Abstract
In an insightful and theoretically rich examination of American women living with genital herpes infections (HSV) and human papillomavirus (HPV), Adrina Nack examines how the persistence of stigmatizing views towards sexual transmitted diseases generates an aura of sexual invincibility among women. Women view females susceptible to STDs as a distant other, promiscuous, dirty and immoral. This invincibility increases their susceptibility to increasingly common incurable sexually transmitted diseases. Tracing the life trajectories of women living with HSV and HPV, Nack highlights chronic illnesses rarely discussed in the media and lacking their own ribbon of recognition. She lends insight into how individuals navigate issues of illness identification, treatment, disclosure and reproduction when idealized views of health and sexuality are challenged by incurable STDs. Extending our understanding of the power that formal and informal sexual education can have on young women, the text encourages a critical engagement with approaches to the stigmatization of illness by focusing on hidden health issues, and provides insight into the lives of women strategizing how to live well with incurable STDs.
Using an auto-ethnographic approach, Nack collected 43 conversational interviews with women living with HSV (11), HPV (32) or both (3). Data collection was limited to a single interview, and as the author points out, the women interviewed are primarily Caucasian (38), heterosexual (37) and middle class (18). The large sample size and use of basic pseudonyms makes tracing the importance of race, class and age difficult, necessitating frequent flipping back to appendix details on the sample. While highly selective, the composition of the sample lends insight into well-educated, relatively privileged women with good access to medical care. The persistent challenges of negotiating the pain, costs, and anger associated with HSV and HPV across the sample emphasize the commonality of women’s experiences, while highlighting the inability of social status to completely mediate the stigma and shame associated with a STD diagnosis. Nack traces the ways in which each of her respondents moved through a reassessment of sexual invincibility, illness anxiety, diagnosis acceptance, self-stigmatization, and care and treatment challenges. Concluding chapters on sexual reintegration and calls for social change are hopeful. However, in terms of social change, pernicious and persistent barriers to sexual education, as her discussion of preliminary reactions to the HPV vaccine illustrates, prevent effective changes to women’s sexual health in America.
The middle chapters of the book, which rely heavily upon the interview narratives, are particularly compelling. Respondent recollections of initial interactions with health care professionals are replete with misinformation (advancing the toilet seat transmission myth), defensiveness (dismissing patient research), poor understanding of pain management needs, needless judgments, and an underlying feeling that male patients coping with STDs would receive more appropriate treatment. Many of the respondents find empowerment and develop coping skills through learning about both HSV and HPV on their own and through supportive peer networks. Health care providers appear distant and ill-trained, reflecting the biases of their larger cultural context in dealing with women with STDs. It is difficult to disagree with the call in the text for improved STD training and improved sexual education, among health care providers and within schools, but the interview data also highlights that real change will be very difficult to achieve, given the powerful underlying issues of stigma. Additional information from practitioners themselves is needed.
Nack also explores the unique challenges of living with a chronic STD through discussions of respondent disclosure strategies and practices, focusing on how her respondents seek the recreation of a sexual self once diagnosed with HSV or HPV. This section of the book relates well with growing research examining disclosure practices among people living with HIV and AIDS. Are individuals suffering with chronic diseases always in the sick role? What are the responsibilities of disclosure if one is living with an incurable STD? Respondents in the book often report becoming advocates for sexual health, encouraging partners to get tested and sharing sexual health information with others. They reach a “comfortable accommodation” with their condition in a variety of ways, employing advocacy as a means of overcoming their role as a STD victim. Linking nicely to broader studies of chronic diseases and coping, Chapter Seven specifically highlights the unique influence of gender norms on chronic sexual diseases.
The Centers for Disease Control and Prevention estimate that approximately 50 percent of all sexually active adults will contract HPV at some point in their life, and cite survey data indicating a 17 percent adult prevalence rate for genital herpes (HSV). In bringing together issues of chronic illness, gender and sexuality, Damaged Goods provides a valuable addition to studies of women’s health and draws attention to the increasing importance of sexual health studies in the United States.