Sexual rights and sexual pleasure: Sustainable Development Goals and the omitted dimensions of the leave no one behind sexual health agenda

ABSTRACT

This commentary explores the missing discourse of sexual rights and sexual pleasure in the Sustainable Development Goals (SDG) that purport to leave no one behind. The SDG propose a welcome focus on sexual health and human rights for all, expanding beyond the Millennium Development Goals. While promising in many ways for advancing global sexual and reproductive health, and reproductive rights, the omission of sexual rights is troubling. So too is the erasure of lesbian, gay, bisexual, transgender and queer (LGBTQ) persons, and sex workers, from the SDG discussions of social inequities. Illustrative examples are provided to demonstrate how a sexual rights focus could advance SDG 3 focused on healthy lives and well-being for all. First, sexual rights are presented as integral to realizing Target 3.3’s focus on ending the HIV pandemic among LGBTQ persons and sex workers (and LGBTQ sex workers). Second, sexual pleasure is introduced as an integral component of sexual health and sexual rights that could facilitate the realization of Target 3.7’s aim to provide universal access to sexual and reproductive health information and education. To truly leave no one behind and realize sexual health for all, the SDG need to begin from a foundation of sexual rights.

KEYWORDS:

• Sustainable Development Goals
• sex work
• lesbian
• gay
• bisexual
• transgender
• sexual health
• HIV
• sexual rights
• sexual pleasure

As we embark on this great collective journey, we pledge that no one will be left behind. Recognizing that the dignity of the human person is fundamental, we wish to see the Goals and targets met for all nations and peoples and for all segments of society. And we will endeavor to reach the furthest behind first. (United Nations, Preamble 2015)

In 2015, The United Nations introduced the Sustainable Development Goals (SDGs) as part of the 2030 Agenda for Sustainable Development (United Nations, 2018). ‘Leaving no one behind’, as described in the opening quotation, is the overarching aim of the SDG (United Nations, 2018). The SDG Preamble also focuses on reducing inequalities, building inclusive societies, and protecting human rights (United Nations, 2018). Indeed, the very United Nations General Assembly that adopted the SDG resolution described the aim of this post-2015 development agenda as ‘transforming our world’ (United Nations, 2015). The radical and transformative aspirations embedded in the SDG were welcomed after the framework for the Millennium Development Goals (2000–2015) was critiqued for not adequately addressing issues of gender equity, human rights or reproductive health, and not engaging civil society and community stakeholders in priority setting (Briant Carant, 2017; Fehling et al., 2013; Freistein & Mahlert, 2016; Gabizon, 2016; Galati, 2015).

The SDG replaced the Millennium Development Goals which featured 8 goals, 21 targets and 63 indicators. With 17 goals and 169 targets, and an explicit human-rights framing, the SDG reflect a significant expansion of the Millennium Development Goals and thus increased potential to address social inequalities (Freistein & Mahlert, 2016; United Nations, 2018). Creation of the SDG involved global stakeholder consultations and civil society advocacy (Gabizon, 2016; Rosche, 2016; Stuart & Woodroffe, 2016), yet this process has been critiqued for excluding persons with limited literacy and/or internet from global polls and surveys (Briant Carant, 2017). Hope was expressed that in their framing, the SDG could reduce multiple forms of inequality, beyond only economic dimensions (Galati, 2015; Stuart & Woodroffe, 2016).

The SDG’s Goal 5 aims to ‘achieve gender equality and empower all women and girls’, and addresses factors such as discrimination, violence against women, access to sexual health and reproductive rights. This stand-alone gender goal has been lauded by international women’s rights experts and activists for its rights-based approach to gender equality and explicit naming of violence against women as a problem (Rosche, 2016). Critiques of the SDG gender focus include a lack of attention to gendered inequities in employment (Stuart & Woodroffe, 2016). Nevertheless, due to its focus on inequalities spanning beyond income, and in naming that these 17 goals should be met among all persons, irrespective of age, disability, race, religion, and other statuses, the SDG hold the potential for an intersectional analyses that consider the interplay between social identities and linked inequalities (Crenshaw, 1989; Stuart & Woodroffe, 2016).

