Sexuality, Rights and Social Justice

The term “sexual rights” consists of the little discussed and poorly understood combination of the concepts of “sexuality” and “rights”. Perhaps the unease about sexual rights would be lessened if it were clear that the concept does not mean “the right to have sex”, just as “reproductive rights” is not about the right to reproduce. What is it about then and why is this a legitimate subject for an international journal on reproductive and sexual health?

Based on a technical consultation on sexual health at the World Health Organization in 2002 the following working definition of sexual rights was devised:

“Sexual rights embrace human rights that are already recognized in national laws, international human rights documents and other consensus documents. These include the right of all persons, free of coercion, discrimination and violence, to:

•	the highest attainable standard of health in relation to sexuality, including access to sexual and reproductive health care services;
•	seek, receive and impart information in relation to sexuality;
•	sexuality education;
•	respect for bodily integrity;
•	choice of partner;
•	decide to be sexually active or not;
•	consensual sexual relations;
•	consensual marriage;
•	decide whether or not, and when to have children; and
•	pursue a satisfying, safe and pleasurable sexual life.

The responsible exercise of human rights requires that all persons respect the rights of others.” ¹

In 1995, and in a much simpler form, the Platform for Action of the World Conference on Women in Beijing included the following statement in relation to women, which can be taken as an internationally agreed (though not enforceable) definition of sexual rights:

“The human rights of women include their right to have control over and decide freely and responsibly matters related to their sexuality.” (Paragraph 96)

A small group of academics and human rights advocates worldwide are deeply concerned with what “sexuality” consists of. The papers in this journal issue, however, are concerned more with “matters related to sexuality” and their message is loud and clear. Women are far, far from a world in which such rights are near to being attained, even predicated in as simple and straightforward a fashion as in the Beijing statement. Indeed, many men are equally far from having sexual rights, particularly men who are not exclusively heterosexual in practice.

The concepts arising from the words “control”, “freely” and “responsibly”, juxtaposed with the threat to sexual rights posed by violence, misogyny (including in reproductive health care) and life-threatening sexually transmitted infections, are the subject of this journal issue.

Matters related to sexuality

This journal issue offers a rich and varied snapshot of matters related to sexuality, including problems with body image due to delayed puberty in adolescents born with HIV infection; the anti-sexuality content of so much sexuality education material and of government policies and statements by ultra-conservative secular and religious leaders; the appalling extent of sexual violence experienced by sex workers; and the horror of sexual torture during armed conflict and war.

Some of these papers make for deeply depressing reading. Yet they are also about the multi-faceted fight for sexual rights in response to anti–sexuality policies and stances and violations of sexual autonomy. If there is any hope of reducing the violence perpetrated by members of the human race on each other in general, then there is hope also for attaining sexual rights.

What does it mean to support sexual rights

Human beings are sexual by nature. If nothing else, one thing seems certain–people will never stop having sex or wanting to have sex. At the same time, government policy in every country in the world legislates on and seeks to control sex between its citizens in one form or another, as does every religion. Whether their laws and policies support sexual rights or restrict and punish certain sexual practices and relationships is of crucial concern. This is where rights and concepts of social justice come in.

It is without doubt easier to give examples of anti-sexuality stances, because they proliferate so widely, than to define a progressive stance on sexuality which supports individual and public health and the right of individuals, with special care for children and young people, to respect for their bodies and their feelings. Such a stance, as I understand it, is one in which the sexual nature of human beings is accepted. With this acceptance comes a commitment by governments to protect individuals from sexual harm and to help them to protect themselves, and to promote safe sexual relationships.

The devil, however, is in the details. Thanks to well-organised international campaigns by feminist activists, almost all governments have laws and policies against various forms of rape and sexual violence, including increasingly against rape in marriage. Yet the extent and type of implementation of these laws remains seriously flawed and limited. Sexual torture of both women and men in war and armed conflict has been included in international law in recent years, but goes virtually unpunished in spite of its mass nature.

