Transcript Sex_Sexuality_and_Sexual_Health__pretoria_April

Sex, sexuality and
sexual health
Peter Aggleton
School of Education and Social Work
University of Sussex
Some starting points
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Fundamental issues
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How we talk about an issue reveals much
about how we ‘understand’ it
Concepts we use in the field of sexuality and
sexual health ‘position’ both the speaker and
that which is spoken about
Precision and consensus are vital in the use of
terms and terminology
Where valid debate exists it must be
acknowledged
In recent times
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Globally
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move to move from vertical programming to
horizontal ‘integration’
move from AIDS ‘exceptionalism’ to HIV
mainstreaming
shift from a focus on individual risk to concern for
social vulnerability
growing interest in structural ‘drivers’ of the epidemic
desire to identify structural programmes/interventions
with beneficial effects
Some key concepts
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Gender
Sexuality
More intimately linked than originally
supposed
Gender
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Refers to societal and cultural norms about
‘appropriate’ male/female behaviour,
characteristics and roles
Is intimately linked to power (gender systems),
oppression, resistance and inequalities
Is mutable, contextual and contested
‘Positions’ individuals and groups in relation to
each other and within the social structure
Articulates with other sets of power relations (e.g.
of class/economic status, age, ethnicity, etc)
Sexuality – a ‘more than’ explanation
Sexuality encompasses more than sexual behavior. The
many aspects of sexuality include not only the physical but
the mental and spiritual as well. Sexuality is a core
component of the personality and a fundamental part of
human life. It carries potential to create new life, can foster
intimacy and bonding as well as shared pleasure in our
relationships. Human sexuality serves many functions in
addition to reproduction, and implies psychological as well
as physiological/biological responses
Adapted from US Surgeon General’s Call to Action to Promote Sexual
Health and Responsible Sexual Behavior, 2001
Sexuality – a psychological explanation
Sexuality is an integral part of the personality of
every human being. Its full development depends
upon the satisfaction of basic human needs such as
desire for contact, intimacy, emotional expression,
pleasure, tenderness and love. Sexuality is
constructed through the interaction between the
individual and social structures. Full development of
sexuality is essential for individual, interpersonal and
societal well being
World Association for Sexology (1999) Declaration of Sexual Rights.
Adopted August 1999.
Sexuality – a more eclectic definition
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Sexuality is
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a central aspect of being human
exists throughout the lifespan
encompasses sex, gender identities and roles, sexual orientation,
eroticism, pleasure, intimacy and reproduction
is experienced and expressed in thoughts, fantasies, desires,
beliefs, attitudes, values, behaviours, practices, roles and
relationships
is influenced by the interaction between biological,
psychological, social, economic, political, cultural, ethical, legal,
historical and religious and spiritual factors.
WHO ongoing consultation process
Sexual Health
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Negative definitions
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Avoidance of unintended pregnancy
Avoidance of sexually transmitted infections
Absence of sexual dysfunctions
Positive definitions (the above plus)
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Equitable relationships
Sexual fulfilment
Sexual rights (and responsibilities)
The development of global consensus
some landmarks
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1974 – Education and Treatment in Human
Sexuality: The training of health professionals,
WHO Copenhagen
2000 – Promotion of Sexual Health, PAHO,
WHO and Waorld Association of Sexology,
Antigua Guatemala
2002 -- Challenges in sexual and reproductive
health: technical consultation on sexual health,
WHO, Geneva
Thereafter ….
Some changing definitions
Sexual Health – an early definition
Sexual health is the integration of the somatic,
emotional intellectual, and social aspects of sexual
well-being in ways that are positively enriching and
that enhance personality, communication and love.
(World Health Organization (1975) Education and Treatment in Human
Sexuality: The training of health professionals. Technical Report Series
572, 1975.)
Sexual Health – a more recent definition
Sexual health is a state of complete physical, mental and
social well being related to sexuality. It is not merely the
absence of dysfunction, disease or infirmity. Sexual
health is evidenced in the free and responsible expression
of sexuality that enhances life and personal relations. For
sexual health to be attained and maintained a sociocultural milieu conducive to well being related to
sexuality must be fostered and the sexual rights of all
persons must be recognised and upheld.
PAHO (2000) Promoting Sexual Health. Washington DC, PAHO.
Sexual Health – a ‘bit of everything’
definition
…a state of physical, emotional, mental and social
well-being in relation to sexuality; it is not merely the
absence of disease, dysfunction or infirmity. Sexual
health requires a positive and respectful approach to
sexuality and sexual relationships, as well as the
possibility of having pleasurable and safe sexual
experiences, free of coercion, discrimination and
violence. For sexual health to be attained and
maintained, the sexual rights of all persons must be
respected, protected and fulfilled.
WHO post-2002 working definition
Where are we now?
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Sexual health is fundamental to the
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physical and emotional health and well-being of
individuals, couples and families, and
to the social and economic development of
communities and countries.