There is a notable focus on sexual and reproductive health in the SDG, including in the Health SDG Target 3.7 that aims for: access to sexual and reproductive health care services; knowledge about sexual and reproductive health and rights; and respectful care and human rights in sexual and reproductive health information and service provision. In the Gender Equality Target 5.6, there is also a focus on reproductive rights alongside sexual and reproductive health (‘ensure universal access to sexual and reproductive health and reproductive rights’), gender equality in sexual and reproductive health and rights regarding women’s sexual autonomy in marriage, and universal access to sexual and reproductive health information and services. Despite this discussion of sexual and reproductive health and reproductive rights, the SDG are not focused on advancing sexual rights, with knowledge of sexual rights being only mentioned once. Sexual rights have been defined by the World Health Organization as inclusive of freedom from discrimination and the ability to express one’s sexuality:

The application of existing human rights to sexuality and sexual health constitute sexual rights. Sexual rights protect all people's rights to fulfil and express their sexuality and enjoy sexual health, with due regard for the rights of others and within a framework of protection against discrimination. (World Health Organization, 2017, p. 3)

The SDG’s leaving no one behind approach requires examination of who is being left behind, for what goals, and the root causes of differential progress. Stuart and Woodroffe described: ‘The Leave No-one Behind approach, in one sentence, implies a requirement not just to mainstream a gender analysis across all goals, but also to do the same for groups marginalised by income, race, age discrimination, disability, and other areas’ (Stuart & Woodroffe, 2016, p. 74). Others have advocated for including additional socio-demographic characteristics, including sexual orientation, to better evaluate who is left behind in the SDG (Galati, 2015). How transformative have the SDG been for persons whose sexual rights are constrained, and could the SDG’s potential for leaving no one behind and advancing human rights be optimized by applying a sexual rights approach?

Why does it matter if sexual rights are mentioned in the SDG?

The concept of sexual rights emerged from grassroots and social movements among communities advocating, navigating and producing change to address sexual health needs and challenges (Parker, 2007). Sexual rights vary across contexts and communities and continue to be contested with advocacy regarding issues such as HIV policies, lesbian, gay, bisexual, transgender and queer (LGBTQ) rights, sex worker rights, and sexual and gender-based violence. The focus in sexuality research on the ways that sexual agency, rights and freedom are shaped by social, economic, religious, and political systems of power has influenced our understanding and approach to sexual health, which is fundamentally connected with sexual rights (Corrêa et al., 2008; Ferguson et al., 2019; Kippax et al., 2013; Wiggins, 2012). Due to the stigma, discrimination and marginalization that both underpin and reproduce constrained sexual rights among varying populations, such as LGBTQ persons and sex workers, these are the very groups that may be left behind in realizing the human rights promised by the SDG. Thus, to meaningfully advance human rights there must be also be a focus on sexual rights, without which one cannot achieve optimal health or human rights (Parker, 2007).

The realization of sexual rights does not show up explicitly in the SDG although Oxfam, Guttmacher, among other women’s rights organizations, had prioritized guaranteeing sexual rights in the SDG (Gabizon, 2016; Galati, 2015; Rosche, 2016). As Galati described, this absence matters:

… most notably, sexual rights remain poorly represented: That topic has been excluded from the adopted SDG targets, making it difficult to introduce at the indicator level. Although there is no universally agreed upon definition of the term, for years the SRHR community has drawn from both the internationally negotiated 1995 UN Conference on Women in Beijing and the World Health Organization’s working definitions, which include the rights to choose one’s partner, to information and education and to a satisfying, safe and pleasurable sex life. In recent years, the understanding and use of ‘sexual rights’ has expanded to include sexual orientation and gender identity. (Galati, 2015, p. 82)

Illustrative examples will be provided below to demonstrate how a sexual rights focus could advance SDG 3 to ‘Ensure healthy lives and promote well-being for all ages.’ Groups for whom sexual rights are constrained include LGBTQ persons, evidenced by the 69 countries that continue to criminalize same sex practices, (Mendos et al., 2020) as well as sex workers who experience criminalization and a lack of employment protection across diverse global contexts (Bekker et al., 2015; Lyons et al., 2020; NSWP, 2019; Platt et al., 2020; Poteat et al., 2021). These examples are not meant to be comprehensive, rather serve as a way to apply a sexual rights framing to the SDG. LGBTQ persons, and sex workers, will be included in the examples below, with the caveats that: all of the SDG are interconnected and could integrate sexual rights; people hold intersectional identities that also constrain the realization of sexual rights, including but not limited to race, dis/ability, im/migration and citizenship status, gender, and socio-economic status; and no one is inherently vulnerable, rather structural forces such as rights violations constrain access to power, agency and opportunity (Katz et al., 2020; Logie, Perez-Brumer, et al., 2021; McLaren et al., 2020).

