New Technologies in Promoting Women’s Sexuality

1. New Technologies in Promoting Women’s Sexuality G. I. Serour, FRCOG, FRCS Professor of Obstetrics and Gynaecology Director, International Islamic Center for Population Studies and Research , Al-Azhar University Clinical Director, The Egyptian IVF-ET Center, Maadi, Cairo, Egypt FIGO President Elect 2006-2009 Abuja-Nigeria Feb. 2008

2. Health Technologies Health technologies refer to the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives. WHA 60, 29,2007. EB 122/13,2008 Jan. 21-26.

3. New Technologies in Sexuality • - Medicines • Vaccines • Devices and Procedures. • Information- policies & Health systems

4. Problems Associated with Health Technologies • Safety and Efficacy • Inavailability. • Lack of access. • Overuse or underuse. • Continuous assessment & evaluation. WHO 2008. EB 122/13, Jan. 21-26th .

5. ITEMS ADDRESSED • Sexual Health and its Current indicators. • New Technologies in promoting sexuality. Conclusions &Recommendations.

6. WHO Constitution HEALTH Health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

7. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. WHO Constitution

8. Sexual Health S H is 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.

9. Sexual Health Women have the right of a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of pleasurable and safe sexual experiences, free of coercion, discrimination and violence.

10. The world now boaosts the largest generation in history of youth between 15-24 years age (1.1 billion) UNFP 2003, Making 1 Billion count . UNFPA, NY

11. Worldwide UNFP 2003, Making 1 Billion count . UNFPA, NY

12. Worldwide UNFP 2003, Making 1 Billion count . UNFPA, NY

13. !!! It is amazing that a woman can claim ownership to different parts of her body, but with an exception which she cannot claim to be her own, the sexual and reproductive system. Fathalla M, 2007

14. Women in many countries have neither the freedom to pursue their own sexual health nor the entitlements to their sexualhealth needs.

15. Inequality in Women’ Sexual Health A major barrier for women to the achievement of the highest attainable standard of sexual health is inequality, both between men and women and among women in different geographic region, social classes and indigenous and ethnic groups.

16. CURRENT INDICATORS OF SEXUAL HEALTH

17. STIs Every day, 500,000 young people are infected with an STI. Most infections occur in the 20 to 24 age group, followed by the 15 to 19 age group. Population Reports 2001, vol XXIX No 3, Baltimore Johns Hopkins.

18. HIV/AIDS New cases 2006 UNAIDS, UNICEF, WFP, UNFPA,UNODC, ILO, UNESCO, WHO, World Bank, 2006.

19. HIV in young Women There is dramatic increase in HIV infection among young women, who now make up over 60 percent of 15- to 24- years old living with HIV/AIDS. Globally young women are 1.6 times more likely to be living with HIV/AIDS than young men. UNAIDS, UNFPA and UNIFEM 2004

20. AIDS is affecting women more severely in places where heterosexual sex is the dominant mode of HIV transmission, as is the case in sub-Saharan Africa and the Caribbean.

21. HIV transmission rates from males to females are almost double the rates from females to males due to a higher viral load of semen, and a greater area of mucous membrane is exposed in women.

22. ABC Abstinence is meaningless to married women. Be faithful offers little protection to wives whose husbands have several partners or were infected before they were married. Condoms require the cooperation of men, who may refuse to use them.

23. AIDS deaths 2006

24. HIV/AIDS 2007 Number of people living with HIV : UNAIDS, UNICEF, WFP, UNFPA,UNODC, ILO, UNESCO, WHO, World Bank, 2007.

25. HIV Knowledge In 24 sub-Saharan countries two thirds or more of young women (aged 15-24 years) lacked comprehensive knowledge of HIV transmission.

26. Cervical Cancer 2005 HPV subtypes 16 and 18 are the proximate cause of 70% of cervical cancer. • 500.000 women affected, • 400.000 women in developing countries WHO 2006. www.who.int/bulletin.84/2 news. 20 2 206/en/index.html

27. Virtually all cervical cancer cases result from genital infection with HPV. • High risk genotypes HPV include genotypes 16,18,31,33, 35,39,45,52,56,58,59 and 66. WHO 2006. www.who.int/bulletin.84/2 news. 20 2 206/en/index.html

28. HPV is a sexually communicable disease for which the burden of death and disability falls disproportionately on women.

