 Are you sure you don't have gonorrhea? Like, totally sure. When were you last tested? This is the kind of romantic conversation none of us wishes to have on a steamy date, but we should. Well, maybe with a bit better wording, but sexually transmitted diseases are the uninvited guests always ready to crash the party, even though no one wants them around. Let's talk about sex education. You mean the series? No. Kidding. Which season? They realize that actually, you know, half of the population is boys, and sometimes, you know, their partners are not girls. Oh, they're gonna be so mad at you, you called them Eastern Europeans. Oh, yes, especially Slovenians. Am I talking something crazy? Don't ask me. If I really wanted to create educational content that was gonna have that type of impact, I needed to go where people were. And they weren't in the hospital, they were on their phones. You will have the same life expectancy and the same life quality with medication as anyone who doesn't have HIV. If we could remove even a fraction of the stigma that still surrounds sexual health and STIs, I think everybody's lives would be better. Prevention is so much cheaper than having to manage late-stage complications and cure. I will submit this to Santa Claus tomorrow. Good time of the day to you all. Whenever you tune in to Standard Time, I'm Reiko Kingopop, editor-in-chief of EuroZine. It's the magazine showcasing this talk show and a co-founder of the Display Europe platform, where you'll find content from all over Europe covering many languages and viewpoints. We have strong evidence that sexually transmitted infections have been a defining feature of the entire history of human civilization. We have seen skeletons bearing syphilis marks, classical literature dedicated to gonorrhea and loads of royal gossip about used infections. Sexually transmitted diseases or STDs have been a subject of medical fascination and social conversation for that matter for thousands of years. Even today, we can't seem to get enough of the historical bingo of who contracted what. However, Europeans are less keen on dealing with their present-day sexual health. The discourse makes it seem like all of these contagions are a thing of the past. It couldn't be further from the truth, though. Since the early 2000s, our collective attention on STDs has decreased, even though epidemics are on the rise. The World Health Organization and UNAIDS are beating the drums because the total number of people living with HIV has increased from 26.6 million in 2000 to 39 million in 2022. That's a lot of new infections. On a global scale, the WHO reports that more than one million STDs are acquired every day worldwide, with an estimated 374 million new infections each year involving one of four curable STDs. Chlamydia, gonorrhea, syphilis and trichomoniasis. And even though treatment is available for a great number of them, it doesn't make undiagnosed ailments any less dangerous or contagious for that matter. Knowledge is our first line of defense. Most crucially, if you know your HIV status, with the available treatment options you can live a long and fulfilling life and without infecting any partners, but for this, you have to be aware of it and to be able to access the existing treatment. So let's talk about sex and sexually transmitted infections. We have antibiotics-resistant super gonorrhea, the wide array of HPV viruses, chlamydia on every corner and more for you to discuss. But don't fret, we'll also talk about solutions. Prevention, screening, treatments and importantly, sexual education. No, we're not teaching you new poses. You have an F material for that, about two-thirds of the entire internet. Sexual education is about all the things beyond the birds and the bees. We'll also delve into the role of community involvement and the stigma affecting sex workers and LGBTQIA plus communities, both of whom are at the forefront of finding solutions, while the majority of our societies try to look away or find a scapegoat. Today, we enjoy the hospitality of the Central European University at their Budapest Library. Dr. Bela Tamasi is a clinical dermatologist and the founder of an evidence-based dermatology and sexual health clinic. He has been the director of the National Center for STIs in Budapest. Dr. Dane Marayutakis is a medical doctor and the co-founder of Jocsly, the company providing at-home STI testing. Her social media channels have more than a million followers making sexual health education engaging and accessible. Trajca Janushev is the program officer at SWAN, the Sex Workers' Rights Advocacy Network. SWAN supports sex workers' rights in Central and Eastern Europe and Central Asia. Their work underlines the importance of inclusivity and advocacy in addressing sexual health. Stick around as we delve into a topic often whispered but seldom discussed openly. Right here on Standard Time. Welcome and thank you all for being here. We are here to discuss STIs today, which is a nice program for December, whatever time of the day, anyone might tune in. May we start with Dr. Bela Tamasi? Why don't we talk about this? It's a very good question and I think that partly it has some historical roots because in the Middle Ages, for example, you only had the chance to contract a sexually transmitted infection if you stepped out your marriage or if you went to a sex worker and that's why that this issue has been stigmatized. And people still think that if they get a sexually transmitted infection then it is something disgusting and it's not normal and it's not according to our expectations within society. But it is simply not true because we do know that everybody who has sex can have a sexually transmitted infection. Yeah, and also those supposedly very strict and disciplined Middle Ages and early modern times somehow syphilis managed to get around Europe in just a couple of years. So I'm pretty sure they weren't that strict about things as we like to imagine or sort of project backwards. Yeah, it can be and we still have a problem with syphilis, especially with syphilis because in Hungary last year, for example, we had a skyrocketing number of syphilis cases compared to the previous year. Is there like a specific issue that you can identify the reason for this or it just happens to be the case? Lack of knowledge, lack of testing, lack of prophylaxis. Syphilis can be completely symptom free so you