It took a while to get the courage to go; I was nervous, sticking to the vinyl chair in the waiting room. I knew that I needed to get tested, but I couldn’t tell my family doctor that I’d _(fill in blank)_ (used injection drugs, had condomless sex, had a one-night stand, had sex outside my relationship). This was uncharted territory, and I was uncomfortable. I felt so much guilt about what I’d done, and then when they asked me about why I wanted to get tested—what had I done?—I saw the look in her eyes: judgement. She asked “Why?” But her eyes asked how could I have done something so stupid? How could I have done this?
Sound familiar? Many of us have faced judgement when we access STI testing, which is an awful feeling. Sometimes it’s just because, with no ‘risk activity’, the only box the health care provider can tick is labeled ANXIETY.
Hey, STI testing should be a part of everybody’s regular health care routine: just because I take my sexual health seriously and get tested regularly doesn’t mean that I’m obsessively neurotic about it.
Despite the overt sexuality in our media (watched any music videos lately?), sex and intimacy can be loaded with feelings of guilt and shame. Pornography is incredibly accessible on the internet, but doesn’t necessarily start an open conversation about sex and sexuality.
In our culture, we rarely talk about sex and sexual health in an engaging and ongoing way. Most people last received sexual health education somewhere between elementary and high school, and what you learned was dependent on what school you learned it in, and who taught it. Leaving the majority of the information we get on sex and sexuality to our peers. How do we know that what our friends, or Google, tells us is accurate?
It can often take a while for a person to muster the courage to access sexual health services and STI testing, where they can be faced with judgement by health care providers.
With judgement comes guilt and shame. Brene Brown, a shame researcher, (see her awesome TEDtalk here) calls the difference between guilt and shame as the difference between behaviour and self. Guilt = behaviour, so I did something bad. Shame = self, so I am bad.
Shame is often used as a tool to motivate behaviour change, I guess the logic being that the worse we make a person feel, the more likely they are to change. However, there is plenty of research out there that looks at how shaming a person does the exact opposite: instead of changing my behaviour, I am probably going to avoid coming back to you, and to avoid asking you about it again. Therefore, I will continue whatever behaviour it is you want me to change. I probably feel ashamed of it already; I don’t need you to make me feel worse.
There is plenty of research documenting that shame is totally ineffective at motivating sustained behaviour change, and that judgemental services are a strong deterrent for accessing care. So, service providers, the more we keep our thoughts and feelings to ourselves, the more effectively we can engage patients and clients in a meaningful way.
Keep your feelings out of it, regardless of how you feel about my choices. Especially if you think I’m making a grave mistake, you still don’t have the right to make me feel ashamed. Why? Maybe if you asked me about it compassionately and sensitively, I would be more likely to have an open discussion. Maybe then you could ask me about why I engaged in that behaviour, and the barriers that I face to changing those behaviours.
Have you ever been shamed by your doctor or other health care provider? How did it make you feel? Tell us your stories!
Free and confidential HIV/STI testing and treatment is available at the STI Clinic
Sheldon M Chumir Health Centre
1213 4 street SW
Open Monday through Saturday
Call (403) 955-6700 for hours