Sexuality and public health

Sexuality and public health Faculty of Medicine Department of Community Medicine DrSudabehMohamadi

Introduction • Over the course of the mid-twentieth century, growing interest began to focus not so much on sexually transmitted diseases, but on the wider range of what might be thought of as ‘normal’ sexual behavioursof both men and women—less with the goal of protecting them from disease than to seek to promote their health and well-being.

It was only in the wake of the emerging human immunodeficiency virus (HIV) epidemic in the early 1980s that the consequences of this long-term neglect of public health work focusing on sexuality became apparent.

There are individual-centred identities which define subcultures within the lesbian, gay, bisexual, transgender, and queer (LGBTQ) framework.

Three-dimensional perspective on sexuality: • Identity • Behaviour • Desire

The impact of AIDS • Behaviouralresearch sought to build a scientific foundation for public health policies and intervention programmesthat would more effectively prevent HIV infection.

‘Men who have sex with men’ (or ‘MSM’) were adopted both in research and in public health practice in order to avoid imposing culturally inaccurate orinappropriate labels and classifications.

Public health research on marginalized populations such as female sex workers and male and female injecting drug users and their sexual partners also focused growing attention on the broader synergy that exists in many societies between vulnerability to HIV infection and: • Poverty • Racialor ethnic discrimination • Gender power inequality

Sexual behaviourcan only be understood within the context of social processes. • Sexual risk behaviour must be understood not just as ‘behaviouralrisk’ but as ‘social risk’.

Concept of ‘risk’ should perhaps be abandoned altogether in favour of a greater emphasis on ‘social vulnerability’ that would be more useful in seeking to understand the social drivers of the epidemic.

Youth, sexuality, and genderedexperience Two important considerations for public health researchers and practitioners designing sexual health interventions: • The definition of ‘youth’ • The timing of a young person’s first experience of sexuality

There are gendered disparities in human development related to both education and health. • A gendered division of labourpresents significant barriers to closing the gap in illiteracy and access to essential health services in resource-poor settings.

Girls are often married-off to older men, and boys are sometimes forced to migrate from rural to urban settings to find work. • Both intergenerational sex and migration are factors that contribute to sexual risk.

Campaignsto prevent STIs and HIV are only beginning to target youth facing structural barriers.

Heterosexual relations • ‘Heteronormativity’ has been used in critical public health frameworks to describe the ways in which men and women form both casual and steady partnerships, which are moulded by social and cultural norms. • This concept has theoretical traction for understanding patterns of sexual behaviourwith important implications for public health outcomes.

Preserving a sense of heterosexual manhood and invincibility has been a barrier to seeking health services. • The concept of ‘machismo’ or male chauvinism has often been used to analyse the effects of Latin American heterosexual masculinity and its implications for health.

Studies on machismohave associated this ideology with sexual risk behaviours and intimate partner violence. • Sexual behavioursare dependent on social and interpersonal context.

Same-sex socialization among heterosexual men has been linked to higher levels of sexual risk-taking with women, drug use, and sexual violence. • Femininityhas also been shown to have effects on the health of women.

Heterosexual women are affected by eating disorders such as anorexia nervosa and bulimia more than non-heterosexual women. • Heteronormative femininity is a ‘social determinant’ of women’s sexual health according to the Healthy People 2020’s definition.

Healthy People 2020’s definition lists the factors that limit the ‘availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods’ , such as violence and discrimination.

Sexual diversity and alternativesexualities • Addressing sexual identities might be easier in social and behavioural research because there is more reliability in measures when the respondent identifies either to themselves or openly to society about being a LGBTQ individual.

Alternative sexualities go beyond identity. • A person who practisessame-sex sexual behaviours or sex work might not identify with a particular group culture.

Using theories such as ‘minority stress’ scholars have focused on distal and proximal factors that affect depression, anxiety, and healthcare utilization.

[minority stress theory] Minority stress theory has three primary tenets: • Minority status leads to increased exposure to distal stressors. • Minority status leads to increased exposure to proximal stressors, due to distal stressors. • Minority individuals suffer adverse health outcomes, which are caused by exposure to proximal and distal stressors.

Sexual diversity interacts with other social factors, such as race and poverty, which lead to differential access to healthcare and exposure to disease.

Sex on the ‘down low’ describes patterns of secrecy and discretion that facilitate extra-marital sex, keeping a heterosexual identitywhile having same-sex sexual relations, and sexual concurrency.

There has been less attention to the particular health disparities that affect lesbians and women who have sex with women in the public health literature. • This gap is probably due to the lesser impact that HIV and AIDS has had on these populations.

Lesbians and bisexuals have been identified as having a higher rate of cigarette smoking than heterosexuals in national studies.

The mental and physical health of transgender men and women has drawn special attention in public health. • Illegal hormone and silicone injection has been of particular concern due to the high cost of gender transformation.

Male and female sex workers are among the most vulnerable populations for HIV infection, sexual violence, and drug use. • No sampling frame exists for them because their boundaries and their size are unclear or unknown.

Snowball sampling or chain-referral sampling are common techniques in achieving a theoretically defined number of participants in qualitativeresearch in fields such as anthropology and sociology.

Respondent-drivensampling is a type of chain-referral sampling in which study participants refer others to the study.

Social regulation of sexuality • Legal frameworks are regulations with implications on sexual practices as well as on gender roles. • Throughout the world, laws determine the ways in which sexuality affects economic and politicalissues, such as through the institution of marriage, which marginalizes non-heterosexuals.

Social networks might regulate sexuality through ‘soft’ mechanisms such as gossip or ‘harder’ mechanisms such as ostracism from communities if non-conforming sexualities or gender roles are expressed.

Sexual health and sexual rights • Even though international mobilization has dominated the use of the term ‘sexual rights’ as a rallying framework in global activism, sexual rights are often only regulated effectively as they are interpreted and understood on the local level in families, at schoolyards, by community-based groups and non-governmental organizations

Sexual rights emerged under the umbrella of reproductive rights which focused primarily on: • Gender inequality • Violence against women • Population control

Health rights activists and LGBTQ groups have developed a concept that goes beyond human reproduction and addresses non-heterosexual health and rights-based issues.

According to WHO, sexual health include: • The right of all persons, free of coercion, discrimination and violence, to: ‘a state of physical, mental and social well-being in relation to sexuality.

Within the framework elaborated by WHO, sexual and reproductive health are central aspects of life at all ages and encompass sex, gender identities and roles, sexual orientation, pleasure, and reproduction.

The protection from harm, be it for heterosexual or non-heterosexual populations, has been the main focus of the sexual rights movement.

Conclusion • It is only by bringing sexuality out into the open, by freeing it of stigma, prejudice, and discrimination, and by building a culture of sexual rights, freedoms, and protections, that we can truly advance the cause of sexual health and well-being.

Sexuality and public health