can give it to your partner without knowing that you are having it. In the UK we saw syphilis go up 15% last year as well and I think you're 100% right. I think it's a lack of awareness and education. People aren't getting tested and treated and a lot of that is because syphilis and other STIs don't have any symptoms. So until people have symptoms, they don't go and get tested and this is why routine testing is so important because even when they don't have symptoms they can still transmit the infection to a partner. So yeah, so that's very, very true. And just one remark regarding syphilis. If it causes symptoms it will cause skin symptoms. So patients with syphilis will go to see a dermatologist most likely and if the dermatologist doesn't think of syphilis he or she won't have a syphilis screening test and then the patient won't be diagnosed and treated. So this is also kind of an intersectional awareness for the medical doctors. Do you, I guess, would have to inform your colleagues to watch out for something like this? Yes, but I think one of the problems in Hungary is that most physicians are simply afraid of sexually transmitted infections and are afraid of patients who have sexually transmitted infections. Now let's talk about the stigma because that's a whole can of worms and Trayce Janushev, you work with the Sex Workers Rights Advocacy Network. We're going to call it swan because that's easier to pronounce and also way more gracious. I would like you to address this component of the stigma like the traditional sort of not very well informed first association with STIs in public discourse would be gay men, not even all LGBTQIA people but specifically I guess because of the AIDS crisis and how it was handled. It would be gay men and sex workers. And oftentimes a responsibility is also attributed to the sex workers. How does that affect their rights and advocacy? It's a really broad topic. From all of your questions I will take only one word but it's like problematic, let's say, like putting the responsibility to the sex workers. So speaking about health, speaking about reproductive and sexual health we need to learn and it's to be a base of the education system so we are self-responsible for our health state. We don't need to look for blaming someone why we catch something. This is the traditional way to scapegoat a specific group. This is not my business, this is theirs to deal with. We can discuss deeply why is this like that or from where it's coming this blaming let's say to the sex workers. Of course I will start with the sexism and with the patriarchal society where we are living. So it's always more easy to take some women who are on the vulnerable position who are perceived by the society as a promise quitted and someone who are not fulfilling the society acceptable values. We have research also from the medical field from professionals and doctors but a lot of research also from the community what is coming from the sex pro community. One thing maybe what I will say here is the mandatory health checking for sex workers starting with the basic human rights because the government, because the institution are taking authorities of the bodies of sex workers they are deciding when sex workers will be tested, how they will be tested and on which circumstances they will do this testing. The society, we, an institution and decision makers need to understand that providing sexual education and for these kind of groups like vulnerable groups in this case because I'm speaking for sex workers it's very important to understand that we need to provide accessible and sensitive services for sex workers. Let's talk about the availability of testing. Renee, you work specifically with testing, you provide testing kits why do you think at home testing and this kind of sort of taking things, matters into people's own hands eases the situation? Why do you introduce the at home element for instance? So when it comes to sexual health I think the challenges are twofold. So you have people who struggle to access services because they can't get appointments because of long wait times because of embarrassments, fear of judgments, so there are all those factors and then there are the people who don't even know they need to access services right and that's that kind of lack of awareness and education in general exists. So whatever it is that we do, whether it's in clinic testing or at home testing I think general education needs to be key and then there are certain subgroups that are at higher risk for which they need more maybe specialized outreach services but I think the benefit of at home testing is that it makes it convenient for people and it removes some of those access barriers like oh I can't get time off work to get there or I have to pick up my kids after school or I'm embarrassed to have a face-to-face conversation with a provider about what I did last weekend and why I need this test. Or who I would meet in a waiting room. I did meet old classmates, that was fun. Yes, yes, so exactly. So depending on how many clinics are available in your area you may very well run into people that you know. So confidentiality is breached in that sense and so people I mean giving them the opportunity to test in the comfort of their own home on their own time I mean works as a wonderful screening tool and that's one of the reasons we decided to offer the at home testing. Now admittedly there are certain tests where you cannot diagnose them exclusively at home so with the at home testing it's a screening service if somebody receives a preliminary positive test result then they need to have that diagnosis confirmed in a clinic with a second blood sample that's taken from a vein not like a pinprick blood test that you do at home. But that being said it's a starting point and it gets people thinking along the right lines and it gets infections picked up and hopefully treated much more quickly. And now a word from our partners. Hello a big thank you to the library of the Central European University in Budapest, Hungary for hosting our show today. The CEU library boasts the region's largest collection of English language materials in the field of social sciences and the humanities at both campuses in Vienna and Budapest it's a welcoming place for all learners. In Vienna their campus houses around 40,000 books and various study posts. They also offer media creation, copying