Sex, sexuality and
sexual health
Peter Aggleton
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
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 ….
Changing definitions of sexual health
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.
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
http://www.who.int/reproductivehealth/publications/sexual_health/rhr_hrp_10_22
/en/index.html
Promoting sexual health
a programmatic approach
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Actions to improve sexual health best take
place across a variety of contexts
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in reproductive health programmes
in the context of work on HIV and AIDS
through primary health care
in education
through social welfare
in youth programmes.
Promoting sexual health
a programmatic approach
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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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Requires us to tackle
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Individual risk
Social vulnerability
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
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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
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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
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 in sexual health
service delivery
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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 ……