The contested global politics of pleasure and danger: Sexuality, gender, health and human rights

ABSTRACT

This special issue of Global Public Health brings together papers examining how sexuality, gender, health and human rights have become increasing visible and highly contested within global health. The papers included here question and explore the often contradictory processes through which global equity-seeking populations negotiate pleasure and danger across multiple arenas (including HIV and AIDS, LGBTQ+ health and rights, intersex rights, sex worker rights, realities of refugee and displaced persons, and gender-based violence) and in diverse geographic contexts (Afghanistan, Bangladesh, Canada, Ghana, Haiti, Kenya, Mauritania, Nigeria, Peru, Rwanda, and the USA). These papers examine emerging questions about the gaps and limits in current legal structures that do not legitimize sexual rights as fundamental human rights, the role of agency (and of bounded agency) needed to navigate constrained contexts, ways in which community-based solidarity efforts shape access to sexual rights, and how sexual pleasure and consent are experienced and negotiated in rights-constrained contexts. The interdisciplinary authors included in this collection showcase how the ranging definitions of sexual rights, their enactment, and expressions of pleasure and danger are inextricably entangled with local contexts and cultural systems that underpin not only people’s lived experience but simultaneously become central topics for global health research, policy and practice.

KEYWORDS:

• Sexual rights
• gender
• sexuality
• pleasure
• danger
• power
• politics
• global health

As the field of global health continues to evolve in the twenty-first century, issues related to sexuality, gender, health and human rights have become increasing visible, highly contested, and when comparing across global regions even contradictory. What have increasingly been described as ‘global sex wars’ (Correa et al., 2008) have been actively contested both in local communities and across international arenas. Diverse issues have been taken up as sites for political contestations, social mobilisation, resistance, activism and advocacy, including but not limited to, abortion and reproductive health and rights, HIV and AIDS-related policies and programmes, lesbian, gay, bisexual, transgender and queer (LGBTQ+) health and rights, human trafficking and sex worker rights movements, hate crimes and gender-based violence. On a global scale, the return of religious fervour and political extremism during the past decade has again drawn attention to sexuality and gender as key political battlegrounds at the intersection of the fields of global health and human rights. Paradoxically, both pleasure and danger have become central topics for global health research, policy and practice, and merit critical analysis to better understand this seemingly contradictory connection.

Since 2010, a rise in populism and authoritarian regimes is contributing to global attacks on human rights, requiring alliances across equity-seeking communities (Human Rights Watch, 2017). The U.S. ‘Global Gag Rule’ reinstatement in 2016 limited funding for institutions that provide abortion information or services; 70 countries criminalise same-sex sexual practices (Carroll & Ramon, 2017) and endorse HIV transmission criminalisation (Bernard & Cameron, 2016); and sex worker rights globally are constrained by legislative regulations (Map of Sex Work Law, 2018; Overs, 2015). Solidarity efforts have responded, such as the Global Women’s Marches which advocated for gender, racial, and economic justice (Women’s March, 2020) and #BlackLivesMatter (https://blacklivesmatter.com) which advocates for LGBTQ+, gender, racial, disability, and immigration justice and liberation. Yet, while the concept of sexual rights is situated at the intersection of numerous social movements, including LGBTQ+, abortion rights, people living with HIV (PLHIV), and sex workers, there is still limited cooperation across movements. Sexual rights describes freedom from violence, discrimination, and coercion to realise sexual health; access to sexuality education; and bodily integrity and choice regarding sexual and reproductive practices (World Health Organization, 2006). Recognising siloed agendas and tensions between social movements, there is a need to increase solidarity and transnational coalitions by leveraging commonalities around sexual rights in the twenty-first century.

Shifts in sexuality research

Sexuality research has shifted rapidly over the past 40 years. In the 1970s and 1980s the conceptualisation of sexuality moved from one grounded in biomedical sciences towards an exploration of the role of social, cultural, and historical contexts in shaping sexual lives (Parker, 2009; Weeks, 2002). The impetus for this shift came not only from the work of social scientists and theorists, but also from feminist and LGBTQ+ activists (Parker & Gagnon, 1995). Emergent scholarship exploring the social and historical construction of sexuality focused on the ways in which knowledge and power shape collective sexual identities, interactions, and meanings within socio-cultural contexts (Parker, 2009; Weeks, 2016). Since the mid-1990s, sexuality research has increasingly considered systems of power and domination, and the ways in which political, economic, and cultural systems intersect to shape how people experience sexual agency, rights and freedom (Aggleton et al., 2012; Correa et al., 2008; Weeks, 2016).

