Some…Interesting…Research On STI Stigma

Today I have the distinct pleasure of examining some research from the distinguished Terri Conley once again. Habitual readers of my writing might know the name; in fact, they might even know that I have written about her work before. The first time I did, it was only to mention, briefly, that Terri had proposed that sexual reproduction was a byproduct of sexual pleasure. To put that claim into easily-understandable terms, it would go something like, “sexual reproduction does not itself contribute to reproduction, but is the result of sexual pleasure, which does contribute to reproduction”. I’m sure many of you might be thinking that doesn’t make any sense, and for a very good reason. The second time I wrote about her work, it involved a number of sex differences which had been labeled myths; in this case, they were myths in the sense of “they are all true”, which is a peculiar usage of the term. On the block for today is a claim about how people are irrational about the risks posed by STIs, complete with a paper that meets the high standards set by the previous two pieces.

I think it might be time to finally see a doctor about that problem

I will start my examination of the piece, by Conley et al (2015), by noting that – like so much psychology work before it and like so much more that is sure to come – the predictions made by the authors are made in the absence of anything resembling a theoretical justification. In other words, sections which might include phrases like, “we predicted we would find this effect because…” are not present. With that in mind, the main hypothesis of the current paper is that people are irrationally biased against STIs and those infected by them, perceiving sexual behavior as exceedingly risky and the diseases as especially harmful. The idea was tested in an assortment of ways. In the first study, 680 participants were asked about the number of people (out of 1000) who would be expected to die on either (a) a 300-mile drive or (b) as the result of contracting an HIV infection from a single instance of unprotected sex with a non-injection drug user. Conley et al (2015) note that people are about 20-times as likely to die on that car ride than they are to contract HIV and die from it as the result of a single sexual encounter.

Sure enough, Conley et al (2015) report that their participants were wildly off the mark: while they overestimated both rates of death, the number of people estimated to die from HIV was far, far higher (M = 72, SD = 161) than from a car accident (M = 4, SD = 15). While people were statistically 20-times more likely to die from a car accident, they believed they were 17-times more likely to die from HIV. What a bias! Some things about those numbers does not sit right with me, though. For instance, it seems unlikely that people are that inaccurate: do people really believe that a little less than 1% of causal sexual encounters result in death from HIV? The variance of those estimates also seems to be exceedingly large, at least for STI risk (the standard deviation of which is over 10 times as large as the car accidents). So what’s going on? I think that answer has a lot to do with the particular question Conley et al (2015) asked:

“Assume that 1,000 people had unprotected intercourse (sex without a condom) yesterday. None of the 1,000 people who had sex were previous intra-venous drug users. How many of these 1,000 individuals who had unprotected sex would you expect to die from HIV contracted from the sexual encounter”

This phrasing is unfortunately – perhaps even purposefully – vague. One possible way of interpreting that question is that it is asking about how many people will die given they have become infected. Asking about how many people will become infected and die is much different than asking about how many infected people will die, and that vagueness could account for the widely-varying estimates being reported. As the wording is not at all clear, the estimates of mortality could be overestimated, at least relative to what the authors think they’re measuring. How this point was not addressed by any editors or reviewers is beyond me.

Their second study examined how people perceived those who (sort of) unknowingly transmitted either a sexual- or non-sexual infection to their sexual partner: H1N1 or chlamydia. That is, they knew they had symptoms of something, but wrote it off as either allergies or a UTI. Again, we find Conley et al (2015) going to great pains to emphasis that H1N1 is the much more harmful bug of the pair, so as to suggest people should believe it worse to transmit the flu. In this study, 310 participants were asked to read brief stories about the infection being spread after some unprotected sex, and then assessed the target who spread it on some 6-points scales. The person who had spread the infection was rated as slightly more selfish (Ms = 3.9/3.6), risky (Ms = 4.8/4.4), and dumb (Ms = 4.3/3.9) when they had spread the sexually-transmitted one (sexual/non-sexual means, respectively). Of course, as the transmission of the STI could have been prevented through the use of, say, a condom when encountering a new sexual partner, whereas the same option is not available for the flu, it’s hard to conclude that the participants are irrational or wrong in their judgments. While Conley et al (2015) note this possibility, they do nothing to test it, asserting instead that their data nevertheless represents an ample amount of evidence in favor of their hypothesis.

