Passion, stigma, and STI

> “Any Stigma will do to beat a Dogma.” Philip Guedalla (1889–1944) Historian and irreverent biographer To be invited to deliver a presidential address is a great honour signifying, firstly, the support of peers in being elected to the presidency and, secondly, the impending conclusion of this responsibility. It is, in accordance with tradition, the single occasion on which the opinion of the president is not questioned, when he can even discuss the taboo subjects of sex, religion, and politics without fear of contradiction. I intend to make full use of this opportunity. Presidential addresses come in a number of guises. Some look to the events of the distant or more recent past, while others are more firmly rooted in the present and explore an area of clinical practice or personal expertise. Each is, to some extent, autobiographical. My intention today is to combine something of each of these approaches in my vision for genitourinary (GU) medicine at the start of the 21st century. The inspiration for my presidential address came from an excellent essay1 published in the Lancet in 1999 by Christopher Whitty, an infectious diseases specialist working at the University of Malawi. I would strongly recommend this as required reading for both established clinicians and their students. He was reflecting that Africa is currently facing a sexually transmitted infection (STI) epidemic even more catastrophic than was the introduction of syphilis to Europe in the late 15th century. Now, as then, reactions to the crisis were frequently hysterical. He argues that a public health strategy based upon stigmatising individuals with sexually transmitted infections is not only unhelpful but also inevitably counterproductive. I was a student and young doctor in the late 1960s and early 1970s, at a time when student rebellion, the Vietnam war, riots for peace, and flower …