Addressing S exual Health and E vidence-Based Sexual Health Education

1. Addressing Sexual Health and Evidence-Based Sexual Health Education What to do Next? Massimo Ghidinelli, Senior Advisor HIV; PAHO/WHO

2. Law and Policy Makers need to be educated • A representative in XXX demands that condompackages should state that “using them entails risks for acquiring STIs and for contraception (sic)” (April 2012) • In the same country, a group of legislators insists in restraining condom promotion because “(condom manufacturers) want to sell the idea that the preservative (sic) equals safe sex (!)” (May 2012) • In XXX public health campaigns put a premium on promotion of abstinence among populations who are already sexually active(!)

3. Providers and staff must be properly trained • A study of stigma and discrimination among health facility and social services staff inXXXrevealed widespread stigmatowards MARPs within the health services. • “Fear of casual contact or desire to avoid contact with MARPs occurred in both clinical and nonclinical settings. Measures of shame, blame and judgment … appeared to be the norm.” • While with less frequency, enacted stigma also was reported. MARPs experienced layered stigma, which threatens their quality of care and services thereby increasing their vulnerability. (C-Change, 2012)

4. Youth should receive evidence-based education • In many parts of the world educating about safe sex is against certain ideological views, and therefore people remain unaware of the dangers of HIV infection through sexual intercourse. • Despite evidence that young people are having sex, the ideological message of sexual abstinence until marriage still plays a key role in sex education • Information, skills, competences and knowledge must serve to make people live a happier life (free of fears, worries, guilt and shame)

5. Zero tolerance to intolerance… • Discrimination leads to limited access to and utilization of health services making key populations disproportionately vulnerable to the infection. • Discrimination is frequently associated to ignorance, deeply-rooted misconceptions and prejudices about sexuality • Stigma and discrimination can be reduced with systematically enforced laws and policies, educational approaches and actions aimed at promoting inclusion and acceptance of diversity

6. Homophobia is indeed a public health problem • In places where homophobic views are common and homosexuality is publicly scorned by public leaders it is difficult to target gay men and other MSM with preventive and health-seeking messages. • Disproportionate levels of bullying and harassment against LGBT persons • Hate crimes (over 750 trans persons assassinated in LAC in 2008-2011) • Homicidesof MSM and Trans persons at alarming rates in BRA, COL, MEX, HON, GUT, JAM, VEN & ARG

7. A Niche for Sexual Health Programs • HIV programs have been a platform to advance the sexual agenda with emphasis placed on risk reduction • Reproductive Health programs usually conflate sexuality and reproduction as if they were synonyms • Advancement of the Sexual Health agenda requires a holistic vision of sexuality that demands knowledge about Human Rights, social determinants, behavioral and biomedical science