It is a well-known saying that prostitution is the oldest profession, yet selling and buying sex continues to be punished in criminal law in most countries and socially frowned upon to such an extent that life-threatening violence against sex workers is endemic. Nor is sex work itself widely understood to arise from the social and economic marginalisation of poor, unemployed, migrant, refugee and displaced women. Because sex work is criminalised, health services for those who engage in selling and buying sex are of poor quality, few and far between, and limited in scope and outreach. The existence of HIV and AIDS have made an important difference in this regard, but the current abandonment by donors and international agencies of support for HIV prevention strategies may mean that any such progress is short-lived.

Moreover, the question of who is permitted to be sexual with whom, and at what age, remains deeply controversial. It is not accepted that although a great many people practise lifelong sexual fidelity to one person, this is not universal behaviour; sexual infidelity characterises many marriages as well as many non-marital relationships. A few countries have decriminalised homosexuality and even fewer permit same-sex marriages, and there are campaigns for the acceptance of transgendered persons and transsexuals in all world regions, though in some countries more than others. The social legitimisation of minority sexual identities and of any sexual orientation that is not heterosexual, however, has a long way to go and a steep and rocky road ahead.

Some forms of sexual behaviour exist at the margins of society, such as consensual sado-masochism and bestiality, and are so stigmatised that they can barely be mentioned aloud, let alone studied. Even sex with oneself remains a highly stigmatised behaviour, though it harms absolutely no one and is the safest form of sex.

Finally, there is the question of sexuality among adolescents and young people. Parents, civil servants, teachers and those in charge of education, most of whom seem to have total amnesia about their own burning sexuality at a young age, are only with great reluctance facing up to the need for sexuality information and education for youth that is not deeply prohibitive and full of fear-mongering and dire warnings of danger. Nor is the fact that most adults need such information for themselves widely recognised or acted upon.

And as yet I have not even managed to mention the subject of sexual pleasure nor the controversy and passionate beliefs that are aroused in discussions on who has a right to sexual pleasure.

Sex worker and her husband, a former client. Mexico City, 2000

Social justice in relation to sexuality and rights

Concepts of social justice in relation to sexuality and sexual rights have barely begun to be developed or acted upon, let alone entered into social consciousness. Ensuring social justice on the part of governments in relation to sexuality means ensuring that public and economic policies, and public services and education, prevent discrimination and abuse in relation to sexuality, and promote sexual health and rights. Social justice is denied in forced and other non-consensual marriages, in discrimination against homosexual men and women because of their sexual orientation, in the acceptance of so-called honour killings as crimes of passion, and in arguments that cruel and life-threatening punishments such as stoning of women on grounds of adultery are religiously-sanctioned. Issues of social justice arise in discrimination against pregnant adolescents, such as expelling them from school, or denying single mothers social benefits for themselves and their children as a judgement on them for having sexual relations. Widowed and divorced women often suffer from the social stigma of having survived their husbands in some cultures, and may be condemned and ostracised if they have sexual relations at all. Social justice in the community would take action against such discrimination.

Several articles in this journal issue make recommendations on how to respond to sexual discrimination and promote sexual rights. These include calls for:

•	sexual torture to be prosecuted by international tribunals on war crimes and the new International Criminal Court;
•	the decriminalisation of sex work and prosecution of violence against sex workers or coercion of anyone to provide sex against their will;
•	freedom of speech in academic research on matters of sexuality, including on highly stigmatised sexual practices;
•	information, sexual health and contraceptive and abortion services to be made available to young people;
•	greater attention to the adverse effects on sexuality, not just health, of medical procedures such as unnecessary and poorly carried out episiotomy; and
•	recognition of the effects on mental health of matters related to sexuality and the sexual body.

