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04/11/2012

Review of Related Literature - Sexually Transmitted Diseases (STD)


REVIEW OF RELATED LITERATURE

 

            A significant amount of social science researches point to the implication to human relations of illnesses due to sexual activities of people. There is a school of thought that the diagnosis of and knowledge about one’s illness caused by sexual activities may either make or break any social relation (Weltz, 1990). This survey of literature provides a peep to the massive amount of study done in line with identifying emotional, psychological and social implications of being diagnosed with illnesses which is popularly associated with sexual misconduct, particularly  Sexually Transmitted Diseases, STD.

STD: An Overview

STDs are infectious diseases that can be spread by sexual contact. Some can also be transmitted by nonsexual means, but these make up a minority of the total number of cases. An estimated 10 to 12 million Americans have sexually transmitted diseases, several kinds of which are epidemic, including gonorrhea, infections of the urethra not caused by gonorrhea (nongonococcal urethritis, or NGU), genital herpes virus, genital warts (condyloma acuminata), scabies (mites), and urethral and vaginal infections caused by the bacterium Chlamydia trachomatis the protozoan Trichomonas, and the yeast monilia A number of surveys have shown that sexually transmitted diseases in the United States affect people of both sexes, of all races, and of every economic status.

Large numbers of infections are transmitted largely or exclusively by sexual contact. In addition to those epidemic diseases already mentioned, such diseases include syphilis, crab lice (pediculosis pubis), vaginal infection caused by the Hemophilus bacterium, molluscum contagiosum, chancroid, lymphogranuloma venereum, and granuloma inguinale. Many organisms cause these diseases. Trichomonas is a protozoan; moniliasis is caused by a yeast; the organisms causing chancroid, gonorrhea, syphilis, granuloma inguinale, and Hemophilus vaginitis are bacteria; genital herpes, genital warts , and molluscum contagiosum are caused by viruses; and lymphogranuloma venereum and most cases of nongonococcal urethritis are caused by Chlamydia trachomatis, a bacterium.

Transmission of all these diseases occurs only by intimate contact with an infected person, because all of the causative organisms die quickly if removed from the human body. Although the usual area of contact is the genitals, the practice of anal and oral sex also leads to cases of anal and oral infections. A few of these diseases, notably chancroid and scabies, can be spread by the infected person from one area of skin to another by the hands; scabies, lice, genital herpes, and vaginitis caused by Trichomanas and monilia may also be acquired by other than sexual contact. Gonorrhea, syphilis, and chlamydial infections can also be transmitted from a pregnant woman to her infant, either in the uterus or during birth. Such congenital infections can be quite severe.

Although venereal infections start at the external genitalia, they can spread to the prostate, uterus, testes, and nearby organs. Most of these infections cause only irritation, itching, and minor pain, but gonorrhea and chlamydial urethritis are a major cause of infertility in women.

The epidemic nature of sexually transmitted diseases attests to the difficulty of controlling them. Some public health officials attribute the increase in many of these diseases to increasing sexual activity. Also significant may be the replacement of the condom (which provides some protection) with birth control pills and diaphragms.

Patterns of sexually transmitted disease also change. Whereas syphilis and gonorrhea were both epidemic at one time, widespread use of penicillin brought syphilis under moderate control. Attention then turned to control of gonorrhea, at which time syphilis again began to increase in frequency. Genital herpes and chlamydia also increased in the 1970s and early 1980s.

First-line treatment of sexually transmitted diseases is with antibiotics. Penicillin has been an effective drug against syphilis and gonorrhea, but many gonorrheal organisms now are resistant to this agent. Ceftriaxone or spectinomycin is effective in these instances. Tetracycline is used to treat lymphogranuloma venereum, granuloma inguinale, and chlamydial urethritis. Specific treatments are also available for most other sexually transmitted diseases, with the exception of molluscum contagiosum. The antiviral drug acyclovir is proving useful against herpes.