and scanning facilities and in Budapest a massive collection of about 135,000 books awaits you. You're a clinical physician, you work in the facility, this is your focus does an at home testing option infringe on your territory or does it complement or how would you introduce something? I would say this would be the future so I completely agree with Danae that in-clinic testing is getting more complicated it's getting more confusing, patients don't get appointments and I do think that it will be the future to order in-home testing kits and you will be able to perform the testing in your home and then have it sent to a lab and just one remark, I would put a little blame on HIV because HIV took the show 30 years ago everybody was speaking about HIV and AIDS and we somehow forgot about other STIs and most of the people who want an STI screening only think of HIV and they don't think of syphilis, they don't think of gonorrhea they don't think of chlamydia and we as physicians need to tell them hey, screening for HIV is okay but screening for syphilis and screening for gonorrhea and chlamydia is also very important and it is somehow missing in the community everybody's focused on HIV, nowadays HIV, well it's not a curable disease but it's a completely manageable disease but syphilis and co are bacterial infections that are completely treatable with antibiotics How you can live a long and fulfilling life, actually healthy life with HIV what does that mean in practice? Well, I'm not an infectious disease specialist so I'm not treating officially people living with HIV but we do know that the medication, the anti-retroviral medication against HIV is very modern and basically you will have the same life expectancy and the same life quality with medication as anyone who doesn't have HIV I agree that HIV also in some point did some harm for treating another STI maybe I will shortly talk about the prep here because you know, this focus from HIV and all this funding and huge money invested in the HIV field maybe I'm not a doctor so I don't know but this is the result, so we have the prep and now prep is used but it's protecting only from HIV it's not protecting from another STI prep is the best option but it's not only one option we still have condoms as option and we still have four communities as sex workers community-led services, community outreach condom distribution so all of these services are very valuable and very helping in protection of STI and HIV together Can we check with the two medical doctors about their position on compulsory testing would you prefer compulsory testing or do you think that the community involvement is a strong enough component? I would say community because peer pressure is always somehow more efficient than pressure from an authority or from a government especially in an issue that is so sensitive and so stigmatized but this is my personal point of view The first question I would have actually is why are people resistant to testing and is it that they are resistant to testing or are they resistant to the way the government is demanding that they test because I imagine if you are in a line of work where you are going to be exposed or your risk of exposure is greater then I imagine you would want to keep yourself and those around you safe with regular testing I think the challenge does come when the government comes in and says this is something that you have to do and the results will be on your record which we can access because unfortunately STI has remained quite stigmatized and it is a fear of judgment and so I think concordance with patients is a lot more important and trying to get them on board and trying to convince them and help them to understand why testing, regular testing is important for them and how it protects them rather than saying this is a rule you have to follow because it's what the government said That being said, I think regular testing is important because of public health measures So in the UK I know we do anonymous partner notification we do contact tracing in order to stem this spread of infection and I agree that with the advent of PREP which is an incredible medical breakthrough if taken consistently and correctly it will reduce the risk of picking up HIV it's absolutely phenomenal but it does leave you at risk of contracting all of the other STIs and so I feel like there's almost been because HIV with PREP has almost been the risk of that has kind of come down because people are taking this medication perhaps there has been a reduction in the use of barrier methods which has led or partially led to the rise in some of the other STIs that we've been saying Let's talk HPV supposedly it's everywhere so my understanding is that there is a vaccine available to prevent HPV infections I always check with you am I talking something crazy? no so a vaccine is available and this is at least in the countries that I'm familiar with offered to 13 year olds or somewhere around that age barrier and for everyone else it's available but it's very pricey and very often out of stock why don't we have HPV vaccines rolling off the shelves readily and easily available when it causes multiple types of cancer I don't want any of us to have those don't ask me because I'm not sure I can answer this question but I can answer or I can give you an answer that HPV is very prevalent as you said I think 70% of the population will have at least once HPV in their life what I see very problematic is most people and most physicians sorry think that HPV remains in the body like herpes or like HIV but this is not true because the immune system can clear the infection and you can become HPV negative or HPV free but if you are not vaccinated you can get it again from an infected partner and that's why the vaccination against HPV is or would be very important as you said teenager girls and boys but later in your life if you wasn't vaccinated when you were a teenager and you won the vaccine it costs quite a lot of money let's not forget that officially the vaccine is advised up to 50 so not only teenagers can get it or can benefit of it but all other people as well so and it's interesting in the UK when it first started the HPV vaccine they were only giving it to girls and then they realized that actually half of the population is boys and sometimes their partners are not girls so it's actually really important to vaccinate both