Sexual rights have been described as ‘the new kid on the block’ in current attempts to expand the definition of human rights (Petchesky, 2000, p. 81). The concept of sexual rights is informed theoretically by the broader sociology of human rights and social movements to explore how they are socially and historically constructed and how they are interpreted at the local level (Dunford & Madhok, 2015; Goldstein, 2012). Sexual rights are also rooted in a ‘multicultural conception of human rights’ that explores the work of constructing cultures of human rights (de Sousa Santos, 2000). The term sexual rights has also been strategically taken up to challenge heternormativity in conventional human rights discourse (Parker et al., 2004). The evolving definition of sexual rights includes the right of persons to: live free of coercion, discrimination and violence, realise sexual wellbeing, have sexuality and sexual relationships respected, and have access to sexual pleasure and safety (World Health Organization, 2015). This aligns with conceptualizations of sexuality as being shaped by biological, psychological, social, economic, political, historical, cultural, religious and legal worlds (Correa et al., 2008; Weeks, 2016). Sexual rights include negative rights (e.g. not being subjected to violence, being able to redress harm) and positive rights (e.g. freedom of sexual expression, choice of sexual partners, ability to access to services) (Correa et al., 2008).

The 1990s also saw an increasing adoption and re-interpretation of the concept of sexual rights by feminist, LGBTQ+, and HIV advocates across the globe (Correa et al., 2008; Giami, 2015; Lottes, 2013; Petchesky, 2000). Sexual rights were advocated for by feminists in the 1993 World Conference on Human Rights in Vienna, the 1994 International Conference on Population and Development in Cairo, and the 1995 Fourth World Women’s Conference in Beijing. Since the 2000s diverse social movements – including LGBTQ+, PLHIV, and sex worker groups – have taken up sexual rights as a strategic tool to advance advocacy goals. Despite differences and tensions between these groups on priorities (e.g. LGBTQ+ persons may advocate for marriage rights in contexts where sex workers strive for decriminalisation), there are growing global activist coalitions focused on sexual rights (Correa et al., 2008). Yet knowledge gaps remain regarding how sexual rights is understood within these movements, how it is claimed by persons at the grassroots, and if sexual rights can remain effectual while incorporating multiple diverse sexual rights experiences and social movements.

Sexual rights movements have largely emerged from communities with a shared sexual identity (Parker, Garcia, and Buffington, 2014; Parker, Garcia, and Muñoz-Laboy, 2014; Weeks, 2000; Wieringa & Sivori, 2013), and cross-movement coalitions are limited due to fragmentation between identities (Bernstein, 2005). Yet solidarity between social movements is an effective and powerful means of mobilisation and producing policy and socio-cultural transformation (Kraak, 1998). To build on identity-based politics, sexual rights coalitions (e.g. HIV, LGBTQ+ rights) have focused on solidarity, social justice, and the shared experience that sexual rights are regulated by legal, cultural, religious, scientific and familial actors (Correa et al., 2008; Gevisser, 2016, 2020; Parker et al., 2007). Sexual rights movements also experience reactionary responses by traditional movements advocating for conservative family values and fundamentalist religious beliefs that limit sexual rights (Bendroth, 1999; Diniz & Andrezzo, 2017; Girard, 2017; Parker & Gagnon, 1995; Sheldon, 2016; Symons & Altman, 2015). Mobilisation of sexual rights coalitions is shaped by socio-political, cultural and economic contexts (Correa et al., 2008, 2014; Seckinelgin, 2011), stressing the need to better understand local knowledge of these movements.

Contemporary research on sexuality, gender, health and human rights

In this special issue, authors explore the contemporary contested arena at the intersection of sexuality, gender and global health. The geographical focus of these papers spans global regions (Afghanistan, Bangladesh, Canada, Ghana, Haiti, Kenya, Mauritania, Nigeria, Peru, Rwanda, and the USA), offering a breadth of multiple, sometimes contradictory insights into the ways that diverse populations negotiate (or experience barriers to negotiating) pleasure and danger. Cross-cutting themes include: (1) gaps and limits in current legal structures (e.g. legislation, principles, institutions) that do not go far enough in legitimising sexual rights as fundamental human rights, particularly within the context of how marginalised populations experience these structures; (2) a call for examining agency that individuals tap into to navigate constrained contexts and the role of communities in shaping access to sexual rights; and (3) the ways that sexual pleasure and consent are experienced and negotiated in often rights-constrained contexts.

