Beyond Infection: The Effect of Sexual Framing on Disease Shame, Stigma, and Testing Attitudes

Across two studies (N = 960), we examined whether sexually transmitted infections (STIs) were perceived as more shameful and stigmatizing than other infectious diseases because of their sexual nature and the implications for testing-related feelings and attitudes. College students (N = 361, Mage = 19.32) in Study 1 rated shamefulness of chlamydia/gonorrhea, HIV, or a general infectious disease (randomized). In Study 2, college students (N = 242, Mage = 18.72) and Prolific-recruited adults (N = 357, Mage = 28.29) were randomized in a 2 (disease framing: STI vs. non-STI) × 2 (severity: mild vs. severe) design involving a fictitious disease. The disease-framing manipulation was implemented as a bundle that jointly varied the transmission mode, risk factors, public assumptions, and screening procedures. Participants reported perceived shame (Studies 1 and 2), stigma (Study 2), anticipated feelings if testing positive (Study 1), and automatic attitudes toward testing (Study 2). STIs were viewed as more shameful and stigmatizing. STI-related shame and stigma were associated with stronger anticipated negative affect if testing positive for STIs (Study 1) as well as unfavorable attitudes toward testing (Study 2). The findings support the need to address shame and stigma to promote STI testing. Because shame and stigma arose from the sexual framing of a disease rather than from its clinical features, factual education about transmission and risk is unlikely to be sufficient on its own. How screening is presented and discussed, including the procedures involved, may itself contribute to “gut-level” avoidance that can hinder service utilization.