biological sexes not just one but is it only me seeing sexism everywhere or was this actually blatant sexism I was pregnant with my daughter when I heard the news on the radio that this vaccination was going to be introduced and I was like yes there was 13 years ago but I remember at that point the talk at least in like popular reporting was mainly about cervical cancer HPV viruses are responsible for more types of cancer and I thought maybe they think it's only relevant for girls because it's identified as like a woman's problem initially the focus was around cervical cancer you're 100% right and then as time went on it was also associated with anal and oropharyngeal cancers as well so cancer is the mouth and the throat and so they realized very quickly that they're going to have to do more than just vaccinate women Tricer how do you feel about vaccinations introducing vaccination campaigns the sex work movement even many years ago 2013-2014 together with a lot of experts with the World Bank with UNA's a lot of international bodies produce a huge book what is called sweet sex work implementation tool what is speaking everything about community support and everything about STI everything about HIV and how all of these services and all of these programs needs to be developed needs to be implemented from the community perspective of you valuable how for the community but also for decision makers for those who are making strategies for those who are making HIV national strategies it was long path of research of community consultation all across the globe and everything is in this book it's very valuable it's very interesting it's very clear with giving direction for all sides not only for community as I already said this program is presented by Eurazine an online magazine offering insightful reads from over 100 partner publications across numerous European languages to support our work and enjoy exclusive benefits from as little as 3 euros a month visit patreon.com slash Eurazine and become a supporter let's talk about sex education then this is a shared favorite topic of all of us I believe you mean the series which season wouldn't that be love so Danae as you mentioned previously when we talked before the recording you said you didn't expect to use your medical degree like this but you are a very prominent sex educator on tiktok how did the idea surface how does this come about so I suppose I am a medical doctor and I have a background in public health and so we were always taught like in medical school that you are supposed to educate your patients in hospitals and in clinics but increasingly that's changing and for any doctor who works or healthcare professional who works in a hospital or clinic you can see patients coming in with their own ideas about health and wellness that they are getting online like for better or for worse like sex education is happening less in the clinics in the classrooms and it is happening much more through digital media so social media and I suppose there are advantages and disadvantages to that so having reliable incredible sexual health information through social media means that everybody has access I think there are I think just over 55% of the world's population has a social media account so that's about 4.5 billion people and I think in 2022 the average smartphone user spent two and a half hours a day on social media accounts which would be 75 hours a month and I suppose I realized quite quickly that if I wanted to actually reach people because not everybody is listening to what I say in the hospital I'm not going to be able to reach as many as I could online if I really wanted to create educational content that was going to have that type of impact I needed to go where people were and they weren't in the hospital, they were on their phones and so that's kind of where we started I also noticed that there was a lot of misinformation and disinformation on social media and so this I found particularly challenging and so part of the reason we wanted to go and create content there is because we could debunk some of this some of this kind of junk science or you know some of these kind of things that other influencers were propagating or promoting that just have no scientific evidence base and I suppose it's been really remarkable to see people from all over the world kind of send us questions through social so we've got girls teenage girls in sub-Saharan Africa just as sex ed but they've got a TikTok account and we've got middle-aged men in the Philippines and we've got people in the US and all over Europe kind of sharing their experiences and submitting their questions and it's incredible that these questions like their concerns are universal there are thousands of other people out there with the exact same question and concern and so it's been fantastic to be able to address that on a platform where so many people can it can reach so many people and I'll say that I could have lived or I could have worked every day in the hospital for the rest of my life and I would have never reached as many people as I've reached in the last seven months through social media and so while social media has the potential to have negative effects I really do believe that healthcare providers can and other kind of advocates, health advocates can can utilize it to make positive change This is very important to react to a problem or a need where it arises and this is not necessarily something that our systems are the most flexible at but of course sex education happens in the home and happens in public discourse and oftentimes it just doesn't happen in schools whatsoever. You want to tell us about the situation in Hungary right now? I think that we do not speak enough about sexually transmitted infections and if we mention it then everybody feels that this issue belongs to LGBT, to sex workers or to people who have or who lead a fearful lifestyle sort of like this. I completely agree with Danae because through the social media you can reach a bunch of people but at least in Hungary not many physicians are willing to be active on social media they should because they have the knowledge they have the number of people whom they could reach but they are intimidated Actually the twin institutions between Budapest and Vienna both called Urania started out as infotainment hubs we would call them today to be sort of these halls for speeches