title: Association of sexually transmitted disease-related stigma with sexual health care among women attending a community clinic program.
abstract: OBJECTIVE
  The objective of this study was to assess the association of sexually transmitted disease (STD)-related stigma on sexual health care behaviors, including Papanicolaou smears and STD testing/treatment, among women from a high-risk community.
  
  
  METHODS
  Descriptive statistics were used to assess the association of demographics, sexual and drug-related risk behaviors, and 3 measures of STD-stigma (internal, social, and tribal stigma, the latter referring to "tribes" of womanhood) with sexual health care in the past year. Pearson's chi-square test and Mann-Whitney test were used to assess significance. Multivariate logistic models were used to determine the association of STD-stigma with sexual health care after controlling for other factors.
  
  
  RESULTS
  Lower internal stigma score was marginally associated with reporting an STD test in the past year [median score (interquartile range) for those reporting and not reporting an STD test were 0.79 (0.30-1.59) and 1.35 (0.67-1.93), respectively]. In an adjusted model, internal stigma retained a negative association with reporting of STD testing in the past year (adjusted odds ratio, 0.92; 95% confidence interval, 0.85-0.99).
  
  
  CONCLUSIONS
  Most women had received a Papanicolaou smear in the past year, and none of the STD-stigma scales were associated with reporting this behavior. Internal stigma retained an association with not having any STD test or treatment. Although sexual stigma is a deeply rooted social construct, paying attention to how prevention messages and STD information are delivered may help remove one barrier to sexual health care.
authors.affiliation: Division of International Health and Cross Cultural Medicine, University of California, San Diego, La Jolla, California 92093-0622, USA. mrusch@ucsd.edu
authors.forename: Melanie
authors.initials: M
authors.lastname: Rusch
authors.forename: Jean
authors.initials: J
authors.lastname: Shoveller
authors.forename: Susan
authors.initials: S
authors.lastname: Burgess
authors.forename: Karen
authors.initials: K
authors.lastname: Stancer
authors.forename: David
authors.initials: D
authors.lastname: Patrick
authors.forename: Mark
authors.initials: M
authors.lastname: Tyndall
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D002170:Canada / Q000453:epidemiology; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D013240:Stereotyping; D014626:Vaginal Smears