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The following excerpt comes from Rebecca Epstein-Levi’s When We Collide: Sex Social Risk, and Jewish Ethics. The book explores contemporary Jewish sexual ethics by putting rabbinic texts in conversation with feminist and queer theory.

This excerpt comes from the book’s fourth chapter, “STIs: Infection, Impurity, and Managing Social Contagion.”

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STIs are one of the paradigmatic risks of sexual interaction; no doubt many of us remember being shown appallingly magnified slides of genital warts as part of our high school sex ed curricula’s attempts to scare and disgust us into abstinence. STIs sit at the intersection of individual sexuality and public concern. Further, because STIs are issues of public concern that are transmissible by specific forms of social and physical contact, they offer a strong parallel to rabbinic frameworks of ritual purity.

When we talk about STIs, there are four critical things to know: First, STIs are incredibly common—and, in fact, far more common than they need to be. Second, STIs are real risks that can have important consequences on both an individual and a public level. Third, those risks are eminently manageable. Fourth and finally, the public perception of STIs, the seriousness of their consequences, and the extent to which the tools available to manage them are used effectively and justly are inextricably entangled with multiple systems of gender, sex, race, class, and ability-based oppression.

STI risk cannot be eliminated, but it can be managed. Simply exhorting people to avoid sexual risk doesn’t work: abstinence-only sex education neither prevents people from engaging in premarital sex nor reduces rates of unplanned pregnancy or STI transmission. Effective management strategies do exist, but they are complex and multifactorial. Modern medical science has developed treatments, vaccines, and physical and chemical methods of prophylaxis that make consensual sex, for those who have access to these wonders, safer than it has ever been at any point in human history.

However, STIs are far from a strictly technological problem. Technological advances are an essential component of STI management, but they are not sufficient, because STIs are socially transmitted among fundamentally social beings. The social components of STI transmission affect the efficacy of our technological tools for STI management in serious ways. [Medical misinformation] and disparities in access to medical care, combined with stigma against people who are infected and faulty reasoning about the moral effect of proactive STI prevention and sex education, mean that potentially effective methods of treatment and prevention fail to reach those who need them most. Furthermore, racial, sexual, and economic minorities overwhelmingly bear a higher burden of risk both in terms of infection rates and in terms of access to prevention, testing, and treatment. [And] the social climate around matters of sexual health makes frank and accurate discussion of STI prevention and treatment socially and politically difficult and makes it shameful to seek out help or even to know and disclose one’s STI status.

Indeed, the dominant discourses surrounding sexually transmitted infections have overwhelmingly been ones of otherness. During the Italian outbreak of 1496, which the Italians referred to at the time as the morbis gallicus, or “French disease,” and which most historians take to be the first recorded outbreak of syphilis, Italians blamed Jews and Arabs who had recently been expelled from Spain in 1492, many of whom had taken refuge in Italy, as well as the French invaders. By 1526, European writers had begun to connect syphilis’s origin to Columbus’s voyages to the New World, which offered in Native Americans a convenient and mutually agreeable scapegoat.

Otherness encompassed not only race and ethnicity but also class and especially gender. Women—sex workers in particular—were understood as potential sources of infection and as dangerous to men…By the modern era, syphilis, both in Europe and the US, was strongly linked to marginalized racial and ethnic groups—Jews and colonized peoples in Europe, and, in the US, immigrants and especially African Americans. HIV/AIDS was famously characterized as the “gay plague,” and it continues to conjure strong associations with race, class, addiction, and sexual orientation. Indeed, early in the AIDS epidemic, the Moral Majority executive Ronald S. Godwin criticized federal spending on AIDS research because it was “a commitment to spend our tax dollars on research to allow these diseased homosexuals to go back to their perverted practices without any standards of accountability.”

[Understanding] the ways STIs have been linked with and even personified as “deviant” persons or groups is particularly instructive for how we might read information about STIs with empirical justice and hermeneutic competency. STIs as we have framed and continue to frame them feed the worst features of our social structures and our social selves. As long as we treat them as afflictions of a vicious other, we allow STIs to feed our own vices of prejudice, domination, apathy, and greed.