Barely touched upon in this issue, however, is public health law and policy in relation to sexuality. An example of the complexity of these issues is found in a recent review of bioethics and public policy by Udo Schuklenk, on how to address transmission of HIV infection in sexual relations. Schuklenk discusses whether infection acquired during voluntary, consensual sexual intercourse should be classified as a case of harm to others or harm to self. Two main positions emerge. One is that it is entirely a problem of individuals infecting themselves and others. The other is that the issue cannot be reduced to one of individuals, but should rather be seen as a public health matter because societal interests are at stake if individuals cannot keep from infecting themselves and others. Thus, he discusses the example of a law proposal in South Africa to classify voluntary sexual intercourse between two people as rape when one of the two is HIV infected, knows about it and does nothing to disclose this to his/her sexual partner.² At the heart of the problem, he says, are the following questions:

“If you have voluntarily unsafe sex with a person whose HIV status is unknown to you, and you acquire an infection during your sexual relationship with that person, have you been harmed by that person or have you harmed yourself? I have for many years maintained that an infection occurring as a consequence of sexual intercourse, under the circumstances described, should be interpreted as a form of harm to self. After all, you could have inquired about your sex partner's HIV status or you could have played it safe and insisted on safe sex regardless… This argument could certainly be applied to many cases under which infections occur, that is between sexual partners who know very little or quite possibly nothing about each other… [where] it can reasonably be argued that if you volunteer to have unsafe sex with such a person, it is your responsibility to protect yourself. It is less clear, however, that this argument could succeed when applied to people in long-term relationships, be they married or otherwise.” ²

On the basis of such different points of view, however, decisions have been made in a number of countries about whether the law should criminalise those who infect others with HIV, whether marriage to an HIV-positive person is permitted, and whether the promotion of condoms to those who are not married is a legitimate form of public expenditure.

Social policy on matters related to sexuality, as with information on sexuality for young people, can be punitive or supportive from both a social justice and public health point of view. An article on current US government policy on women listed (among many others) the following restrictive and anti-sexuality policies. The head of a right-wing women's group actively opposed to the Violence Against Women Act was chosen to serve on the National Advisory Committee on Violence against Women. Bush's party backed the Personal Responsibility, Work and Family Promotion Act of 2003, which provided among other things US$200 million annually to promote marriage and US$50 million to promote abstinence. His administration decided to remove information about condoms and teenage pregnancy prevention from the US Centers for Disease Control and Prevention's website. Bush appointed as assistant secretary for family support in the US Health and Human Services Department a man who said that low-income children whose parents are not married should be last in line for certain benefits.³ More recently, the Bush administration has required money for HIV prevention spent abroad to focus at least as much on encouraging people not to have sex–while restricting protection to only some of those who do.

Yet while abstaining from sex with another person and having only one lifetime partner are the surest ways to avoid getting an STI, it is when people have sex outside these parameters that they need protection, and that is where public expenditure needs to be targeted–both before people get an infection and when they need treatment afterwards.

In the past few years, in response to what is, in the eyes of some, a fin de siècle loosening of sexuality morality, the global atmosphere in relation to what constitutes legitimate vs. illicit sexual relations has moved so far to the right that the US, whose Constitution separates church and state, has adopted and is legislating fundamentalist Christian policies. Senior figures in the Catholic Church hierarchy have had the temerity to claim that condoms do not protect against HIV infection, without apparent concern or responsibility for the consequences for those of their parishioners who are unknowledgeable enough about the facts to believe them. And several Islamist governments are re-instituting or seeking to implement forms of punishment and the death penalty in relation to sex outside marriage that should have gone out with the Dark Ages.

On the other hand, a growing number of meetings are being held on sexual and bodily rights as human rights, e.g. in the Middle East and North Africa, and South and Southeast Asia, in which many aspects of public health and social policy in those regions are being challenged. The analysis of civil codes, penal codes and personal status codes, as well as other forms of discrimination and social injustice, all point towards a clear imperative for progressive legal and social reform. The devastating and damaging effects of locking people “in the closet” are being acknowledged. Sex workers and sexual minorities are organising to demand their rights, and a growing number of efforts to address many matters related to sexuality are being reported around the world.

