ISPUB.COM The Internet Journal of Advanced Nursing Practice Volume 6 Number 1 1 of 7 Counteracting Stigma in Sexual Health Care Settings G White, A Mortensen Citation G White, A Mortensen. Counteracting Stigma in Sexual Health Care Settings. The Internet Journal of Advanced Nursing Practice. 2002 Volume 6 Number 1. Abstract Sexual health clinics and the people who visit them commonly face stigma. Sexually transmitted infections have historically been used to divide people into "clean" and "dirty". A grounded theory study of the work of sixteen nurses in six Sexual Health services in New Zealand was undertaken to explore the management of sexual health care. The study uncovered the psychological impact of negative social attitudes towards the people who visit sexual health services and to the staff who work there. Sexual health nurses manage the results of stigma daily and reveal in their interactions with clients a process of destigmatisation. INTRODUCTION The provision of sexual health care is socially complex and difficult work. A contributing factor is the widespread stigma associated with sexual health clinics and sexually transmitted diseases (STDs) 1 . Daily, nurses encounter people who feel ashamed, humiliated, defensive and frightened about their situation. Nurses working in sexual health clinics know how to respond to social, psychological and cultural reactions based on their experience in practice and are aware that clients anticipate negative reactions. Sexual health nurses also encounter negative public and professional reactions to their work. Other health professionals and the community may view sexual health nurses, as being involved with the ‘dirty' aspects of sexuality. 2 , 3 , 4 , 5 Accordingly, staff in sexual health settings adopt strategies that convey humanity, safety and normality to counteract stigma. Counteracting stigma (destigmatisation) is a complex process during which sexual health care nurses are engaged with dignifying and advocating for clients who attend sexual health clinics. The destigmatisation process was uncovered through a grounded theory study of sixteen sexual health nurses in New Zealand. In this paper, the study will be described and the theoretical framework of destigmatisation explained. BACKGROUND The concept of stigmatisation associated with sexually transmitted infections is well identified in the social science and medical literature. 1 , 6 , 7 , 8 , 9 Historically, people with sexually transmitted diseases have been stigmatised. Sexually transmitted infections were incurable until the advent of antibiotics in the 1940s. 1 Prior to this time; syphilis and gonorrhoea were difficult to treat. Venereal diseases were a serious threat as they could be fatal, commonly caused infertility, infected neonates, and caused chronic debilitating illnesses 10 . Although medical treatment has been available for sexually transmitted diseases since the 1940s, curable diseases such as chlamydia and gonorrhoea persist, and the prevalence is increasing. 1 Individuals and society use the coping mechanisms of denial and displacement including, stigmatisation, scapegoating and discrimination when faced with illnesses that are threatening or fatal, or for which there is no cure. 9 Stigma remains a significant barrier to the prevention of curable infections even when treatment is freely available. Often society, including some health care professionals consider that clients have deviated from the norms of respectable illnesses, and therefore should be punished by being treated as socially undesirable. The sociological phenomenon of stigmatising sexual minorities and people with HIV/AIDS and STDs is well documented in the literature. 6 Stigma operates when individuals fail to meet what is considered to be normal and healthy which ‘‘spoils' the social identity, isolating the individual from self, as well as, societal acceptance' 6 . The tools of derogatory language, mythology and negative social responses are used to shape attitudes towards targeted social groups. People with sexually transmitted diseases become ‘them' or the ‘other”. Gilmore and Somerville 9