Too bad these don’t protect against bad interpretations of data

The third study is perhaps the funniest of them all. It’s not an experiment, but rather a retrospective analysis of information provided on government websites concerning the prevention of driving accidents and contracting STIs (tying into their first study). Conley et al’s (2015) bold prediction was that:

“…government public information websites would promote abstinence as the best way to avoid acquiring an STI, but that these websites would not promote abstinence from driving, which is, statistically, riskier.”

You are reading that correctly: the prediction is that government websites will not advocate that people avoid driving entirely, as opposed to avoiding having sex (or, rather, postponing it until certain criteria have been met, such as marriage). This is not what I would consider a “prediction”, inasmuch as I’m sure they knew what they would find. In any case, 86% of state websites discussed STI prevention, with 72% mentioning that abstinence is the most effective way of avoiding one (a claim which is true beyond dispute); by contrast, 78% of state websites discussed driving accidents and, shockingly, none of them advocated that people avoid driving altogether. What an astounding bias!

Now perhaps that is because, as the authors briefly mention, navigating one’s daily life without the use of a car (or some form of transportation) is all but impossible for many. However, the authors feel that – because sex, not driving, is biologically motivated – asking people to give up (or rather, postpone) sex is more unnatural and difficult. Foregoing the matter of what that is supposed to mean, I remain skeptical as to whether this lack of asking people to avoid driving entirely is evidence of “inappropriately negative” reactions to STIs in particular, despite Conley et al’s (2015) enthusiasm for that interpretation.

There was one detail of the paper which really stood out to me throughout all of this, however. It wasn’t their weak methods or poor interpretations of the data, either, but rather the following sentence:

“This component of the study provides strong evidence for the hypothesis that people who transmit STIs are unjustly stigmatised in society.”

The emphasis on “unjustly” in that passage was made by the authors; not me. While it’s possible I am reading too much into their emphasis, that strikes me as an (unintentional?) slip that puts the biases of the authors on display rather prominently. Taken together with the general poor quality of their work, it appears that there is a particular social agenda which is being pushed by this research. Perhaps that agenda is noble; perhaps it isn’t. Regardless of which it happens to be, once agendas begin to make their way into research, the soundness of the interpretations of data often suffer serious damage. In this case, Conley et al (2015) seem to be doing all they can to make people look irrational and, importantly, wrong, rather than earnestly assessing their work. They’re trying to game the system and their research suffers because of it.

 ”People are unjustly biased against living in my house”

Now, to be clear, I do feel there exists a certain percentage of the population with a vested interest in pushing ideas that make other people more or less likely to engage in certain kinds of intercourse, be that intercourse promiscuous or monogamous in nature. That is, if I want there to be more sexually-available options in the population, I might try to convince others that casual sex is really quite good for them, regardless of the truth in my claim. The current research is not a solid demonstration of people doing this, however; it’s not even a decent one. Ironically, the current research paper instead seems to serve as an example of that very bias it is hoping to find in others. After all, making it seem like STIs really aren’t that big of a deal would do wonders for making the costs associated with short-term encounters seem far less relevant. Also ironically, if such efforts were successful, the costs of casual encounters would likely rise over time, as more promiscuous people less concerned with STIs will likely lead to them spreading the things more regularly, and the STIs mutating into more harmful strains (as they no longer need to keep their host alive as long to successfully reproduce themselves). All that aside, with the glaring problems in this paper, I find it remarkable it ever saw the light of publication.

References: Conley, T., Moors, A., Matsick, J., & Ziegler, A. (2015). Sexuality-related risks are judged more harshly than comparable health risks. International Journal of Sexual Health, DOI: 10.1080/19317611.2015.1063556.

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