Sex and Public Service
However, these testing locations, while often being somewhat limited in their offerings, provide a near-priceless public service. They ensure that everyone, regardless of insurance or financial status, may receive confidential STD testing. Additionally, they counsel the people that come through their doors about safer sex behaviors and help obtain treatment for those who test positive. They also gather data to help the local jurisdiction or non-profit organizations implement new and better strategies to reduce STD incidence in their population.
Recently, we decided to take a look at free clinics in a very personal way—my partner and I made a ‘testing date’ to go to a local clinic and get our regular STD tests. The catch is that my partner had never been tested in a public clinic; I, however, have been to quite a few over the years and I knew what to expect. Or at least I thought I did. I’ve decided to share the experience with Sexis readers, to offer a first-person view of the process, along with some of the questions you should be prepared to ask and answer the next time you go get tested.
We chose for our testing location a county-run clinic in northern Virginia. This particular county has a number of different testing locations, each with a different schedule of times and days that they have their “drop in” clinic hours. It also does not limit its services to county residents, which was important for us as we live in different jurisdictions. These clinics are staffed by county employees; while some STD clinics have volunteer staff, very rarely are volunteers given the responsibility of informing clients of the results of their tests, for a variety of reasons ranging from legal implications to ensuring accurate information delivery to those who have tested positive.
Both of us were a bit nervous. It may seem odd, but every time I go I get a little nervous, even if I haven’t any particular cause for concern. I worry that maybe they missed something last time, or that maybe I had caught something from a situation like a tear in a condom or dental dam. Now mind you, these aren’t even worries I usually have; I am pretty knowledgeable about safer sex practices, and I feel very comfortable and confident.
My partner, who we’ll call Joe, was nervous as well. “I didn’t know what my test results would be; I’d only been tested previously for individual infections, so I was worried that I might not have been tested completely and might have been carrying something for years. I also hate needles, so knowing that they were going to be drawing blood was nerve-wracking all on its own”.
Unfortunately, the clinic setup doesn’t exactly help with the nervousness. Clients end up sitting in a large waiting area, often with people who are there for dozens of other reasons, including parents with children that are visiting a well-baby clinic, or people who are there for any of the other health services available. There is often a TV that’s on in the corner, usually showing something that’s kid friendly (and let me tell you, watching Dora the Explorer when you’re waiting to have your crotch checked out for diseases isn’t exactly the kind of beginning to the experience you really want). There are plenty of multi-lingual posters on the wall, encouraging everything from adequate prenatal care, to learning about the food pyramid, to ensuring that you consider the HPV vaccine for your daughter (which was the only drug company-sponsored promotional material that I could see).
Thankfully, Joe was called back pretty quickly. He reported afterward that his interviewer was very friendly and helpful. “She asked me why I had come in to get tested. I told her how long it had been since my last tests and that I wanted to make sure that I had up-to-date tests and was being tested for all of the major STDs. When I told her that I had multiple partners, she asked whether I used condoms with my partners and practiced other methods of safer sex, and noted my answers on my file”.
She was also very clear about specifically what they were testing him for. “Every time she switched out vials of blood as she was drawing them, she told me what each vial was going to be tested for, and she explained that I would also have swabs taken to check for other diseases, such as gonorrhea.” Overall, he felt much more comfortable about the process because of the clinician’s communication; her non-judgmental approach to his information, coupled with her clear explanations of exactly what they were doing, helped to ease his mind and help him relax a bit about the process.
Testing centers use a variety of different tests in order to diagnose infections. Many of the STIs that are usually tested for can be identified through a range of methods, so clinics will often use whatever test is easiest (and cheapest) for them to purchase and for their staff to process. In the clinic we went to, most of the STDs tested for are identified through blood work, but to Joe’s chagrin, swabbed cells needed to be collected. What this means is, if you happen to be a person with a penis, the attendant will need to slip the end of a cotton-tipped swab into your urethra. Joe was quick to relate that he was not a fan of the experience; in fact, he was pretty uncomfortable, but thankfully it died down pretty quickly (I have no idea how it would compare with a pap smear, but I can imagine that it’s similar to those cytology brushes in the cervix). In this case, it was required to test for gonorrhea—one of the most prevalent STDs in the U.S.
I have multiple sexual partners, I said, and stated that I wanted to make sure that I remained disease-free.
“Are you here with someone?” she asked, obviously a bit confused. I assured her that I was here with one of my partners, that he and I were both non-monogamous, and that we used condoms and barriers with other partners.
“You know you can still get diseases with a condom? You’re playing with fire there.”
Yes, I assured her I was aware that I was still at risk for herpes and HPV.
“And how do you know that your partner uses condoms with other people?”
I trust him.
“Do you know he’s clean?”
I knew his last test results, yes.
“And you believed him when he told you that?”
Why yes, yes I did; otherwise I wouldn’t be sleeping with him, or giving him the keys to my house and my truck. He also gets to feed my cats, an honor as grand and sacrosanct as getting to have sex with me.