Legal barriers to realising sexual rights

Articles advance the argument that legal structures are a structural determinant of health and central to realising sexual rights across diverse contexts and communities. For instance, in ‘Lack of full citizenship rights linked to heightened client condom refusal among im/migrant sex workers in Metro Vancouver (2010-2018)’, McBride et al. (2020) discuss how the denial of sex work labour rights converges with a lack of citizenship rights among sex workers with precarious immigration status to reduce sexual agency and sexual decision making. Their longitudinal study documents pathways from precarious immigration status to client condom refusal: sex workers with precarious immigration status had 2.5-fold higher odds of experiencing client condom refusal. They also found these client condom refusal risks were heightened – more than 4-fold higher – among im/migrant sex workers following ‘end-demand’ sex work legislation. This legislation criminalises clients purchasing sex, and criminalised third parties who advertise for sex workers, while legally allowing sexual services to be sold. Yet persons holding work permits and temporary residents in Canada are not legally permitted to sell sexual services. Not only do immigrant sex workers experience increased legal precarity of sex work and immigration, criminalising third party material benefits also reduce immigrant sex workers’ ability to receive security, support and other benefits from working in managed work environments. Decriminalisation of all facets of sex work, alongside support for immigrant sex workers’ rights, are essential for realising sexual rights.

In ‘Intersex care in the United States and international standards of human rights’, Jorge et al. (2019) explore how international human rights frameworks impact medical care for intersex people. They examine how legal policies and mechanisms across diverse contexts regulate or prohibit surgery on intersex people to alter healthy body parts. Yet other biomedical experts across varied countries – including the United States, France, Belgium, Canada, Italy, Sweden, Qatar, the United Kingdom, and Morocco follow intersex management guidelines that focus on medical institutions’ legal rights rather than on the human rights of intersex persons. Despite growing attention to human rights principles in medical care for intersex persons, authors argue that clinical policy recommendations are not sufficient: further policy and legal changes are required by States to reflect international rights treaties for sexual health and children’s rights. In this way, clinical ‘wisdom’ is allowed to take precedent over human rights in the context of intersexuality. Until intersex persons have legally enforceable sexual rights protections they are, as in McBride et al.’s (2020) example above with im/migrant sex workers, denied human rights and access to full citizenship.

Adding to this analysis of how legal barriers limit sexual rights, in ‘“Even peacekeepers expect something in return”: A qualitative analysis of sexual interactions between UN peacekeepers and female Haitians’, Vahedi et al. (2019) focus on providing a nuanced understanding of sexual relationships between United Nations (UN) peacekeepers and women and girls – the UN conceptualises such relationships as sexual exploitation and abuse for which it has ‘zero tolerance’. Despite this stated zero tolerance, sufficient UN peacekeepers in post-earthquake Haiti had such relationships that the babies between local women and peacekeepers were termed ‘peace babies’. Gendered economic inequities – economic hardship and poverty – were structural forces that often undergirded Haitian women and girls’ sexual relationships with peacekeepers. Participants shared examples of precarious living situations, including insufficient resources for education, unstable employment, and hunger, that often resulted in exchanging sex with peacekeepers for survival needs. A constant finding was a lack of financial support for these peace babies once UN peacekeepers finished their mission and left Haiti. Though not the central focus of their study, Vahedi et al. (2019) note that a lack of legal structures to protect the ‘beneficiaries’ of UN peacekeeping missions from sexual exploitation, abuse and violence, denies them not only this protection but also access to justice when such violence is perpetrated. Together these examples signal the important role that structural drivers such as poverty play in reinforcing power imbalances in sexual relationships, with long lasting impacts.

Turning to assessing the lived experience of gay and transgender Peruvian youth, in ‘Contesting everyday violence: Resilience pathways of gay and transgender youth in Peru’, Suarez et al. (2020) discuss the impacts of the legal exclusion of violence targeting lesbian, gay, bisexual, transgender and intersex persons in Peru from hate crime legislation. This creates a puzzling situation where LGBTQ+ persons have human rights protections in Peru’s legal system yet are not protected specifically from LGBTQ+ directed violence. The authors document how the social worlds of youth are shaped by ‘everyday’ violence to illustrate how systems of homophobia, transphobia and machismo converge to produce employment discrimination particularly impacting transgender women, with survival sex work a result of socio-economic exclusion. These exclusionary social contexts constrained opportunities for forming long-term sexual relationships, producing despair. Findings signal the need to reinforce LGBTQ+ rights protections in ways that offer protection from violence and recourse to justice, alongside viable employment opportunities.

