You probably already know that sexually transmitted infections (STIs) are a critical health concern for Black women because they disproportionately affect us. There are a few reasons for that:
- We have higher rates of specific diseases such as chlamydia, gonorrhea, and syphilis than white women. The CDC reported that Black Americans had 31% of cases reported in 2022. Rescripted says that those of us who identify as Black women also contract long-term STIs like herpes simplex more frequently.
But our high rates are not the result of sexual activity alone but also access to quality healthcare, education, and medical racism. Add in the shame and fear of asking a partner to wear protection. We wanted some insight into this sensitive topic and the need for more discussion among women of all ages, so we turned to Dr. Shea Graham, a published researcher, university instructor, licensed psychotherapist, and Clinical Supervisor at Addiction Recovery Systems Supervisor at ARS-Pantops in Central Virginia. She is recognized as an “expert” under Virginia code §19.2-300 and collaborates with courts to provide mental health evaluations.
She offered us some insight into why we need to start talking about sexual health with current and future partners, what happens when we don’t, how STIs impact us emotionally and mentally, and how therapy can help.
BHM: How can we advocate for ourselves when navigating our sexual health?
Dr. Graham: The first thing is to realize that you deserve to have good health, to be in good health, to protect your good health if you have been blessed with it. Sometimes, there is a lot of guilt around safeguarding your health, which means, “Oh, I don’t want to ask my partner to wear a condom because that will signal to him that I don’t trust him.” Or “I don’t want to ask my partner to get tested because that will signal that I don’t trust him even if he says that he is clean.”
The bottom line is that your responsibility is to protect your body and health status. Your partner could be unintentionally misrepresenting his health status.
Most STIs don’t have symptoms, so unless he presents you with his test results, you should operate like every test is positive. So, when you enter a relationship with a new partner, assume they are positive for every STI possible, and if so, what would you do differently? Being an informed partner is one way to empower yourself to protect your health. Communicating is another way to protect your health.
BHM: How can we break down barriers to discussing sexual health and prevention with our partners?
Dr. Graham: When talking to your partner, do it as soon as possible. The moment that you realize that you want to have sex with someone, you should talk about sexual health. It could be as simple as saying, “Hey, when was the last time you were tested?” If you have your test results, feel free to share your test results with your partner. This will also signify your willingness to be vulnerable, which can aid in reciprocating vulnerability; sometimes, you must initiate discussion.
Also, within our community, because there is such a heavy stigma around STIs, most people feel ashamed even just mentioning it.
Introduce the health discussion and frame it in a way that allows your partner to know that you are asking these questions because, as an adult, it is your responsibility to know your medical status and to protect yourself against STIs.
It is okay to open the conversation by acknowledging how uncomfortable the topic can be, but it is crucial to push through and address the matter to protect your and your partner’s health. So, start the conversation with honesty, and hopefully, if your partner is serious about health and sexual health, they will be open to the discussion.
Ladies, it is a red flag if you start a sexual health conversation and your partner is dismissive. That is a massive red flag, and you should not ignore it. You should take a step back and examine if this is a person you want to trust your body with and risk your health for.
So, communicate, get tested, advocate for yourself, and sit with those uncomfortable feelings. Just because something is uncomfortable does not mean you should avoid it.
BHM: What role does emotional well-being play in managing STIs?
Emotional well-being plays a huge part because every human experience has that emotional undertone. It would be impossible to go through any stage in life without experiencing some emotion: the human experience. Sometimes, when things happen to us, our bodies hold onto that. If a trauma happens or something significant happens, our initial response is what our body does. So, our initial response is our stomach may turn, or something will happen, and we will get hot; that’s our nervous system at play, our fight, flight freeze response.
Once our bodies respond, our mind starts to make sense of it. Once our mind starts to process these things, our emotions respond. You can’t have one without the other. Sometimes, your body will respond, and there is such fragmentation; for some people, their minds, bodies, and spirits are fragmented. It can be difficult for these people to understand what is happening around them; their bodies will respond, and they won’t know why. They are in this constant state of fight, flight, freeze, and that is when seeing a therapist can help. You can process stressors with a professional who can give you the coping skills to either deal with your reality or who can help you construct a narrative to take those fragmented pieces of trauma and put them together in a way that is empowering to you.
BHM: Is there a way to make therapy a more prominent option for those living with STIs?
Dr. Graham: One of the central tenets of talk therapy is self-determination. The client enters therapy, and then the therapist provides the service. If you are thinking that you can push a loved one into treatment so that they can get the help that they need, that is not going to be helpful. For those seeking treatment, there are resources to find a qualified therapist in your area. The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) is an excellent platform to find a certified therapist in your area to process these things with. Not every therapist is qualified or trained to support you in an affirming way. Some therapists have not done the necessary work to challenge their own biases, and they may pass negative judgment on your medical situation.
BHM: When Black women receive STI diagnoses, how can they address the internalized shame that they may feel?
Dr. Graham: Unfortunately, there isn’t an easy solution. My suggestion would be to start to journal about the untruths that you internalize that you carry as it relates to your diagnosis. Then, bring those notes to therapy to process and challenge them. A great therapeutic intervention called cognitive behavioral therapy (CBT) helps my clients identify, challenge, and replace negative thoughts about their reality.
BHM: What advice would you give to someone looking for ways to manage their STI diagnosis as it relates to their psychological and social wellness?
Dr. Graham: Know that you are not alone. You do not have to cope with this new diagnosis by yourself. There are support groups, and once you are diagnosed, if you utilize a wraparound clinic along with your diagnosis, your provider should give you resources so that you can get linked to a nonprofit or a community board in your area. Start attending those weekly support groups. If you are in an underserved area, meaning you are not provided with these resources, you can attend a NAMI support group. You can also do individual therapy with a certified sex therapist; I cannot stress that enough; if you want to talk about STIs and don’t want to be judged by your therapist, work with someone who understands that these things happen to humans. You are not any less human or any less deserving of evidence-based care simply because of a medical diagnosis. Remember that awareness and action are great tools in managing an STI or proper prevention.
To end things off, we’d like to leave you with one of Dr. Graham’s favorite phrases: “Emotions are wonderful consultants; they are terrible CEOs, and they should not be calling the shots.” Don’t be afraid to break the silence regarding your sexual health and to care for yourself in all ways, including medical and psychological services.