Illustrative example for Target 3.3: end the epidemic of AIDS

Within this goal, Target 3.3 expresses the aim to end the AIDS epidemic by 2030 (United Nations, 2018). Sexual rights could advance the potential to advance HIV prevention, care and treatment; in fact, sexual rights may be essential to realize this goal. As Parker (2007) described: ‘ … the road to sexual health is underpinned by the struggle for sexual rights. Without being firmly rooted in a conception of and commitment to sexual rights, sexual health promotion can never be effective’ (p. 973). Human rights violations experienced by LGBTQ persons across global contexts, including violence from families, state actors, intimate partners, and community members, in addition to healthcare discrimination, converge to reduce access to and engagement in healthcare (Logie, Lacombe-Duncan, Brien, et al., 2017; Muller & Hughes, 2016; Parker & Aggleton, 2003; Perez-Brumer et al., 2018). Sex workers, who include LGBTQ persons, also experience widespread violence and human rights violations that present significant barriers to healthcare access and engagement (Argento et al., 2019; Deering et al., 2014; McBride et al., 2021; Murray et al., 2021; Shannon et al., 2014, 2015). Transgender women are another community overrepresented in the HIV pandemic, in a large part due to social and structural contexts of violence, healthcare discrimination, socio-economic exclusion, and a lack of rights protection (Chakrapani, 2021; Jin et al., 2019; Perez-Brumer et al., 2018; Poteat et al., 2016).

Naming communities who are disproportionately impacted by HIV in the SDG – in a large part due to sexual rights violations – could direct funding for research and programs to address the root causes of this health disparity. More than 40 years into the HIV epidemic, gay, bisexual and other sexually diverse men remain a key population disproportionately impacted by HIV (Mayer et al., 2021; Rodriguez-Diaz et al., 2021), as do sex workers (Argento et al., 2019; Kerr et al., 2016; Lyons et al., 2020). In fact, UNAIDS (2019) reported that key populations, defined as including gay, bisexual and other sexually diverse men, people who inject drugs, sex workers, transgender persons, and incarcerated persons, comprised 62% of the world’s new HIV infections in 2019. There is clear evidence that without sexual rights, LGBTQ persons and sex workers cannot reach optimal sexual health, including realizing this SDG goal to end the AIDS epidemic.

To illustrate, a lack of human rights and criminalizing laws against same sex sexual practices produce barriers for gay, bisexual and other men who have sex with men from accessing healthcare (Sekoni et al., 2016), including HIV services (Logie, Lacombe-Duncan, Kenny, et al., 2017; Matovu et al., 2019; Schwartz et al., 2015). While less studied, lesbian, bisexual and queer women also experience underexamined HIV risks due to a lack of sexual rights, including elevated exposure to homophobic sexual violence, healthcare stigma, and a lack of tailored HIV prevention services, including when engaged in sex work (Logie, 2015; Logie et al., 2018; Poteat et al., 2014; Poteat, Logie, et al., 2015). Lack of recognition of transgender persons’ gender identity, and no protection from discrimination and rights violations, are also associated with reduced engagement in HIV services among transgender persons (Logie et al., 2020; Logie, Lacombe-Duncan, Kenny, et al., 2017; Poteat et al., 2019; Poteat, Wirtz, et al., 2015).

Punitive laws and a lack of rights protection for sex workers were linked with increased HIV prevalence among sex workers across ten Sub-Saharan African countries, and this HIV risk was exacerbated by the convergence of stigma and rights violations (Lyons et al., 2020). Elias and Holliday thoughtfully examine the missed opportunities to include sex workers across the SDG to advance human rights, including with regard to SDG 8 on decent work, and SDG 5 on gender equality (Elias & Holliday, 2019). Considering sex work in labour migration and the lack of rights protection ‘brings everyday and structural forms of violence more clearly into focus and also necessitates that we consider rights that are easily overlooked such as access to health and sexual and reproductive rights’ (Elias & Holliday, 2019, p. 2567).