I finally used my big-girl voice and told her that while I appreciated her concern, this was a decision of which I was fully aware of the consequences, and I had made these choices intelligently, ethically, and in full conjunction with all of my partners.
This was, fortunately, the first and only time that I’d ever been belittled, shamed, or criticized by a clinic staffer for my sexual choices. Usually, the response I get when I tell them that I’m consensually and carefully non-monogamous is either a professional, “Ok, let’s move on then,” or a supportive comment about my responsibility in taking safety precautions and choosing low-risk activities. I was quite honestly surprised by her reaction—but then again, I educate people about safer sex, so I’m in a better position to fully understand the ramifications of my choices and speak very clearly about them than the average clinic patron.
Once we finished the checklist, I asked her what specific STDs they would be testing for.
Her response? “We test for everything—why, what do you think you have?”
At this point, I almost walked out of the office. The rudeness of her response, coupled with her earlier behavior, left me flabbergasted. I reaffirmed that I simply wanted to know what she was going to be testing for, in order to be informed and understand what exactly was happening; after a few repeated requests, she gave me the answer I was looking for—they would be testing for HIV, Chlamydia, gonorrhea, syphilis, and trichomoniasis, as well as other signs of bacterial vaginosis. They would culture any sores that they might find during the vaginal exam to determine if they were HPV or Herpes, but would otherwise not test for those illnesses.
The doctor who actually performed my pelvic exam was professional and quick. She explained exactly what she was doing, and what it was testing for as she moved through the procedure. She did the usual for a pelvic exam—speculum, swabbing sides and cervix to collect cells for testing, and a bimanual exam to check for ovarian cysts or swelling. A small swab of my throat (to check for oral infections of STDs), and we were all done.
Joe and I met up in the waiting room; he was all done, but my tests for trich and BV would be a few minutes more, so we compared notes until they called my name to inform me (privately, of course) that I came back with negative results for each. The doctor took the time to explain what the results were, and what each of them meant. She also told me when I should call back for my non-HIV test results (they are reading within a week, at this clinic), as well as reminding me that I need to come back in person for my HIV results, as they do not give those over the phone. That is a fairly standard method of doing HIV tests; the goal is that clients receive test results in a private setting where they can be counseled either on reducing future risks or getting treatment or re-testing if the results are positive.
1. Call ahead to find out what tests are offered, and what costs that you might be expected to cover—and ask for specifics.
2. Get the names of the STDs that they test for (and, if possible, the names of the tests themselves). Make sure that any STDs that you may have been exposed to are included in that list; if they aren’t, ask them for testing resources that include the particular test(s) you require.
3. Read up on safer sex behaviors, and be able to answer the clinics questions honestly.
While you may not want everyone to know your business, you do need to provide the information that they need to know, so that they can accurately assess your risk and guide you towards options to reduce said risks. They will need to know things like the number of partners you have and the types of sex you have (if it includes vaginal, anal, or oral sex, it’s a potential means of STD transmission), as well as other high-risk indicators such as using injectible drugs (or having partners who do so), or having partners who have other partners. They also should know if you practice sex without the use of barriers (condoms and/or dental dams). They do not, however, need to know the specifics of your relationships, and you definitely do not need to stick around if they ask questions that seem to be judgmental or overly personal. If you encounter such behavior, or are very worried about it, call a local organization that serves the health of LGBT individuals, or your local Planned Parenthood, to find options that they recommend.
Make sure that you find out when your results will be ready, and how you will need to get them; some jurisdictions have limits on what STD information can be given over the phone, so you may have to make a return trip to your results in person. You may also want to ask for a copy of their privacy policies to review, and you can ask what information (if any) is shared with your state’s department of health or other entities.
Finding a clinic should be a fairly easy task. Start with the websites for your county or city health department, or surrounding counties if necessary (many counties limit their services to residents only, so check before you head out to the testing center). If you don’t find one through your local governmental website, look up the closest Planned Parenthood office and ask them who they suggest. Many Planned Parenthood clinics offer STD testing, but not all of them are able to offer it for free or low-cost. Finally, especially if you identify as queer, gay, lesbian, bisexual, or trans, you can call your nearest LGBT service organization and ask them for references; again, many of these groups offer occasional STD testing and counseling services, and are less likely to be judgmental about your sex life.
Many people choose to use free clinics for a variety of reasons: they may not want their request for testing noted in their doctor’s records, or they may not want their insurance company to pay for the tests, in order to avoid any further issues that they worry might arise. Still others use them because they’re cheaper than co-payments for lab work and doctors visits, and of course many people visit clinics because they are the only option that is affordable. Going to an STD testing clinic doesn’t mean that you necessarily believe that you have an infection; it means that you put your physical well being, and that of your partner(s), high on your priority list—and that is a reason to be proud, not ashamed.