By Amy Harris
Cultural, social, economic, and structural factors influence who gets sexually transmitted infections (STIs), who has access to STI testing and treatment, and who learns about safe sex. This is true for STI infections in Maine, throughout the U.S., and globally as well. On any given day, one in five people in the U.S. will have a sexually transmitted infection.
Examples of STIs are chlamydia, gonorrhea, herpes, human papilloma virus (HPV), syphilis, trichomoniasis, hepatitis B and C, and HIV. People can get an STI from having vaginal, oral, or anal sex – even with only one partner. It does not matter whether sexual partners are male, female, or both. People at all stages of life can get STIs. However, the fewer the sex partners, the lower the chance of having an STI.
People should be screened for STIs whenever they have a new sexual partner or their partner has a new sexual partner. Regular screening and quick treatment prevent long-term health consequences from untreated STIs, which can increase the risk of HIV infection, cause lifelong pelvic pain, problems getting pregnant, pregnancy complications, newborn health problems, and even infant death.
Maine offers expedited partner therapy (EPT) for fast, convenient, and confidential treatment of sexual partners if someone tests positive for gonorrhea and chlamydia. In EPT, the provider gives the patient medicine for their partner so that the partner doesn’t have to go to the doctor to get treatment.
Unfortunately, talking openly and honestly about sexual health and STIs is hard for most people, and this is even more true for those speaking through an interpreter or across cultural differences. For this reason, Maine Family Planning, one of Maine’s largest providers of STI healthcare, partners with community organizations such as In Her Presence and Greater Portland Health. The goal of these partnerships is to provide education, access, and care for sexual and reproductive health among Maine’s refugee and immigrant communities.
Maine Family Planning received $160,000 in federal grant money to pay new community health outreach worker (CHOW) salaries, offer point-of-care HIV tests kits, conduct focus groups with community stakeholders, and deliver additional provider training. CHOWs learn how different communities talk about STIs and work to build trust and break through traditional taboos and silence about STIs. Normalizing screening and education about STI symptoms is a key part of outreach.
Trends in STIs are no different from national trends in how different races and ethnicities approach STIs. For many groups, cultural and linguistic barriers mix with economic factors and lead to low screening rates and delayed treatment. Nationally in 2019, STD rates for African American or Black people were five to eight times that of non-Hispanic white people; three to five times that of non-Hispanic white people, as well as for Native American or Alaska Native and Native Hawaiian or Other Pacific Islander people, and one to two times higher for Hispanic or Latinx people than that of non-Hispanic white people.
The Maine Center for Disease Control STD Prevention Program works across the state to distribute federal funds for testing, treatment, and education about STIs. Free and confidential testing is available at multiple sites, including some school-based health centers like those in Portland and Lewiston. In addition, the U.S. CDC’s GetTested website (www.gettested.cdc.gov) lists testing centers, although not all sites are free, and not all offer HIV testing.
Teaching kids how to have safe sex is a critical part of reducing STI infections. In the U.S., more than half of all new STIs occur in youth ages 15-24. In many immigrant families, with younger generations growing up immersed in U.S. culture, talking about sex and STIs presents significant challenges. Some families fear that talking about sex will encourage promiscuity.
Murseal Nabi, a Muslim, American-born daughter of Pakistani and Afghani parents, is working on a one-year contract with Greater Portland Health to conduct a needs assessment project with immigrants living in the Lewiston-Auburn and Portland metropolitan areas who are from African, Middle Eastern, and Central Asian countries. She has personal experience with the stigma associated with talking about sex. In fact, she chose her career path because she believes “there is way too much stigma. No one should be judged for wanting to be healthy, even when it comes to sex… [But] even today, at age 24, in the job I have, my mom and I will never have the sex talk!” she said.
Fowsia Musse, a Somali-Muslim mother of five U.S.-born children, and Executive Director of Maine Community Integration, reports that in the Lewiston-Auburn school system, what she calls “fear-based resistance” leads many families to opt-out of school-based sexuality education.
So Musse offers weekly, women-only workshops following a “second-generation educational approach,” which involves teaching both children and parents. In her workshops, she “upskills” mothers separately – teaching them about STIs, sexuality education, gender equity, mental health, female genital mutilation (FGM), and opioid use disorders. Later, mothers and daughters meet together to have an “honest, intentional, and culturally-responsive” dialogue about traditionally taboo topics. Musse reported that more than 42 women from around the world attended her most recent workshop, including participants from newly resettled Afghan families
Mareisa Weil, Vice President of Maine Family Planning Community Development and Engagement – like most sexuality educators in the state – said she wants all parents to know that sex education is not just about sex, but also about consent, boundaries, and the communication strategies needed for safe, healthy relationships. Cultural brokers are essential for communicating with parents, she said. Because they are multilingual and share cultural backgrounds with their clients, they can help surmount barriers and overcome fear, misinformation, taboos, or mistaken beliefs about contraception and infections within refugee and immigrant communities.
Rates of STIs continue to rise in the U.S. The last year for which data is available, 2019, broke the previous year’s record in STI rates for the sixth year in a row. Particularly concerning was the rapid increase in numbers of syphilis cases and babies born with syphilis, which can cause serious harm and death.
Normalizing STI screening, and finding ways to talk openly about safe sex across cultures, is essential for keeping all of Maine’s communities healthy. And with the COVID-19 pandemic disrupting STI testing and treatment, even more people than usual are behind in their screenings. Since some of the most common STIs do not have symptoms, all sexually active people should schedule regular screenings to keep themselves and their partners healthy.