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Association of Sexually Transmitted Disease-Related Stigma With Sexual Health Care Among Women Attending a Community Clinic Program

Rusch, Melanie PhD*†‡; Shoveller, Jean PhD; Burgess, Susan MD§; Stancer, Karen MD; Patrick, David MD, MHS†∥; Tyndall, Mark MD, ScD‡§

Sexually Transmitted Diseases: June 2008 - Volume 35 - Issue 6 - p 553-557
doi: 10.1097/OLQ.0b013e3181685855

Objectives: The objective of this study was to assess the association of sexually transmitted disease (STD)-related stigma on sexual health care behaviors, including Papanicolaou smears and STD testing/treatment, among women from a high-risk community.

Methods: Descriptive statistics were used to assess the association of demographics, sexual and drug-related risk behaviors, and 3 measures of STD-stigma (internal, social, and tribal stigma, the latter referring to “tribes” of womanhood) with sexual health care in the past year. Pearson’s chi-square test and Mann-Whitney test were used to assess significance. Multivariate logistic models were used to determine the association of STD-stigma with sexual health care after controlling for other factors.

Results: Lower internal stigma score was marginally associated with reporting an STD test in the past year [median score (interquartile range) for those reporting and not reporting an STD test were 0.79 (0.30–1.59) and 1.35 (0.67–1.93), respectively]. In an adjusted model, internal stigma retained a negative association with reporting of STD testing in the past year (adjusted odds ratio, 0.92; 95% confidence interval, 0.85–0.99).

Discussion: Most women had received a Papanicolaou smear in the past year, and none of the STD-stigma scales were associated with reporting this behavior. Internal stigma retained an association with not having any STD test or treatment. Although sexual stigma is a deeply rooted social construct, paying attention to how prevention messages and STD information are delivered may help remove one barrier to sexual health care.

A cross-sectional survey was carried out among women at a community clinic to determine sexually transmitted disease-related stigma and access to sexual health care services.

From the *Division of International Health and Cross Cultural Medicine, University of California, San Diego, California; †Department of Health Care and Epidemiology, University of British Columbia; ‡BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; §Department of Medicine, University of British Columbia; and ∥BC Centre for Disease Control, Vancouver, British Columbia, Canada

Supported by the Michael Smith Foundation for Health Research and the Canadian Institutes for Health Research.

Correspondence: Melanie Rusch, Division of International Health and Cross Cultural Medicine, University of California, San Diego, 9500 Gilman Drive, Mailstop 0622, La Jolla, CA 92093-0622. E-mail: mrusch@

Received for publication August 30, 2007, and accepted January 2, 2008.

© Copyright 2008 American Sexually Transmitted Diseases Association