We need to talk (about STIs)

Around this time last year, in January of 2017, the twitter-based community of the sex industry panicked over a rise in the occurrence of antibiotic-resistant gonorrhoea. The funny thing is that we were all perfectly content to go about our lives, in and out of the bedroom, blissfully ignorant of the fact that antibiotic-resistant gonorrhoea had been on the rise in Australia since 2013. This begs the question: for a community that’s supposed to be well educated on the topic of sexual health, why are we so afraid of joining the conversation? The biggest challenge we face regarding sexual health and wellbeing is stigma. The stigma directed towards not just the act of sex, but also sexual health, is the only reason that my inbox was flooded with concerned emails from my clients last year, asking if “we were safe?” The truth is, we only really fear the things that we don’t understand.

Recently, I read an article on Coveteur about how we should all join “the wellness conversation.” Writers interviewed Vanessa Packer and Meika Hollender; co-founders of Sustain - a company that makes environmentally (and vaginally) friendly condoms. These women, inspired to empower women and encourage conversation about sexual wellbeing, created a project named Get on Top. “Safe sex is about protecting your health, protecting your body, and protecting your future,” said Vanessa Packer (as quoted by Coveteur). “It (safe sex) goes deeper than not wanting to get pregnant - you don’t want to get a sexually transmitted disease (STD).” I need to ask: what is so devastating about an incident regarding sexual health, that our entire future becomes compromised? Why have we been programmed to think that our life is over, once we have contracted a sexually transmitted infection (STI)? Notice that I didn’t use the term ‘STD’.

While the terms ‘STI’ and ‘STD’ have been used interchangeably by medical and civilian communities for years, the term ‘sexually transmitted disease’ implies a lifelong, painful and often terminal outcome. Teamed with the generalised opinion that condoms are all-protective, to suggest that someone has contracted an STD implies that not only are they going to die a painful death, but also that they are responsible for it, by some failure to use adequate protection. We are lucky enough to live in a world where infections can be managed before they become diseases, as most untreated infections tend to do. Nowadays people no longer die of syphilis, and HIV can be addressed before it becomes lethal. Infections such as chlamydia and gonorrhoea have not been referred to as diseases since the 90’s, as it only takes a short course of antibiotics to kill them. Therefore, if these infections are as readily treated as a chest infection, why do we behave as if they pose a threat to our very existence? Why do we shun and shame those who might, at some point in their lives, catch an STI? It is essential that we prevent our fear from allowing us to shame others, especially in the context of sexual health.

As a sex worker operating in Victoria, I am required by law to have a thorough sexual health check every three months. Funnily enough, no medical professional has ever performed a throat swab on me without my asking for it. The sad reality is that when I request one, the prospect of my having potentially uncovered oral sex is enough to warrant a lecture from my chosen health professional, while they shift their seat back a little and treat me as if I have the plague. Why do I put up with this? Because condoms aren’t the be-all and end-all of safer sex. While the idea that condoms are 98% effective helps us to sleep at night, there is no such thing as 100% safe sex, and to rely solely on condoms is (in my opinion) a little naive. There is always a small chance that condoms may fail; through tears, breaks or, in the case of Lelo’s controversial Hex condom, the frighteningly intentional inclusion of micropores (detailed here by the Lorax of Sex). Though a seemingly small mistake, choosing the incorrect size will only end badly, and to have one slip off just negates the need for protection in the first place.

Now, I know how this must sound. If condoms are so dangerous, why use them, right? Wrong. I’m not even remotely suggesting that we all embrace the pitfalls of contraception, and start having unprotected sex with strangers. I’m just suggesting that we educate ourselves on the risks, so that we can start using it effectively. I know that I can cure a head cold in a week with antibiotics, but that doesn’t mean that I’m okay with getting sick, it just means that I’m educated enough to deal with the consequences when I do. If we all started to employ this casual acceptance towards sexual health issues, stigma would be a thing of the past. By introducing STI’s into the wellness conversation, so that it has a place amongst pregnancy concerns and complaints about “that person who gave me their flu after we kissed last night,” not only do we normalise our sexual health, but we also stop unintentionally vilifying others. It shouldn’t be awkward to have ‘the talk’ with new sexual partners, or offensive to ask if they’ve been tested recently.

The safest sex is guaranteed by taking the necessary precautions with condoms and dental dams (yes, you read correctly!), and reinforcing them with regular testing. This allows us to be on top of issues if they crop up, so that we don’t go sharing the wrong kind of love (too corny?). It also doesn’t hurt to familiarise yourself with, well, yourself. Recently, I ran a series of opinion polls on twitter to gauge my following’s understanding of sexual wellness. Over 200 people, both sex workers and clients of sex workers, took the time to participate (thank you!) and, overall, there were some pretty interesting results. While the majority of voters claimed to be well educated about their sexual health, 21% of despondents admitted that they do not know themselves well enough to tell if they had a reproductive health issue. Further, 17% admitted that they do not check their sexual health, and 19% voters would still have sex in the presence of a reproductive health issue.

Admittedly, I’m surprised to know that there are people who haven’t given themselves a once over with a compact mirror, or haven’t had a bulk-billing medical professional do it for them. This might just be me, but I have some very distinct memories of getting my kit off in front of a mirror, before exercising my favourite vibrator. I guess I took a deeper interest in understanding what went where and, as a result, what a healthy ‘me’ looked like. Taking a look at yourself isn’t taboo or ‘gross’, it’s healthy, and for members of the sex industry, it’s essential. Understanding what a healthy you looks like is the first step to taking control of your sexual health, especially in an arena where having multiple sexual partners is the norm. If we don’t know what our healthy bits look like, how will we know when there is an issue?

I feel that it’s important to talk about those people who would still have sex in the presence of a health issue. I find it challenging to interpret this data as everyone has their reasons, from a need to make money to something more sinister. Before your eyes fall out of your head, I’d like to preface this by saying that I attempted to normalise STIs by intentionally failing to specify them in my poll question. Sexual health issues can encompass yeast infections and urinary tract infections (UTIs), for example, which should never prevent anyone from being able to earn money through sex work. While I don’t condone having sex with a UTI, I do believe in making educated decisions. As a provider, it is my role to understand the risks and weigh them against the benefits in every encounter I have. If I proceed, then I am being as safe as I can be because I have educated myself on the situation. As a reader, whether you’re a peer, a client, or a spectator, I’m asking you to take ownership of your health by understanding the risks and knowing what to do and what to look for in the presence of an issue. If you decide to go ahead, well, that’s up to you. If you choose to go ahead and have an infection, you need to disclose, so that your partner can make the best decision for them.  

Currently, there is no evidence to say that the Australian sex work community has a higher STI prevalence by comparison to the rest of the population. I feel proud to be a part of a community that is so educated about their health, and feel strongly about educating others without perpetuating stigma. However, it’s important to remember that stereotypes don’t speak for everyone. My poll results show that there is always room for not just education, but also understanding. We need to be taking ownership of our health on a regular basis, with the knowledge that an adverse event isn’t the end of the world, and that it isn’t a result of engaging in the sex industry or a result of having multiple partners. With some realism, we can remind ourselves that catching an STI is actually more difficult than catching the flu during sex, and we don’t banish people to the naughty corner when they get a little sick.