The only way to prevent spread of sexually transmitted diseases is by locating people who have had sexual contact with the infected person and determining whether these individuals also need treatment. Usually this is done through public health clinics, where the majority of sexually transmitted diseases are reported. Locating all sexual contacts, however, can be difficult. In addition, many people with sexually transmitted diseases go to a private physician for treatment, and not all cases are reported. Acquired Immune Deficiency Syndrome (AIDS) and hepatitis B are also transmitted by sexual contact, although they are commonly acquired in other ways as well.

            Many scientists, both social and hard view STD cases as a significant contribution to the wealth of knowledge of the scientific community This survey of literature focuses on the social science aspect of this fatal dilemma, and is particularly interested in studies that deal with the social relationship of an STD positive individual to his partner(s) and families after the diagnosis. Some literature were also found to focus on the patients’ notion or concept of his “self” in relation to his environment and other people in his community Studies on the Psychological and

 

Sociological Impact of an STD Diagnosis

            In a six-month participant observation done by Weitz (1990) in which immense interviews of 23 STD patients and their families was conducted, it was found that all STD patients run a risk that their families will reject them, either because of their illness per se or because their illness exposes or emphasizes that they are gay or use drugs. By means of narratives,  which was the predominating mode of generating information on such cases at that time, Weitz was able to draw specific emotional distress felt by these people. One of the men in the study, a 27 year old computer operator whose parents lived in a small town in another state felt that he had a good relationship with his parents, but he had never told them of his sexual orientation. When asked how he thought his family would react to news of his diagnosis, he said:

 

                        “You just can’t predict. They might find it so disgusting that you’ll basically lose them. They’ll be gone. Or they’ll go through the adjustment period and not mind. I really don’t know.”

 

            Virtually every respondent reported that at least one family member had ceased contact with him after learning of his illness. One source of this rejection is that diagnosis with STD can reinforce families’ belief that homosexuality is immoral. Families who had always questioned the morality of homosexuality may interpret an individual’s illness as divine punishment, regarding it as a proof that homosexual behavior and sexual “misconducts” should not be tolerated (Shultz, 2000). 

            Shultz (2000) examined the determinants of social and self constructs of persons with STD. In her study, a 26 year old herpes positive tailor from a fundamentalist Christian family, whose family has not known he was gay, described how AIDS forced him to reveal his sexual orientation and thus “put a wedge” between him and his family. His family considered homosexuality sinful and questioned whether they should help him with his health problem if he would not change his behaviors. He was still in contact with his parents, even though his mother had told him that his homosexuality is an “embarrassment” to her. But he had stopped taking with his sister because he cannot abide her constant admonitions “to repent” and “to confess sin”. Even other STD positive individuals whose families have in the past appeared to accept their lifestyle were found to be rejected once their diagnosis became known. When questioned about these, the patients suggested that somehow, their disease had made their homosexuality more real and salient to their families. Shultz compared this to pregnancy and concluded that,  “just as pregnancy forces parents to recognize that their daughters are not just living with men but having sex, diagnosis with STD apparently forces families to recognize that their sons or brothers are not simply gay in some abstract way, but actually engage or engaged in homosexual activities. As a result, families who have tolerated their relative’s homosexuality despite deep reservations about its morality find that they no longer do so. In the study, a 38 year old business manager reported than when he first told his parents he was gay, “their reaction while it wasn’t initially effusive at least it was grudgingly accepting. ”Now, however, he felt that his parents had used his “whole STD thing against me” by telling him that STD was just “desserts for the homosexual community.”  Similarly, a 29 year old blue collar worker recounted how his mother, who previously had seemed to tolerate his lifestyle, responded to the news of hisdiagnosis by telling him, “I think your lifestyle is vulgar. I have never understood it, Ive never accepted it… Your lifestyle repulses me.” She subsequently refused to let him in her house or help him obtain medical insurance.