29. Cervical Cancer Deaths 2005 • 250.000 women died from cervical cancer. • 80 % of deaths in developing countries • The most common cancer related cause of death in developing countries WHO 2006

30. Female Genital Mutilation/Cutting FGM/C , is a worldwide problem. It is estimated that between 100 million and 140 million girls and women worldwide have been subjected to some form of female genital cutting. World Health Organisatin, (2005) “Female Genital Mutilation” fact sheet No 241 (June 2000) accessed on the Web at http//:www.who.int/mediacenter/facts sheets/fs241/en.

31. NEW CASES In spite of all efforts to abandon FGC, it is estimated that every year up to 3 million girls still undergo FGC in Sub-Saharan Africa, Egypt and Sudan. World Health Organisatin, (2005) “Female Genital Mutilation” fact sheet No 241 (June 2000) accessed on the Web at http//:www.who.int/mediacenter/facts sheets/fs241/en.

32. FGM/C is an extreme example of discrimination based on sex as a way to control women's sexuality; FGM/C denies girls and women the full enjoyment of their personal physical and psychological integrity, rights, and liberties. FIGO Committee for Ethical Aspects of Human Reproduction and Women's Health and WSRR Committee. Int. J. Obst & Gynec, 2006, 94,176-177.

33. ART With the advent of ART since the birth of Louise Brown in U.K. on 25 July 1978 it became possible to separate the bonding of reproduction from sexual act.

34. ART, whether in vivo or in-vitro, enabled women to conceive without having sex. This challenged the age-old ideas and provoked discussion all over the world .

35. The introduction of ICSI in 1992 enabled men with severe oligoasthenospermia or azospermia to father children without having sex.

36. Access to ART (IVE/ICSI) in many low income countries is limited by its availability, cost, affordability, gender and other socio-cultural constraints.

37. New Technologies in promoting sexuality

38. MEDICINES • Antiretroviral treatment. • Microbicides. • Long term contraceptives as injectables, implants and medicated devices.

39. Antiretroviral Treatment There is still very little access to antiretroviral treatment and health-care provision for other HIV-related illnesses. Five to six million people in low- and middle-income countries are in immediate need of antiretroviral treatment.

40. Antiretroviral Treatment The yearly number of new infections outpaces our ability to expand access to treatment. M. Chan, 2008. WHO EB 122/2 January 21-26th

41. Antiretroviral Treatment In the developing world, women's only access to treatment, if any, may be a single dose of antiretroviral medication at the onset of labor.

42. Antiretroviral Treatment/ Children 2006 • > 2 million children are living with HIV or • AIDS. • > 15 million children have lost mother / • parents due to AIDS. • 15% only of those who needed antiretroviral • treatment received it. UNICEF, Geneva 19 Nov. , 2007. For Every Child . Health , Education, Wquality, Protection. Advance Humanity.

43. While mother – to – child transmission had been virtually eliminated form industrialized countries, it still falls far short in most of Sub- Saharan Africa.

44. New estimates from, UNAIDS and WHO indicate that global HIV incidence peaked in late 1990s. • The number of people dying from AIDS- related illness declined over the past two years. M. Chan, 2008. WHO EB/122/2 January EB 21-26th

45. Evidence suggests that preventive efforts and expansion of coverage with antiretroviral therapy contributed to these trends. However we are still a long way from the goal of universal access. M. Chan, 2008. WHO EB/122/2 January EB 21-26th

46. Microbicides Microbicides may compensate for shortage of antiretroviral drugs with just a simple cream, foam, or gel that can be inserted vaginally to protect women when condom use isn't possible.

47. Five candidate microbicides are now in large-scale efficacy trials and dozens more are in the preclinical and clinical trial pipeline. Research to develop rectal microbicides is also finally underway. Forbes A, 2006 BETA 18 (4) 37-41

48. Long Term Contraceptive Methods Clients must rely on health care providers to obtain and to discontinue IUDs, injectables implants and sterilization. Concerns about the potential for abuse and coercion have been expressed.

49. About 350 million couples do not have access to a range of effective and affordable family planning services. UNFP 2003, Making 1 Billion count . UNFPA, NY

50. VACCINES • Breast feeding. • HPV vaccines • Antifertility vaccines.