Informed Consent: Risk Assessment vs. Stigma

As part of my informed consent post series, I’d like to talk about the issue of risk assessment regarding STIs when deciding whether to have sex with someone, and how to grapple with the problem of stigma.

I wrote about stigma in my post on the adjacency effect, but the brief recap is that stigma is a sense of judgment or pollution attached to people who deviate from the norm. They’re seen to be dirty, unworthy, and so on. People who have been diagnosed with STIs certainly fall into this category; many face judgments such as slut-shaming, intolerance, and even human rights violations.

In the context of informed consent, it is incredibly important for people to disclose their STI status to potential sexual partners. This, of course, presumes that people know their STI status, which is not always the case (we recommend talking to your doctor about STI testing, or finding a nearby Planned Parenthood, which offers affordable STI testing and counseling). And even if you do know your status, it can be difficult to be courageous enough to disclose a diagnosis, because of the aforementioned issue of stigma.

However, I firmly believe that potential sexual partners have the right to know if they’re going to be putting themselves at risk before engaging in sexual acts. This awareness allows them to do risk assessment for themselves, which is going to be a very individual act. Some people might shrug at the prospect of contracting HPV, which according to the CDC almost every American has acquired at some point in their lives. For others, even exposure to HPV might be considered an unacceptably high risk.

The key thing is to distinguish risk assessment from stigma. From the perspective of risk assessment, potential partners are within their rights to say, “Thank you for sharing that with me. I do not currently feel that it’s an acceptable risk for me to take, so let’s not have sex [or unprotected sex, or oral sex, or unprotected oral sex, or whatever act is being considered].” The main thing is for the potential partner to not engage in stigmatizing behavior, which is based on fear, not facts. Stigmatizing behavior is often unreasonable, such as saying, “I don’t want an HIV-positive person in my house,” when, obviously, simply being in the presence of a person with an STI will not transmit it.

This Hairpin post on disclosing a herpes diagnosis to potential partners describes how the author handled the stigma of disclosing her status, and, eventually, began to find it empowering: “Herpes, oddly, did not turn me into damaged goods. Instead, it became a filter for expendable men in my life.”

Stigma is hurtful by its very nature, as it is irrational and fear-based. Risk assessment may feel hurtful – as it’s rarely pleasant to proposition someone and then be rejected – but ultimately it’s the more ethically sound option to give your potential partners the ability to make an informed decision about whether to be sexually active with you.

When you’ve been exposed to an STI (such as having sex with someone with a diagnosis, but before you’ve gone and gotten tested yourself), then you’re in something of a gray area: is that still something you need to disclose to potential partners? I’d say that it’s probably best to take the ethical high road and do so, all in the interest of giving them the option of giving consent with as much information as possible – even if that information comes down to playing a numbers game and running stats in their heads (which I imagine can get pretty complicated, along the lines of “hm, well, if that STI only has a 3-5% transmission female-to-male rate while using a condom over the course of a year, and they only had sex once while using a condom, and then if we use a condom…”).

Another gray area presents itself in polyamory and open relationships, where one person may feel that a certain STI risk is acceptable, but their partner(s) may feel that such a risk is too high, and the one partner’s choices have consequences for their partners, and their partners’ partners, and so on down the chain. At that point, who has the right to know what? Does it change when you’re three partners down the line, or four, or five? The important thing, I think, is to have open conversations about these topics so that there’s a protocol in place for discussing risk assessment and which behaviors constitute an acceptable risk (if any).

Again: giving your potential partners as much information as possible, so that they can make informed decisions and fully consent to having sex with you, is the right thing to do. Rejection sucks, but coercing people into having sex that may be unacceptably risky to them sucks even more.

For more on stigma and HIV/AIDS, see this MSP post by Craig. For a lengthy discussion of this ethical dilemma, see this blog post at the STD project, which asserts (and I agree): “it is not ok, moral, or ethical to put a person at risk of contracting an STD without allowing them an opportunity to make a conscientious and informed decision.” (see? it all comes back to informed consent!!!)

About Jeana

Jeana

Jeana Jorgensen, PhD recently completed her doctoral degree in folklore and gender studies at Indiana University. She studies fairy tales and other narratives, dance, body art, feminist theory, digital humanities, and gender identity.