Similarly, Dorey and colleagues provide examples of the ways in which LGBTQ people could be included across the SDG, including Goal 3 as examined in this Commentary, but also in Goal 1 (ending poverty in all its forms everywhere), Goal 4 (ensuring inclusive and equitable quality education and lifelong opportunities for all), Goal 5 (achieving gender equality and empowerment of all women and girls), Goal 10 (reducing inequality within and among countries), Goal 11 (making cities and settlements inclusive, safe, resilience and sustainable), and Goal 16 (promoting peaceful and inclusive societies, access to justice) (Dorey & O’Connor, 2016). In sum, without prioritizing sex workers and LGBTQ communities who face structural barriers to accessing HIV prevention and sexual health services due to a lack of sexual rights in varying global contexts, these communities will continue to be left behind in not only the global HIV response but in the targets detailed across the SDG.

Illustrative example for Target 3.7: provide universal access to sexual and reproductive health care services, inclusive of information and education

Target 3.7 aims to provide universal access to sexual and reproductive health care services, inclusive of information and education. As detailed above, health services – including sexual healthcare – often discriminate and provide uninformed and/or incompetent care for LGBTQ persons and sex workers, and this may be exacerbated by other socially devalued identities, including income, race, gender, citizenship status, to name a few (Logie et al., 2011; Logie, Earnshaw, et al., 2021; Nyblade et al., 2019; Stangl et al., 2019; Turan et al., 2019). Also important, is that sexual health information and education be tailored to meet the needs and lived experiences of all communities, including LGBTQ persons and sex workers. For instance, heteronormativity and cisnormativity in comprehensive sexuality education precludes LGBTQ persons from acquiring safer sex information that could reduce HIV exposure, alongside harming mental health and reproducing social exclusion (Hobaica et al., 2019; Hobaica & Kwon, 2017; Jarpe-Ratner, 2020; Logie et al., 2012; Roberts et al., 2020).

In contrast, comprehensive sexuality education that centres gender, power and rights can facilitate sexual empowerment and agency (Haberland & Rogow, 2015). While there is not a unified definition of comprehensive sexuality education, it is often conceptualized as including synergies between: sexual and reproductive health issues and practices; rights, participation and agency among youth; power and gender equality; and positive sexualities and respect in relationships (Miedema et al., 2020). It is debatable, however, how comprehensive ‘comprehensive' sexuality education is, as ‘sexuality education – what and how it is taught – is always a political project’ (Miedema et al., 2020, p. 748). This is particularly true with regard to integrating sexual health and rights in comprehensive sexuality education that largely reinforces and normalizes heteronormative and cisnormative sexual scripts (Miedema et al., 2020).

A review of sexuality education programs found that those that addressed gender and power were associated with significant reductions in STI acquisition and unplanned pregnancy, signalling the key role of gender and power in HIV prevention and sexual health promotion (Haberland, 2015). In fact, comprehensive sexuality education that was LGBTQ inclusive was associated with safer school climates for LGBTQ students in the Netherlands, assessed by reduced LGBTQ name calling and willingness to intervene among bystanders to LGBTQ name calling (Baams et al., 2017). Sexual health education tailored for LGBTQ persons, and sexual health services that are LGBTQ competent and affirming, therefore have the potential to both improve sexual health outcomes and protect sexual rights (Keuroghlian et al., 2017). Similarly, sex work affirming health information, resources and services can increase engagement and uptake, in turn enhancing sexual health (Argento et al., 2019; Benoit et al., 2017; Kim et al., 2015; McBride et al., 2019; Rocha-Jiménez et al., 2018).

Another key component of sexual health is sexual pleasure, yet this is also absent from SDG discussions of sexual health. Sexual pleasure is multifaceted and includes satisfaction, consent, self-determination, communication skills, sexual negotiation skills and power – congruent with the SDG Target 3.7 focus on sexual health services, information and education – and is embedded in larger contexts of sexual rights (Ford et al., 2019; Gruskin et al., 2019). At the 2019 24th World Congress of the World Association for Sexual Health, the Mexico City World Congress of Sexual Health produced the Declaration of Sexual Pleasure with the following assertions:

1. The possibility of having pleasurable and safe sexual experiences free of discrimination, coercion, and violence is a fundamental part of sexual health and well-being for all;

2. Access to sources of sexual pleasure is part of human experience and subjective well-being;

3. Sexual pleasure is a fundamental part of sexual rights as a matter of human rights;

4. Sexual pleasure includes the possibility of diverse sexual experiences;

5. Sexual pleasure shall be integrated into education, health promotion and service delivery, research and advocacy in all parts of the world;

6. The programmatic inclusion of sexual pleasure to meet individuals’ needs, aspirations, and realities ultimately contributes to global health and sustainable development and it should require comprehensive, immediate and sustainable action (World Association for Sexual Health, 2019, p. 1).