Sexual health, when viewed affirmatively,
encompasses
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the rights of all persons to have the knowledge and
opportunity to pursue a safe and threat free sexual
life.
Key conceptual elements of sexual health
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Sexual health
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is about well-being, not merely the absence of
disease
involves respect, safety and freedom from
discrimination and violence
depends on the fulfilment of human rights
is relevant throughout the lifespan, not only in the
reproductive years, but also to younger girls and
boys and older women and men
is expressed through diverse sexualities and forms of
sexual expression
is influenced by gender norms, roles, expectations
and power dynamics
The foundation for sexual rights –
WHO working definition
The human rights of individuals include their
right to have control over and decide freely
and responsibly on matters related to their
sexuality, including sexual and reproductive
health, free of coercion, discrimination, and
violence.
Sexual Rights – WHO working definition
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Sexual rights include the right of all persons, free of coercion,
discrimination and violence, to
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the highest attainable standard of sexual health, including access to
sexual and reproductive health care services
seek, receive and impart information related to sexuality
sexuality education
respect for bodily integrity
choose their partner
decide to be sexually active or not
consensual sexual relations
consensual marriage
decide whether or not, and when, to have children
pursue a satisfying, safe and pleasurable sexual life
Promoting sexual health
a programmatic approach
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Actions to improve sexual health should take
place across a variety of contexts
In order to ensure that people attain the highest
possible level of sexual health, we need to
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promote healthy sexuality throughout the lifespan
offer sexual health services that are appropriate, affordable, accessible
and of good quality
provide services to all without discrimination on the basis of race,
ethnicity, age, lifestyle, income, marital status, sexual orientation or
gender expression
Promoting sexual health
a programmatic approach
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Promoting sexual health requires us
to tackle
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Individual risk
Social vulnerability
Simultaneously
Risk
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Risk is the probability that a person will acquire
infection and/or disease. Certain individual
behaviours (such as unsafe sex) increase such
risk. Risk is also influenced by multiple factors,
including aspects of individuals’ physical and
psychological development, sexual history,
history of abuse, ability to negotiate, awareness
of sexuality-related issues, access to support,
and membership of social networks;
Vulnerability
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Vulnerability forms the backdrop to risk-taking, and
arises from the broader social, political and
environmental factors that provide the context in which
people act, and influence the kinds of risks they take.
These contextual factors include political economy,
inequalities and exclusions relating to gender, ethnicity
and sexuality, and legislative context. The existence or
absence of health and education programmes, and their
accessibility, capacity, content and delivery, also
influence sexual health.
Promoting sexual health
a programmatic approach
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Sexual health programme activities
need to take place across a variety of
programme areas
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Laws, policies and human rights
Education
Society and culture
Economics
Health systems
Laws, policies and human rights
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International conventions (e.g. CRC) and consensus
statements (e.g. ICPD, Beijing) can provide a supportive
environment for sexual health
Laws and legal frameworks can
 obstruct (laws which criminalize sex outside of marriage or set a
different age of consent)
facilitate (e.g. laws outlawing sexual discrimination)
the attainment of sexual health goals
Laws and policies can help reduce stigma and
discrimination
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Education
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Sexual health education can provide information and
skills to reduce risk
Correlation between educational level and sexual
health outcomes
 Better knowledge
 High levels of health seeking
Good quality comprehensive sexuality education
reduces unintended pregnancies, delays sexual debut
and promotes condom use
Society and culture
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Family and community are double edged
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Enhance vulnerability (denial of information, gender based
violence, incest, abuse)
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Promote sexual health (accurate information, respect,
acceptance, signposting of services)
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Religious and cultural values are double edged
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Enhance vulnerability (denial of full range of accurate
information, violence, ‘corrective’ rape)
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Promote sexual health (promoting service access, tackling
gender-based violence)
Economics
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Poor, marginalized communities have poorer
sexual health outcomes
Poor sexual health can contribute to poverty (by
limited earning potential and necessitating spending on health care)
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Poverty intimately connected to participation
in sex work and transactional sex
In many contexts, participation in sex work
and transactional sex associated with poorer
health outcomes
Last but not least
Because promoting sexual health
involves a lot more than the health
sector alone
Health
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Services should
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Be available to all regardless of age, sex, sexuality, marital status
Be provided in confidential, private and non-discriminatory way
Include identification and referral for victims of sexual and other
forms of violence
Include voluntary counselling and testing for HIV
Offer access to safe abortion to the full extent of the law,
together with post-abortion care including provision of
contraceptive information, counselling and methods
Diagnosis and referral for sexual dysfunction
Diagnosis and treatment for RTIs, reproductive cancers and
associated infertility
Conceptual shifts
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From hospital to community
From vertical to horizontal programming
From individual behaviour change to a focus on networks
and broader context
From a focus on reproductive age to a lifespan
perspective
From a focus on women to a concern for gender
From a needs-based approach to a concern for rights
From sexual ill-health to sexual well-being and pleasure
Thank you ……