for travelers to screen their photographs and medical doctors to give lectures to the general public about public health issues and their recent findings. It is not at all a new invention, it's like applied to a new medium and that makes me a little bit bewildered why so many people are reluctant to use the publicity that comes with well, now social media but 10, 15 years ago it was TV primarily It's not something that doctors receive very much training on you're used to having one-on-one conversations with patients in a room, they get to ask questions you get to provide information when I first started this there was always the sphere of needing to caveat everything so excessively because it may apply in this situation but not in this situation and so there's a tendency to over medicalize I mean it's fine if you're speaking with other healthcare providers but it becomes really challenging when you're trying to explain things simply to an audience that large and so it's not something a lot of doctors are comfortable doing and in fact I mean for most of your medical career you're taught to keep a low profile I mean in academia you want to publish, you want to give lectures but I think it's quite vulnerable to all of a sudden go on camera and start talking about you know, these topics in a way that you can't certainly discuss everything that you want to discuss on the subject in a 30 second tiktok, that's really hard but some information and you know, credible information in this instance, at least it gets people thinking and asking questions and that's better than no information or the wrong information that they may come across you know, going through other channels or other platforms I feel like sexual education shouldn't be limited to just a couple of lectures because it doesn't really constitute this like deep deeply inherent knowledge which for instance I would think that a sex worker has to acquire because this is on the surface all the time, right? The sex workers are excellent peer educators because of course person who is working in the sex work industry is aware that this is their work and they must to take care of their sexual health and it's improved with a lot of research that sex workers are pretty great and amazing peer educators they are leading outreach programs as I already say, so from the sex worker part of you it's definitely we have successful stories about dealing with STI or HIV also including and SWAN works in Central and Eastern Europe and Central Asia do you see like big regional differences in the local discourse or how things are treated across the regions? We have really vibrant I would say region to work with and very different circumstances, different political systems so of course that there is a big difference if we take to compare Slovenia and Croatia who are Eastern European countries but also in the same time they are members in EU they are going to be so mad at you you called them Eastern European Oh yes, especially Slovenians Cut this No, so you say between Slovenia and Croatia Just give like a simple example between Eastern European countries who are member in EU and who already let's say some regulation in terms of health, in terms of providing some services, in terms of funding for NGOs also let's say, even in some European countries funding to community based project is also on very low level. Global fund has huge funding did pretty nice job helping and supporting community-led organization, community-led services in those countries and we have great result but global fund is leaving the region and now we are facing with losing some of these successful community stories and successful community services and there is a huge lack of funding HIV funding and HIV money on global level are huge amount of money and from all of this package let's say about the HIV funding only one percentage is going to the sex workers If you can make one wish that comes true right now related to this field, what would that be? So of course in the future I see community engagement in public health institution in services because peer-to-peer education is something what I really believe will bring win-win situation for community for the institution and for the public health in general I will submit this to Santa Claus tomorrow and both our names Yes okay let me know for the deadline Dana what would be your one thing that you would like to see like realize tomorrow it would make a huge immediate difference and you'd be happy about that I think if we could remove even a fraction of the stigma that still surrounds sexual health and STIs I think everybody's lives would be better not only like individuals in terms of the level of disease burden but also the cost to governments prevention is so much cheaper than having to manage late-stage complications and cure and so much of the struggle that we have with sexual health and STIs is centered around the stigma which is outdated and it's just no longer, it's just not acceptable and so if we could challenge and break that down tomorrow I think we would see a triangle improvement possible Bela, what would be your golden card? I guess my ultimate wish would be to reach each sexually active individual and make them do a full STI test every year That would turn things around immediately for sure okay I support you thank you guys so much it has been as fun as I had hoped it would be and I hope we get to meet sometime soon to come back to the results which we realized within 2-3 working days thank you so much This program is presented by EuroZine an online magazine offering insightful reads from over 100 partner publications across numerous European languages to support our work and enjoy exclusive benefits from as little as 3 euros a month visit patreon.com and become a supporter This talk show is a display Europe production a new content sharing platform that respects your user data Stay tuned for its premiere covering politics, culture and more The venue for this episode is kindly provided by the library of the Central European University This program is co-funded by the Creative Europe Program and the European Cultural Foundation Please note that the views expressed here are solely those of the authors and guests and do not necessarily reflect the opinions of the European Union or the European Education and Cultural Executive Agency They might take advice from us but we don't speak for them