The interconnections between sexual rights, sexual pleasure and sexual health are described as the ‘perfect triangle’ by Gruskin and colleagues (Gruskin et al., 2019). Pleasure-focused and sex-positive sexual health education can produce increased and sustained safer sex practices (Ford et al., 2019; Singh et al., 2021). Yet the focus of sexual health research and education, particularly with LGBTQ persons and sex workers, has often focused on HIV risks rather than pleasure (Ford et al., 2019; Gruskin et al., 2019; Logie, Perez-Brumer, et al., 2021; Miedema et al., 2020; Parker, 2007; Singh et al., 2021). As sexual pleasure is a key motivation behind engaging in sexual practices and is also connected with well-being, it can be infused into high quality, sex-positive sexual health education and healthcare provider training and programs (Castellanos-Usigli & Braeken-van Schaik, 2019; Ford et al., 2019; Singh et al., 2021). Naming sexual rights, alongside sexual pleasure, holds the potential to advance sexual health:

Explicit inclusion of sexual pleasure as a necessary corollary of sexual rights and sexual health strengthens human rights protections and expands public health programing to address sexuality as a personal and social asset rather than simply a health challenge to be prevented or resolved. Improved sexual health and wellbeing are the expected outcomes of this focus on sexual pleasure. (Ford et al., 2019, p. 2)

Barriers to integrating sexual pleasure into the SDG include stigma regarding sex (exacerbated among persons already stigmatized as ‘sexually deviant’ such as LGBTQ persons), gendered power inequities in socio-political systems focused on controlling sexuality, heteronormativity in centering sex as a primarily reproductive activity among (married) heterosexuals, lack of healthcare provider training on sexual rights and sexual pleasure, and political divisions within and between sexual rights social movements (Castellanos-Usigli & Braeken-van Schaik, 2019; Fine & McClelland, 2006; Ford et al., 2019; Gruskin et al., 2019; Singh et al., 2021). Fine and McClelland discussed the importance of ‘thick desire’ where youth can ‘imagine themselves as sexual beings capable of pleasure and cautious about danger without carrying the undue burden of social, medical, and reproductive consequences’ (Fine & McClelland, 2006, p. 301). Not only can sexual pleasure be infused into the SDG to enhance rights, it can also be inclusive of youth and/or LGBTQ experiences which are often overlooked in sexual health education (Gruskin et al., 2019). The Pleasure Project has long advocated, and produced educational and resource tools, for integrating sexual pleasure into sexual health information and resources (https://thepleasureproject.org). The Pleasuremeter is a sexual history and sexual health counselling and education tool for healthcare providers and educators that assess both physical and psychological domains of pleasure and enabling environments, including consent, self-determination, confidence, and communication and negotiation skills (Castellanos-Usigli & Braeken-van Schaik, 2019). Applying such a holistic approach to sexual agency and empowerment conceptualizes sexual pleasure as embedded in larger sexual health enabling environments that consider symbolic (e.g. stigma), relational (e.g. social capital), and material (e.g. socio-economic status) contextual factors (Campbell & Cornish, 2012; Fine & McClelland, 2006; Gruskin et al., 2019).

Conclusion

The common saying that ‘what is measured, matters’ (Stuart & Woodroffe, 2016, p. 75) underscores the importance of naming not only sexual rights and sexual pleasure, but also sex workers and LGBTQ persons in the SDG. Who and what is named, and not named, in sexual health research, programs and policy is political. This is also true for the political tensions underlying the exclusion of sexual rights, and invisibility of LGBTQ persons and sex workers, in the SDG (Dorey & O’Connor, 2016; Elias & Holliday, 2019; Gabizon, 2016; Galati, 2015; Rosche, 2016). Erasure of populations such as sex workers and LGBTQ persons in the SDG precludes a concerted effort to understand and address the underlying causes of the disproportionate burden of HIV and other health issues across global regions. Furthermore, this discursive erasure in the SDG reflects inequitable knowledge production rooted in patriarchy and compulsory heterosexuality that re/produces an epistemology of ignorance regarding sexual pleasure and sexual and gender diversity (Tuana, 2004). As Tuana reflected: ‘what we attend to and what we ignore are often complexly interwoven with values and politics’ (Tuana, 2004, p. 129).