Promoting sexual autonomy and safe, consensual sexual relationships

Throughout the past decade, this journal has emphasised the importance of laws and policies and of public health education and services that promote safer sexual relationships and prevent the harm that can arise from unprotected and non-consensual sexual relations. Indeed, in this issue we continue this process through a number of papers that address contraceptive use in relation to STIs, fertility and education, contraception for unmarried youth, and the problem of uterine prolapse in young, married women.

Promotion of safe, consensual sexual relationships on the part of governments, supported by ministries of health and education and a wide range of NGOs providing both information and services, is still in its infancy. Progressive efforts in public health education to ensure that sexual relations are safe deserves much greater priority in a world where the HIV epidemic is now almost 25 years old. Such efforts will not be initiated, however, until more governments and other leaders in the community are convinced that bodily integrity and sexual autonomy are human rights and that support for safe, consensual sexual relations, inside as well as outside marriage, are a legitimate subject of public education and expenditure.

Thinking on these matters has received a great boost from international youth movements and youth culture, which are breaking down barriers (viz. the concept of “gender-blending”) faster than most adults are willing to admit. As Holzner and Oetomo report in this journal issue, youth are “engaging in different forms of sexual relationships and finding their own sources of information, independent of government, religion and international organisations.”

Nevertheless, the evidence on whether youth and youth culture and behaviour are moving closer to a sexual rights and social justice stance than that of their elders is not yet in. The globalisation of information through visual and print media and via the internet has connected young people and broken down cultural differences among them as perhaps never before. On the other hand, it seems that young people in several developing countries (based on anecdotal evidence from researchers in both Africa and Asia) are easily obtaining so-called “blue movies” and learning a lot of what they know about sex from them. What these movies actually contain has not yet been investigated by researchers on sexuality education. The almost ubiquitous spread of (soft) pornography in advertising and in coverage of fashion in women's and men's clothing, film and TV, music videos, youth magazines and other forms of popular culture, particularly in the west, is also going global. Many people believe it has gone too far because it is sexualising almost everything, often in grossly gender-stereotyped ways. This represents an enormous challenge–not least because of the reactionary backlash it is causing.*

Perspectives on the future for the 10th anniversary of ICPD

It is fitting that we carry an article in this journal issue on “ICPD at 10” which is about how far the world has come since it agreed the Programme of Action in Cairo in 1994. Looking back, there has been incredible movement and progress, more than anyone would have dreamed possible at the time. Looking forward to the second decade of implementing the ICPD Programme of Action, RHM will devote the next two issues of the journal to the theme of “Power, money and autonomy in national policies and programmes” for November 2004 and “Implementing ICPD: what's happening in countries” for May 2005. In both cases, we are looking for analysis of influences on policy and programmes and what they have achieved since 1994 and what they aim to achieve by 2014.

Attention to sexuality and sexual rights was perhaps the most controversial part of the Programme of Action in 1994, yet ten years down the line, these issues are coming firmly onto the agenda. If by insisting on their legitimacy in the coming decades, we are finally able to confront the beliefs and behaviour that allow epidemics of sexually transmitted illness to flourish and sexual violence and torture to happen, we will have come a very long way indeed.

Acknowledgements

Particular thanks to Asha George for pointing me in the direction of authors, papers and topics which have been covered in this journal issue. Thanks also to TK Sundari Ravindran and Jane Cottingham for comments and suggestions on an earlier draft of this editorial, and to Crea and Tarshi for the opportunity to hear and read the papers on gender, rights and sexuality in South and Southeast Asia at their meeting in Bellagio, Italy, September 2003, one of which appears in this journal issue.

Notes

* For an analysis of these trends, see Sorensen.⁴.