Part of the answer has to do with the fellow travelers we bring to intimate relationships: bacteria, viruses, fungi, and parasites we call sexually transmitted infections (STIs). Stigma, pejorative language, and misconceptions pervade how we talk and think about STIs. We might classify prospective partners as 'clean' or 'dirty' based on a myriad of social clues. If we want to access biomedical prevention against acquiring HIV or a bacterial STI, we have to affirm that we are ‘high risk’, unsafe by measures that become increasingly imprecise as try to apply them to our individual lives and loves. Even our supposedly objective scientific language is affected: we use the term ‘healthy controls’ to connote ’someone not living with HIV’, even when we know that with regular HIV care people live long lives free of HIV-related morbidity. In the day and age of condoms, contraception, highly effective HIV PrEP, and doxyPEP, shouldn’t it be easier to talk about sexual health and STIs?
Maybe because of the intimacy of sex, we tend to focus on individual behaviors and characteristics associated with STIs and related disease progression. Yet our vulnerability to STIs is shaped by layers of complexity related to the shifting geography and prevalence of STIs; social structures and systems governing access to care and the quality of care; and norms governing health behaviors including preventive measures against STI acquisition. These aspects that fall outside individual and dyadic characteristics receive far less attention than behavioral risk. As an educator, when I (Tom Carpino) taught Sex and Syndemics to undergraduate public health students at Johns Hopkins, most of the students I engaged with said that my course was the first time they had the opportunity to talk about sexual health in an academic setting. This is a problematic gap: at the individual level, where then do we get information to make decisions about our sexual health? Our informed decision making, bodily autonomy, and ability to pursue the intimate relationships that give pleasure to our lives are all impoverished when our sources of information are incomplete, inaccurate, and/or normatively biased. As public health researchers and practitioners our work is similarly weakened by paradigms that do not fully account for the complex interactions of psychosocial, biological, normative, and structural factors that coalesce around STI epidemics and our response to them.
As we mark World Sexual Health Day today September 4th, this year’s theme, “Every Body,” reminds us that sexual health, rights, justice, and pleasure belong to everyone, while also drawing attention to the social and structural conditions that shape how people experience them. The global landscape of sexual health is changing rapidly. Innovations including long-acting HIV PrEP, new diagnostics, genomic surveillance, and other technologies are expanding our prevention and response toolkit, but the persistent barriers of inequities in access to care and stigma persist. Emerging infections such as mpox challenge traditional boundaries around what constitutes an STI and how sexual transmission is understood.
To help explore these changes, we are guest editing a new Journal of Epidemiology and Global Health Special Collection, Sexually Transmitted Infections in a Changing Global Landscape: Epidemiology, Systems, and Emerging Challenges. The Collection welcomes research, reviews, perspectives, and commentaries examining sexual health across epidemiology, prevention, diagnostics, surveillance, health systems, implementation, structural determinants, and community engagement. Our goal is to encourage work that moves beyond traditional disease silos and recognizes sexual health as a dynamic intersection of biology, behavior, technology, communities, and health systems. On World Sexual Health Day, we invite researchers and practitioners from around the world to join that conversation.
Tom Carpino, PhD and Julie Franks, PhD