Although this Commentary has argued for the importance of the inclusion and naming of sexual rights in the SDG, as well as populations such as LGBTQ persons and sex workers, this does not imply that all LGBTQ persons and sex workers are vulnerable, nor does it suggest these are the only socially marginalized communities that could be better represented in human rights advocacy within the SDG. First, no one is inherently vulnerable, including the broad category of women and girls named in the SDG, nor all sex workers or LGBTQ persons. Calls to move beyond a ‘vulnerability’ focus in public health research note the vagueness of this concept, its lack of attention to the political, economic, social and cultural production of inequities and power imbalances, and the neglect of who is not vulnerable (Katz et al., 2020; McLaren et al., 2020). Similarly, the attention drawn to inclusion of sex workers and LGBTQ persons in the SDG is not because people in these communities are inherently vulnerable, rather the structural inequities enforced in legal, health, political, education and other spheres produce harmful environments that constrain health and human rights. Second, an intersectional approach to the SDG could consider the interplay between multiple social identities and associated inequities, such as race, gender, im/migration and citizenship status, rural/urban residence, socio-economic status, dis/ability, sex work, HIV status, sexual orientation and gender identity (Crenshaw, 1989; Hill Collins, 2009). An intersectional and relational approach to gender in the SDG at large could consider how gender is dynamic, fluid, contextual, produced by structures and interactions that shape access to power, and the ways in which gender is agential and performed (Connell, 2012; Dorey & O’Connor, 2016; Springer et al., 2012). A relational approach to gender, in contrast with the categorical approach currently used in the SDG, would move beyond binary male/female, men/women comparisons to better understand how gender is negotiated, transformed, embodied, and could interrogate the complexity and access to power within masculinities, particularly for men at the social margins (Connell, 2012; Springer et al., 2012). Finally, an intersectional approach to the SDG could draw attention to the strengths, solidarity and resilience within all communities (Combahee River Collective, 1981). Rather than viewing any group as predominantly vulnerable, attention can be paid to the ways that individual and collective agency is enacted to navigate inequitable power relations and produce social change (Campbell & Mannell, 2016; Logie & Daniel, 2016; Logie, Earnshaw, et al., 2021; Mannell et al., 2016; Perez-Brumer et al., 2017). Kippax, Stephenson, Parker and Aggleton describe that without concurrent attention to agency, a focus on vulnerability can result in limited ‘recognition or understanding of what connects people to each other, and what forms the stuff of their social and cultural lives’ (Kippax et al., 2013, p. 1369).

Identifying populations experiencing sexual rights violations – and linkages between these violations and social and health disparities – can support further research to generate data that expands our understanding of lived experiences. This understanding will allow us to identify and address priorities, health needs, and policy change to advance the SDG goal of ensuring ‘that all human beings can fulfill their potential in dignity and equality and in a healthy environment’ (preamble) (United Nations, 2018). In their discussion of the ‘ironies of homophobia in Africa’, Semugoma and colleagues describe that the dearth of data on LGBTQ persons in Sub-Saharan Africa can reinforce a lack of visibility, in turn perpetuating a lack of funding and research needed to bring about improved services for LGBTQ persons in rights-constrained contexts (Semugoma et al., 2012). Similarly, the movement away from human rights in HIV prevention with sex workers in Brazil, as described by Murray, Brigeiro and Monteiro, can result in a lack of investment in addressing structural drivers of HIV and an overemphasis on biomedical approaches (Murray et al., 2021).

Folding populations such as sex workers and LGBTQ persons (and LGBTQ sex workers) into the ‘other status’ category in the SDG is a disservice. While it leaves the door open to naming groups that strive for sexual rights across diverse contexts, unnamed groups in the ‘other category’ remain literally and figuratively the ‘other’. Who is, and is not, represented in global health discourse matters: ‘Representations of the world enable global health research, discursively constructing sites in which studies can legitimately take place’ (Brisbois & Plamondon, 2018, p. 142). Explicitly naming sexual rights, and groups whose sexual rights are constrained such as sex workers and LGBTQ persons, is the first step in being able to challenge heteronormativity, cisnormativity and sex work stigma. To truly leave no one behind and realize sexual health for all, the SDG need to begin from a foundation of sexual rights.

Acknowledgements

The author thanks Uzma Ahmed and Karan Sharma for help with the literature review, and the reviewers for their helpful feedback.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by the Social Sciences & Humanities Research Council of Canada (SSHRC). The author is also supported by the Canada Research Chairs Program, Ontario Ministry of Research and Innovation, and Canada Foundation for Innovation.