When “feeling bad” and “not knowing” make a difference: The impact of stigma and blame on STI healthcare utilization

BACKGROUND: Stigma associated with sexually transmitted infections (STIs) and the extent to which an individual blames, or is blamed by, his or her partner for introducing an STI into the relationship may affect use of healthcare services, especially those services that require partner interaction, including partner notification, testing, and treatment. This study investigated the role of stigma and blame on intentions to engage in these services. METHODS: Structured interviews were conducted among 40 male and 40 female Midwestern U.S. public health clinic patients aged 18-40. Participants were asked about their willingness to participate in various partner-oriented services and benefits, disadvantages, and other factors influencing that willingness. Open-ended thematic analysis led to a conceptual framework which was then re-applied to the data. RESULTS: STI stigma and partner blame emerged as salient themes among participants. Participants indicated that stigma was a major barrier to partner notification, partner testing, and partner treatment. Participants were more likely to engage in health care practices that offered opportunities to minimize stigma. Fear of being blamed for introducing the STI into the partnership was a significant barrier to partner notification. Blaming the notifying partner for introducing the STI influenced the uptake of specific testing and treatment options. DISCUSSION: Results indicate stigma and blame have important implications for partner-oriented healthcare services and suggest that both selection and counseling of patients for services may be better served by directly addressing these issues. Improved understanding of these influences will be important to effective STI prevention and treatment.