (OR) = 0.319; 95% confidence interval (CI) =0.12 to 0.85) while shame was not. Stigma was also independently associated with STD related care seeking in the past year (OR = 0.296; 95% CI = 0.09 to 0.94) while shame was not. There was no association between stigma and shame with perceptions about disclosure or past care seeking in males. Perceived outcomes of disclosing sexual behaviours did not moderate the association of stigma, shame, and past STD related care seeking.Conclusions: Stigma about STDs may influence how female adolescents perceive reactions to disclosure of their sexual behaviour to healthcare providers. It may also be an important factor in their decision seek to STD related care. Perceptions about disclosure of sexual behaviour to a doctor or nurse do not change the relation of stigma or shame to past STD related care seeking. There is an increasing realisation that non-medical, psychological factors influence decisions to obtain medical care. Delay in seeking and obtaining diagnosis and treatment for sexually transmitted diseases (STDs) can allow for continued transmission and the greater probability of adverse sequelae. Recent findings support the view that stigma and shame associated with STDs are important barriers to appropriate diagnostic and treatment services.

Development and Psychometric Assessment of a Multidimensional Measure of Internalized HIV Stigma in a Sample of HIV-positive Adults

“…We hypothesized that our measure of internalized stigma would be strongly and positively correlated (r=0.5-0.7) with feelings of shame. Shame is one psychological experience an individual may have as a result of internalized stigma, and several studies in the literature have demonstrated these constructs to be separate, but related (Cunningham et al, 2002;Duffy, 2005;Fortenberry et al, 2002). Studies of HIV-positive adults living in the US have also demonstrated that stigma is associated with poor social support and depressive symptoms (Bairan et al, 2007;Carr and Gramling, 2004;Sowell et al, 1997;Vanable et al, 2006).…”

Identifying and understanding barriers to sexually transmissible infection testing among young people

“…[14] STI Stigma was measured using 6 items (e.g., "If you had an STI, people would avoid you", α = .92). [11] STI shame was measured using 5 items (e.g., "If you had an STI, how ashamed would you feel? ", α = .90).…”

“…", α = .90). [11] Willingness to disclose sexual histories was measured using four items (e.g., "If you told a doctor/nurse that you had sex with lots of different people, how likely is it that they would think less of you? ", α = .83).…”

“…[8,9] Sexual behaviour is usually private and sensitive: variables that are not included in the TPB but which may exert an important influence on testing behaviour include perceived shame and stigma abut STIs, and willingness to disclose sexual histories. [10,11] In addition, greater bodily embarrassment and embarrassment about being judged for behaviour during medical consultations are related to a lower likelihood of seeking medical care. [12] The aim of this mixed-method study of young people was to identify important influences on STI testing behaviour.…”

Low HIV testing rate and its correlates among men who inject drugs in Iran

“…While barriers to HIV testing among youth in Iran is poorly understood, decreased uptake of HIV testing among youth has been strongly associated with structural-and individual-level HIV-related stigma in numerous settings (Cunningham, Tschann, Gurvey, Fortenberry, & Ellen, 2002;Shoveller, et al, 2009;Tilson, et al, 2004).…”