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Dirty, disgusting but not always deviant: an exploration of the complex narratives and perceptions about HIV and STIs in Britain

Dirty, disgusting but not always deviant: an exploration of the complex narratives and perceptions about HIV and STIs in Britain

Historically STIs have been stigmatised across societies. Biomedical advancements combined with increasingly liberal attitudes have transformed social perceptions of STIs and how infections are talked about and understood. We investigate contemporary narratives about STIs including HIV in Britain. 

Methods: We carried out 25 semi-structured interviews with participants aged 16–44 years who reported STI-associated symptoms and never attending sexual health services as part of a national survey. Interviews focused on meanings of STIs including stigma, experience of symptoms and healthcare services. An innovative flashcard activity was embedded within interviews to elicit novel STI perception data. Participants ranked common STIs according to six pertinent themes drawn from the literature: prevalence, infectiousness, visibility, severity, treatability and individual blameworthiness. Narrative analysis was used to compare descriptions of STIs to give insight into the construction of meanings and narratives about STIs.

Results: Narratives pertaining to STIs were un-rehearsed and created spontaneously, reflecting the absence of this topic in everyday conversation. “Dirty” and “disgusting” were commonly used descriptive words for STIs. Conflicting and inconsistent narratives particularly relating to infection stigma and morality were observed within individual accounts as well as between interviews, highlighting the tension between socially desirable narratives and entrenched personal opinions. Negative views emerged spontaneously within general narratives in the interview. Narratives within the flashcard activity were more detailed and differentiated between infections, except for the blameworthiness continuum; participants tended to homogenize STIs in terms of blame and ultimately presented a less judgemental opinion, when asked explicitly.

Conclusions: Perceptions and the concomitant narratives around STIs remain predominantly negative with social understanding lagging behind biomedical management of infections. Spontaneous narratives were more value-laden than explicit accounts given during the flashcard activity where individuals presented more moderated views about infections. A better understanding of the origin of social perceptions would supplement this study.

Speakers: Fiona Mapp