            Even when families do nor overtly reject ill relatives, it was found that their behavior may still create a sense of shame. This was found to happen when families either hide news of their relatives’ illnesses from altogether or tell others that their relatives have some stigmatized disease. Still on Shultz’ study, A 39 year old floral designer, whose Catholic family had all known he was gay before he became ill, reported that his mother refused to tell his brothers and sisters about his disease, and ordered him not to tell them as well. When his siblings finally were told, they in turn would not tell their spouses. Such behavior forces patients to recognize that, as one fundamentalist Christian said, It was an embarrassment to the family… that I was gay and that I have STD.  This imposed secrecy places heavy burdens on the individuals who subsequently must “live a lie”.

            Families may reinforce a sense of stigma by adopting extreme and medically unwarranted anti-contagion measures (Weltz, 1990). In her study, a respondent told Weltz that hi family brought their own sheets when visiting him in his home. Other families will refuse to allow their ill relatives to touch any food or use the bathrooms, or come closer to an arm’s length away. A 29 year old Mormon salesperson, whose family believed he deserved AIDS as punishment to his sins, reported that initially his family would not come in the room unless thy had gloves and a mask and they wouldn’t touch him. And for a time, he could not go over to somebody’s house for dinner and they used paper plates whenever he ate there. Even STD positive individuals who feel such precautions are necessary on the part of the relatives still miss the experience of physical warmth and intimacy. They report feeling “stigmatized, isolated and contaminated”. 

            Although most of them fear that their families will reject them once their illness became known, they also hope that news of their illness will bring their families closer together. A 38 year old store manager who had never had a particularly close relationship with his family described his fantacy “that something like this – an experience where you come this close to death or the reality of death – is when you realize what’s really important and not who’s right or who’s wrong.”

            For the lucky ones, this fantacy materializes. The oldest man interviewed in the study, a 57 year old lawyer, had always considered his father a cold and selfish man, and had never been on good terms with him. This situation changes, at least partially, when he became ill. As he described it:

 

            “We’ve gotten closer… There’s the verbal “I love you”, there’s the letters. One of the nicest things that’s ever happened to me… is my father sent me a personal card. In the inside he wrote “God bless you. I love you son”… It meant the world to me.”

 

            Another man described how, despite their disapproval of his lifestyle, his dementalist Christian family had provided him with housing, money, and emotional support once they learned of his illness. As he described it, in his family, when “little brother needed help… that took priority over all the other bullshit. They were right there”.

            Diagnosis can also bring families together by ending previous sources of conflict. Whether to preserve their own health, protect others from infection, or because they simply lose interest in sex once diagnosed with a deadly STD, patients may resist sexual activity. For health reasons, they may also stop smoking or drinking. As a result, families that previously disapproved their lifestyle may stop considering them “sick” or “sinful” even if the patients continue to consider themselves gay. Consequently, some STD positive individuals may achieve a new acceptance from relatives who attach fewer stigmas to their disease than to their former behaviors.      

A study on the vitality and growth of HIV-infected gay men (Schwartzberg, 1993) was undertaken due to the recognition of the fact that minimal attention has been given to the beneficial or life-transforming aspects of having HIV.  Seven HIV-positive gay men from a cohort of 19 enrollees that were subjects to another study were interviewed and their narratives were described in this study. These men were found to have successfully integrated HIV into a framework of world- and self-benefits that allows for coherence, stability, emotional vitality, and positive self-regard. Eight characteristics of these men were identified: (1) Belief in personal control or free will; (2) The ability to admit the reality of HIV infection and AIDS and the capacity to see AIDS as an abstraction; (3) HIV as an agent that confers ‘specialness’; (4) A sense of community belonging or membership; (5) A ‘here and now’ focus; (6) The belief in some sort of ‘afterlife’; (7) Altruistic behavior; and (8) The ability to tolerate paradoxical, contradictory thoughts, beliefs and feelings.

