Breaking the Silence

When diagnosed early, most STIs/RTIs can be treated easily and effectively. In addition, the earlier a person seeks treatment for an STI, the less likely it is that the infection will cause serious and irreparable damage, be spread to others, or be passed to a baby.

However, people are often too embarrassed or frightened to ask for help and information. Social stigma, misinformation, fear, shame, cultural barriers, gender inequities, and other factors can keep individuals from practicing safer sex behaviors, notifying partners, or receiving adequate treatment.

In many countries, women find it particularly difficult to talk about STIs and seek services for a variety of reasons. Because of cultural and social factors, a woman may be more likely to blame herself for her infection, fear abuse by a partner, deny the presence of symptoms, or feel too embarrassed to ask for care. Young people may also have particular difficulty in accessing health care facilities because they may lack independent financial resources or fear that they will be denied services or judged by health care workers and others. In some countries, men who have sex with men—particularly those who do not consider themselves bisexual or homosexual—may fail to seek treatment out of embarrassment, fear, or stigmatization.

Other common barriers to STI treatment for clients include:

• Lack of knowledge about STIs, risks, symptoms, and complications
• Absence of signs or symptoms of STIs (especially in women)
• Lack of knowledge about or access to treatment
• Reluctance to discuss sexual matters
• Fear that others will find out
• Fear of a judgmental approach by the health care provider
• Reluctance to undergo a genital examination (particularly by a provider of the opposite sex)
• Laws and restrictions (such as laws restricting health care for minors)

It is important for health care providers to remember that STIs affect men and women of all ages, backgrounds, and socioeconomic levels. Providers of STI services and counseling must avoid judgmental and moralistic attitudes that can deter clients from seeking treatment— especially in the case of clients who might be particularly susceptible to social stigma and bias, such as adolescents, sex workers, unmarried women, and homosexuals.

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