Sexual Health: Stigma, COVID-19, and How Startups Are Tackling It

Ferne Health Co-founder Xi Liu talks to Jumpstart about the stigma associated with sex, its consequences, and what startups can do to improve sexual healthcare.

Sex is an integral part of human lives. Studies indicate that a healthy sexual life can promote fitness and reduce risk of heart problems and diseases like hypertension and rapid heart rate. However, in modern society, most things associated with sex, including the physical act itself, are tinged by embarrassment and stigma.

This keeps people from openly discussing sexual activities and related problems. A survey of young unmarried women in India conducted last year, for instance, pointed out that only 1% of them received sexual and reproductive health and rights information from their mothers, doctors or government campaigns.

According to Liu Xi, the Co-founder of Ferne Health, a Singapore-based startup offering at-home STI screening and consultation services, stigma hinders people from seeking out help when needed.

“Because of the stigma, people feel embarrassed to talk about it [STIs and STDs]. They feel like they’ll be judged like, ‘Oh you’ve got a sexually transmitted infection or disease’. That’s embarrassing,” says Xi. “And this is the whole thing that sort of makes people go away and sort of try to hide it, which only makes things worse.”

STIs can be easily treated, but failure to get tested contributes to higher rates of infections. Data from the World Health Organization (WHO) shows that over 1 million STIs are contracted each day. Annually, there are 376 million new cases of four curable STIs – chlamydia, gonorrhea, syphilis and trichomoniasis – with Southeast Asia accounting for 20% of these new infections.

In the ongoing discussion about the morality of sex, numerous parties insist that people, especially women, feel guilty about engaging in sexual activities and personal choices. This isn’t limited to premarital and extramarital sex, but they believe people attach a stigma to sexual activities in general.

report by Channel News Asia points out that in the face of stigma and shame, people resort to the Internet for information about sexual problems and diseases. This leads to second-hand information and ill-informed decisions, most commonly for sexually transmitted diseases (STDs) and sexually transmitted infections (STIs).

Besides affecting the health of those infected, such stigma also results in discrimination against people living with STDs and STIs. A People Living with HIV Stigma Index survey conducted in Malaysia found that nearly half of the respondents were aware that they were gossiped about because of their HIV status. Significant percentage of respondents also reported that they had been excluded from family and social gatherings, and even religious activities.

If left untreated, STIs can have adverse impact on sexual and reproductive health, including infertility or mother-to-child transmission. In 2016, for instance, syphilis among pregnant women caused around 200,000 stillbirths and newborn deaths, according to WHO.

Moreover, this also affects how people seek out medical help for sexual and reproductive problems. Xi points out that people often prefer to visit clinics that are farther away from their homes to avoid running into acquaintances.

“In Singapore, we actually have clinics all around for STDs, which is super impressive. But for privacy concerns, people I have personally talked to would rather go for more private clinics,” she says. “For example, some private STI testing clinics, or some other clinics or doctors that are a little bit further from their place just to avoid running into people they know.”

And while the taboo and stigma around sexual diseases existed well before the COVID-19 pandemic began, lockdowns and movement restrictions have worsened access to treatments, Xi adds.

“During this period, people were definitely more discouraged to travel around and there have been some difficulties getting a lot of people to sit for their health exams, or just pick out some treatment,” she says. For instance, she says some people have had trouble getting access to birth control, due to COVID-19 restrictions making it harder to visit their preferred doctors.

Double-sided impact of COVID-19 on sexual health

Despite the logistics and accessibility issues caused by the pandemic, Xi insists COVID-19 has impacted sexual health both positively and negatively. For instance, as a positive collateral effect, the pandemic has triggered the rise of convenient and accessible sexual healthcare services.

“I have definitely seen a lot more new services around sexual health emerge in the market during this pandemic,” she says. Ferne, for instance, launched its home-based self-test STI and cervical cancer screening kits in September.

Other startups operating in this niche are gaining a greater share of the limelight and clinching investment deals amid the pandemic. These startups can take the shape of anything from virtual fertility clinics and family planning, to contraceptive medication accessibility and male sexual healthcare.

The downside, however, comes when these services are only available in certain regions. This is because the disruption of the logistics sector has severely affected distribution of services, and the impact is more severe in less developed countries, Xi adds.

“For example, when COVID-19 first started, some HIV-infected patients were having trouble getting medication, because everything was about to go out of stock. Lots of healthcare providers, hospitals, or even nonprofits were having trouble to get the treatment back to normal,” Xi explains. For HIV patients, this constitutes a life-or-death issue.