            The men in the study were identified to develop a positive identity in the face of adversity, while “nonetheless remaining cognizant of the factual reality of the situation”. Whereas considerable emphasis has been given to the psychosocial literature on the traumatic impact of AIDS in terms of morality, bereavement suicide, psychopathology and coping with life amid enormous multiple stressors, the study was able to support the idea that amidst positive personality can develop amidst a negative situation.

            It should be identified, however, that none of these men demonstrated all of these themes and no prominent characteristics definitively or exclusively provided necessary and sufficient criteria for inclusion in this group.

            The study recognizes that “the existence of individuals who are able to forge life-transforming benefit out of HIV infection – regardless of the prevalence with which they are found, or the complex factors that contribute to such an orientation – is a testament to the resilience and durability of the human spirit in meeting profound adversity.”

            In a more general study, Schwartzberg (1994) identified how HIV-positive gay men make sense of AIDS. 19 HIV-positive gay men were enrolled in the study in which intensive clinical interviews were done to discern how these individuals ascribe meaning to AIDS and their HIV infection. In the study, 10 specific cognitive representations of AIDS and HIV emerged. These cognitive representations include: (1) HIV as a catalyst for personal growth; (2) HIV as belonging; (3) HIV as irreparable loss; (4) HIV as punishment; (5) HIV as contamination of one’s self; (6) HIV as a strategy; (7) HIV as a catalyst for spiritual growth; (8) HIV as isolation; (9) HIV as confirmation of one’s powerlessness; and (10) HIV as a relief. Each participant’s interview yielded evidence of at least three of these representations and only one participant’s interview exceeded six categories. This implies that for some of the subjects, HIV was a transformative catalyst for positive change. Many subjects were identified to have adapted well and were coping effectively with the challenge they face.

            Waller (2001), using a multivariate design, studied the perceptions of social support and adaptational outcome of gay men with AIDS. The study examined social support as a mediating variable between the stressor of AIDS and the adaptational outcome in a culturally and socioeconomically diverse sample of 60 urban gay men with AIDS. Whereas earlier studies have suggested that social support to gay men with AIDS is often lacking or ineffective, findings in this study indicated that family of origin and support of friends are strongly correlated with positive outcomes, signifying that social support is an effective determinant of the victim’s positive outlook in life. Participants in the study were made to complete nine self-report inventories addressing present health condition, socioeconomic status, social support and adaptational outcome. The answers were then subjected to cross-sectional and correlation study.

            The findings of the study strongly support the findings that the perceived availability of support from family and friends buffers the effects of stress on adaptation outcomes. Crossley (1997) investigates the destructive potential of HIV positive diagnosis on the “self”. The study recognizes that “the fundamental sense of psychological trauma arises from the shattering of basic, underlying existential assumptions that people hold about themselves and the world”. Terminal illness such as HIV/ AIDS promote such fundamental sense of psychological trauma which leads to the destruction of “self”.  Traumatizing events were found to distort the ontological security given by the healthy self or the healthy environment  which were evident prior to the diagnosis of an ailment. Drawing from the data of a then on-going research (1995) on the emotional, psychological, and service delivery needs of people living with HIV positive diagnosis for five years or more, Crossley focused on 100 member self-help survivor group in England to whom questionnaires were administered. It was identified that “majority of people faced with an HIV positive diagnosis experience an initial radical change of ontological insecurity which, although ever-latent, is, in the long run, controlled by the development of renewed frameworks of meaning, new ways of creating a sense of security”. The desire to create a renewed sense of security was, however, impossible to most HIV positive individuals as this “worst scenario” implies the miserable need to cut themselves off their bodies and other people of the world through suicide. This way of coping is a way of “avoiding nonbeing by avoiding being”. Such a way of coping is doomed to failure (for the participant in the study, at least), in that it has the tendency to “regress into an ever-deepening spiral of hatred, hostility, envy and destructiveness, the ultimate result being the desire to escape through suicide’”.