STIs are also weapons of power-based oppression. Because of their direct connection to behaviors of which societies disapprove and would prefer not to discuss, STIs often serve as an excuse for moral and material neglect—a sort of worldkin of cosmic justice whereby those who misbehave are appropriately stricken, obviating any cause to engage with them or attend to their needs. STIs also act as a metric by which to define out-groups as other, a means to justify ill-treatment of underclasses. Sometimes they are the means of ill-treatment itself, as was the case with the Tuskegee syphilis study. Other times, the out-group is itself pathologized. Poor people, women, and racial and sexual minorities are mapped onto pathogens: syphilis has the body of a beautiful woman, as in many World War II–era propaganda posters; AIDS is the “gay disease.”

(Image by Jackie Ricciardi for Boston University Today)

Discourses of sexual otherness, as well as a lack of frank and accurate public discourse about sex, sexuality, and sexual health, also stymie the successful management of STIs. The consistent portrayal of STIs as the fruits of immoral or antisocial sexual behavior, combined with the view that sex is a fundamentally private matter, means that openly discussing the ubiquity of sex and its attendant risks has not been considered appropriate for polite conversation or thorough public discussion. This is particularly true for adolescents—a group for whom solid education and preventive care is especially important. It is also true even between sexual partners, since “the kind of communication that is necessary to explore a partner’s sexual history, establish STD risk status, and plan for protection against STDs is made difficult by the taboos that surround sex and sexuality.” Such taboos also affect health care providers. Rates of STI screening in primary care settings are far below where they ought to be, a fact that can be at least partly attributed to providers’ lack of comfort asking about their patients’ sex lives—or, conversely, patients’ discomfort with discussing their sex lives with their providers, especially if they worry that the details of their sex lives will cause providers to stigmatize them. Furthermore, at least until quite recently, medical training has offered relatively little about sexuality, since it “continues to reflect the predominant opinion of society that sexual health issues are private issues.”

Thus, any adequate moral account of STIs must, minimally, meet two criteria. First, it must facilitate open conversations about sexuality, sexual risks, and STI status. In practical terms, this means normalizing regular testing, disclosure of STI status, and use of appropriate preventive measures. Second, it must understand that disparities in social stigma and in access to and quality of care are also fundamentally moral issues.

In what follows, I outline a model for thinking about the ethics of STIs that meets these criteria. [I] argue that the mishnaic treatment of ritual impurity offers a promising model for thinking about STIs. The Mishnah, as I demonstrate below, treats ritual impurity as a form of social contagion—an undesirable but unavoidable and manageable consequence of desirable forms of social interaction. Understanding STIs in similar terms, I argue, will do a great deal to reduce stigma and shame and to help us manage STI risk in an effective and humane manner. I discuss the phenomenon of ritual impurity as it appears in the Mishnah, using the Zavim tractate as a case study through which to focus on the aspects of ritual impurity most applicable to STI management. Ultimately, I argue, the rabbis of the Mishnah not only offer us a model for thinking about the ethics of sex and public health; they also offer us a way to think more broadly about the ethics of risk. Crip theory, as I argued in chapter 2, shows us that acknowledging, managing, and honestly living with risk is crip and queer. Mishnaic purity discourse shows us a system by which such practice is also deeply virtuous.

…Here, I examine selected texts from Mishnah Zavim, which deals with irregular genital discharges, or zivah, as type cases. Zavim displays several key traits that offer especially useful models for thinking through contemporary matters of sexual health… First, in Zavim, as with other comparable texts, ritual impurity is ubiquitous and ultimately unavoidable. This is a critical corrective to regnant depictions of STIs as diseases of the other, for the Mishnah gives us a picture of socially transmitted contagion as everyone’s risk and everyone’s concern. Second, Zavim, again like other comparable texts, differentiates between multiple categories and subcategories of impurity, each requiring its own procedures of diagnosis and treatment. Here, too, it offers a critical corrective to regnant accounts of STIs as monolithic, such that one is either infected or “clean” and in which one particularly frightening infection stands in for all possible STIs (think, for example, of how “VD” nearly always meant “syphilis” for much of the twentieth century). Third, Zavim distinguishes between what I call the absolute virulence and absolute severity and the contextual virulence and contextual severity of different types of impurity, understanding that while one type of impurity might affect more overall ritual functions and have more overall routes of transmission than others, it does not always follow that it is the greatest concern in any given circumstance. This account offers a framework for understanding similar distinctions within STI epidemiology: while one STI may be more absolutely virulent than others, it does not follow that it is the greatest public health concern in all contexts.