“If [HIV patients] are treated on time, as we know, they can actually live a normal life for many, many years, just like a normal person. But, once they stop their treatment, it can lead to really serious consequences,” she says.

Additionally, the pandemic has increased the strain on the sexual and reproductive healthcare system. People have started reaching out to their doctors following the lifting of lockdowns, but with the healthcare system to overstretched, doctors are having trouble balancing their schedules.

“I have a personal friend who’s actually looking to have a baby right now, but it has been really challenging to book an appointment because lots of people’s appointments were postponed due to COVID-19,” says Liu. Her friend has been trying to secure an appointment for the last four months.

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Sex education and awareness amid COVID-19

Schools and colleges have been trying to increase education and awareness around sexual issues, particularly for teenagers. However, with education moving entirely online because of school closures, sex education may not be on educators’ priority list.

Moreover, school counsellors are often a primary source of sexual health-related information, guidance and advice for teenagers. But with most schools still being closed, these teens may not feel comfortable sharing their problems from home, even if they could reach their counsellors via phone or video calls.

But most importantly, in the absence of such education and guidance, teens are likely to resort to the Internet in order to self-diagnose or for ‘crowd diagnosis,’ which refers to asking strangers on the Internet to analyze their problems and diagnose possible diseases. There are hundreds of Reddit threads about sexual health, STD and STIs, and the number are steadily rising.

Under the circumstances, Xi believes that schools and parents can play an important role in avoiding the adverse consequences of not seeking professional or medical help for sexual problems.

“Schools, if they could provide an easier, more credible information source and make sexual health education more accessible for students, that could be a good help,” she says.

“From my personal experience, my parents never tried to have these conversations in the first place,” she says. “So we should definitely encourage parents to learn how to convey the messages.”

Role of startups in battling sexual health problems

Xi elaborates on Ferne’s efforts in providing credible sexual health information, and what other startups in the area can do.

“We are trying to provide more articles or blogs [and] information to help people learn about the right things about sexual health. And so, we try to involve as many experts as possible, like we have our doctors on the panel, and we have our medical advisors to back us up in terms of the information,” she says.

According to her, it is important to not only provide credible in-depth knowledge but also to ensure this information is specifically tailored to answer common questions.

“I noticed sometimes the health information out there covers a lot of things, but it might not be the information that kids are looking for,” she says. According to her, startups in the area often focus on providing professional information about sexual health, but that the content does not necessarily answer questions of teenagers and even young adults.

She suggests that organizations in this niche should be looking to provide a lighter and easily-understandable version of the information furnished by the formal education system. In her opinion, sex education should not only include safe sex practices, but also emphasize the importance of sex and combat the taboo and stigma around the topic.

As for her own startup, she says Ferne is focusing on providing basic information to cater to the needs of teens and young adults, aiming to help people feel more comfortable talking about sex. Without this crucial element of the process, it becomes harder for people to seek help for sexual health issues.

“When we say [sex] education, it’s not only just about telling people how to practice safe sex,” she adds. “It’s also a good way for us to bring out [why] sex is important, and why you should never feel bad for feeling a super basic human nature, and how to eliminate stigmas around sexual health.”

Tackling the sexual healthcare gap in Southeast Asia

Besides education and awareness, the other problem with sexual healthcare is the larger wealth gap and healthcare inequity found in Southeast Asia, says Xi. To that end, she says that many startups are trying to move the offline consultation process online through telemedicine. Like Ferne, other startups are also trying to provide home consultation and testing kits to make it easier for people to access sexual healthcare services.

Another big aspect of sexual healthcare is providing emotional support and follow-up treatments and care for STDs and STIs. But Xi says not many startups are targeting this at the moment.

Liu recounts her experience talking to a cervical cancer survivor. The survivor could not share her feelings or fears about future difficulties with conception with any of her close friends or relatives, an experience she described as traumatic.

“When she was going through this, it was just really hard for her to trust other people who didn’t go through [the same],” says Xi. The survivor was fearful that her feelings would not resonate with people who could not understand her experience.

“I think for people like this, [it is] a very important aspect is to provide a community or support group or just some sort of emotional care,” she adds.

To that end, for all patients getting tested through Ferne, the startup encourages them to book a consultation with doctors instead of simply sending the results, in order to help patients better understand their problems and complications. Moreover, this prevents patients suffering from minor problems like urinary tract infections (UTIs) from getting anxious, scared, or experiencing undue stress, says Liu.

Ultimately, in order to elevate the sexual healthcare standard, there has to be a holistic effort to increase access to credible information and sexual healthcare services, while fighting the taboo and stigma around it.

Header image by Reproductive Health Supplies Coalition on Unsplash

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