            Reissman  (1990) examines the strategic use of narrative in the presentation of self and illness. Using Goffman’s theory and methods of narrative analysis, the study examines the separate account of a white working-class man with advanced MS to show how he constructs a definition of his situation and a positive masculine identity, despite the occurrence of disability. It was observed that he regains this positive self through narrative reiteration of key events in his life. In the process, he was able to heal as he structures (and re-structures) his accounts, his life story, to the listener. The strategic choice of genre or forms of narratives made possible the healing process to take place. The study successfully showed the usefulness of close textual analysis of biographical accounts of illness.

In the context of HIV/ AIDS, the ‘self’ was identified to be a potentially destructed due to the ontological insecurity brought about by the diagnosis of the disease (Crossly, 1997). Crossley identified that most of the time, regaining ontological security is impossible to HIV positive individuals and their conscious effort to attain this eventually regresses. In the end, they succumb to the impossibility of gaining security and, when worse comes to worst, they find suicide as the most effective escapist act.

            The literature provides us with enough evidences to the beneficial use of narratives in the presentation of self and illness (Reissman, 1990).

            A number of studies were found to support that the notion or perception of ‘self’ is negatively affected by negative events in one’s life, as in the presence of illness like chronic degenerative diseases (Gara, 1993) and an abnormal state of mind like schizophrenia and suicidal tendencies (Orbach, 1998, Robey 1989). The use narrative analysis in presenting ‘self’ has gained popularity due to the wealth of understanding it can facilitate on the search of physiological and social context of ‘self’ (Leake, 1999).

            Payn et. al. (1999) studied the behavior modification following the diagnosis of STD infection. In the study, 1991 representative household sample were collected, all aged between 20-39. The sample was chosen from the results of the National Survey of Men (NSM), which was statistically clustered. The areas, which were disproportionate, were given a probability design. In the 17, 650 housing units identified (93%) were white, 1,238 were black and 2,088 were non-black.  The study found that  (1) 94% of the STD diagnosed individuals continued to have sex while they were infected with the disease; (2) 92% of subjects individuals did not tell their partners that they were infected; (3) 96% did not go to the doctor to be re-screened following a therapy and (4) 95% did not change their sexual or prophylactic behavior in any way.

 

Summary of Studies on STD and Social Relationships

of STD-positive Individuals  

            This survey of literature provided us with a vast array of studies dealing with the social implications of an STD diagnosis. On the one hand, it is said that a diagnosis of such illness, especially the terminal ones which include AIDS may reinforce family ties or completely break it. Some family members tend to be embarrassed about their relatives’ illness. Some of them find it so disgusting that it made them hate and disown their ill relative. On the other hand, other families may find it an opportune time to show compassion and love to their ill relative.

            In an individual level, it is found that having STD, particularly AIDS help to strengthen the concept of  “self” of some individuals.

            In connection to attitude and behavior after an STD diagnosis, a study have shown that most individuals do not modify their behavior prior to diagnosis of the infection. This may be attributed to the seeming hopelessness about their condition that they opt to be completely nonchalant about it and continue on with their lives as they lived it before the diagnosis of their disease.

            This survey is able to establish that social relationships, particularly familial ones, in the midst of life-challenging situation may be expected to change, so as the notion of one’s “self”. However, behavior modification in relation to one’s sexual behavior may not change as drastically, as this is influenced largely by the perceived emotional support the ill one gets from his significant others.     

 

REFERENCES:

Crossley (1997)

Gara, 1993

Leake, 1999.

Orbach, 1998, Robey 1989.

Payn, Betsy, Tranfer, Kory. “Behavior modification following an STD diagnosis”.

Battlele Center for Health Research and Evaluation,

Seattle,Washington.1999.

Reissman  (1990)

Schwartzberg,

Shultz, Dave. “Determinants of Social and Self Constructs of Gay Men with STD.

American Journal of Social Sciences. Vol. 14, No. 7, 2000.

Waller (2001)

Weitz, Rose. “Living with the Stigma of STD”. Qualitative Sociology, Vol 13, No,1. 1990.

 

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