Zavim’s next key trait deals with the ways those who inhabit an impurity-laden world interact with one another. Zavim’s world is one in which intimate human interaction is inevitable, one of social beings who touch each other in multiple ways. It assumes that people will have regular physical interactions with each other: engaging in household or workplace tasks that cause them to touch, shift, or lean on one another, touching or moving shared items that others will also touch or move, and simply sharing physical space in proximity. While all these interactions involve rabbinically recognized routes of impurity transmission, such interactions are nevertheless inevitable and even desirable. This is a deeply important corrective to a regnant sexual ethic that dichotomizes “safe” and “risky” sex and claims that any sex that seems to risk STI transmission is not worth the risks of doing. But Zavim reminds us that almost all social intimacy carries some risk and models a way of valuing that intimacy while explicitly acknowledging its potential to do harm.

Finally, Zavim, like nearly all classical rabbinic texts, treats its subject matter in exhaustive and explicit detail. For the purposes of sexual ethics, however, it is particularly important that the subject matter that Zavim and other purity texts treat in this exhaustive detail concerns socially transmitted contagion. STIs have historically been treated and often continue to be treated euphemistically, through a thick miasma of shame, stigma, and embarrassment. But rabbinic discourse about ritual impurity models a way of talking about social contagion that can clear this miasma through its sheer barrage of detail and, even more importantly, through its willingness to treat that very detail as a subject that is at once worthy of serious thought and yet is so mundane and so unremarkable as to be all in a day’s discussion.

All together, these key traits explicitly encourage an ethic of self-awareness cultivated through practices of regular self-examination, something that is characteristic of mishnaic impurity discourse more generally and that has clear implications for STI management. Virtuous rabbinic agents build their daily routines around practices of examination meant to foster self-control and self-awareness. Rabbinic subjects must then interpret the results of these examinations, usually with either direct or indirect expert aid, to determine whether it is likely they have contracted some form of impurity that requires mitigation. This sort of self-examination is considered virtuous for everyone, not just those who engage in some sort of high-impurity-risk behavior. Self-inventory is not a behavioral sin tax levied against those who are socially or occupationally lax; it is a mental and behavioral ideal to be striven for. In fact, the ubiquitous character of impurity and the subsequent practical need for regular self-examination are, as Balberg argues, best understood as an opportunity to cultivate self-examination and self-awareness as components of a virtuous character in their own right. In other words, that a particular kind of contagion is practically unavoidable for all social actors means that the management strategies necessitated by that contagion also teach us how to be better social actors more generally.

The worth of the Mishnah’s emphasis on socially embedded self-awareness and regular self-examination should become readily apparent when we consider the fact that a significant contributor to STI transmission is simple ignorance of one’s STI status. Perversely, a potential partner who discloses a known and well-managed infection may appear to present a greater risk than a potential partner who assumes or claims to be infection-free but has no concrete information to back up that assertion. Stigma helps perpetuate ignorance, which then, in a vicious cycle, further perpetuates stigma; the less we know, the more we fill that vacuum with the narratives of STIs as diseases of the other that we are already used to.

That must change. We should encourage knowing more, something that cannot happen if we dread to discover that we might have an STI because we know so little about them and think of them as marks of social shame and moral disgrace. The Mishnah’s emphasis on socially embedded self-knowledge and self-examination offers an alternative vision. The specific traits of Zavim’s treatment of impurity—the ubiquity of impurity, the importance of a fine-grained differential diagnosis among many subtypes of impurity, the distinction among contextual and absolute virulence and severity, the recognition of the many types of transmission-risking intimate social interactions that a person might experience on a given day, and the overarching practice of talking about contagion in exhaustive detail—provide the beginnings of a blueprint for achieving that vision.

Rebecca Epstein-Levi is an Assistant Professor of Jewish Studies and Gender and Sexuality Studies at Vanderbilt University.

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Interested in more on this topic? Check out episode 41 of the Revealer podcast: “Sexual Ethics for Today’s World.”