In ‘Girls and women speak out from Afghan moral prisons: Tackling extremism and violence against women in a conflict environment’, Mahendru (2020) situates Afghan women’s lack of sexual rights in the context of gender inequities rooted in Afghan local power structures, themselves embedded in religious and tribal traditions and customary laws. Religious and tribal leaders of village councils administer justice that largely violate women’s rights, particularly regarding intimate partner violence, forced marriage, child marriage, and punishment of women for violating social conduct codes. Mahendru discusses such ‘moral crimes’, spanning rape, adultery, and leaving home (‘running away’). Findings signal that healthcare workers fear harm and threats from families and communities if they provide sexual and gender-based violence support services, and even lawyers fear retribution if they support a woman’s right to divorce. Women lack access to formal and informal justice systems that often follow Sharia law practices, and can be imprisoned for leaving contexts of forced marriage and reporting sexual and gender-based violence. Once again, this example flags the importance of state protection from violence.

In ‘Queer necropolitics of asylum: Senegalese refugees facing HIV in Mauritania’, Broqua et al. (2020) focus on the situation of Senegalese gay men migrating to Mauritania in search of acquiring refugee status from UNHCR and potential resettlement in Europe or North America. The process of migration, harsh living conditions, and healthcare barriers in Mauritania for these gay men often results in HIV infection and returning to Senegal in poor health – and even contributes to gay men dying of AIDS in Mauritania while seeking asylum. Gay men may leave Senegal due to the criminalisation of same sex practices, homophobic harassment and violence, and travel to Mauritania where there is ostensibly free anti-retroviral therapy treatment. Yet their health worsens in the journey: Broqua et al. term this asylum process as ‘a site of queer necropolitics – that is to say the politics of killing and letting live’. The legal situation is not better than home due to same-sex criminalisation in Mauritania alongside state sanctioned exclusion, as gay migrants are not accepted as citizens. Refugee classification systems and lack of care for asylum seeking gay men produce a ‘slow death’ through uncertainty. Refugee resettlement is itself an ambiguous construct as homosexuality is criminalised in both Senegal and Mauritania, with the only durable solution lying in third country resettlement. The sexual agency and rights of Senegalese gay men are therefore constrained by a lack of legal protections in countries of origin and of asylum, and this in turn produces an ‘in-between’ state where discreteness is required for survival in Mauritania.

Together these papers signal the need for human rights protections at international and national levels for sex workers, intersex persons, displaced women, LGBTQ+ persons, cisgender women and asylum seekers. While varied in cultural context, these equity-seeking groups share experiences that limit their ability to realise sexual rights, including a lack of recourse to justice when experiencing violence, legal precarity that reduces access to full citizenship, and hegemonic and toxic masculinities. Applying an intersectional framing to sexual rights allows us to consider the shared and at times overlapping experiences of these cases.

The importance of agency and community for confronting barriers to sexual rights

This special issue offers a starting point to rethink how addressing structural and legal barriers to sexual rights are required but not sufficient to produce an enabling environment for people to realise these rights. Community environments and their corresponding norms and values shape the lived experiences and opportunities for realising sexual rights, and persons navigate their agency within these relational contexts.

Exploring the factors associated with school attendance among pregnant teenagers and teen mothers in a humanitarian setting in Rwanda, in ‘“They are a shame to the community … ” stigma, school attendance, solitude and resilience among pregnant teenagers and teenage mothers in Mahama refugee camp, Rwanda’, Ruzibiza (2020) highlights how despite policy support for pregnant and parenting adolescents to attend school, stigma targeting teen pregnancy was reproduced by peers, families and the larger community and resulted in social and educational exclusion. Pregnant and parenting teens had educational aspirations yet at times made the decision to drop out of school to avoid stigma. This paper details the ways in which teenage pregnancy violated moral and behavioural norms, resulting in a loss of social, economic, cultural and symbolic capital. These experiences were gendered: the focus on adolescent girls occluded men’s roles and responsibility for the pregnancy, and mothers were often blamed for their adolescent daughter’s pregnancy. Within these punitive social contexts, the author differentiates ‘socially-inflicted solitude’ that results in isolation, from ‘self-inflicted solitude’ that allows persons to avoid stigma, in this case, by dropping out of school or avoiding friends. The author frames decisions to avoid friends and school as a ‘self-care’ strategy to reduce stigma exposure. Girls also sought to rebuild social capital through befriending other teen mothers and generated economic capital through accessing resources at non-government organisations. A focus on legal protection therefore requires concurrent attention to processes of transforming social, community, and familial norms and values to support rights and agency of teen mothers.

In ‘Beyond the talking imperative: The value of silence on sexuality in youth-parent relations in Bangladesh’, Camellia et al. (2020) highlight the ways that conversations regarding sex between children and adults in Bangladesh are framed as shameful and silenced. The authors disentangle the experiences of youth talking to their own parents about sex – which may (unsurprisingly) remain uncomfortable – from young persons’ openness about discussing sexual topics with other adults and with peers. Camellia et al. detail the ways that silence is gendered, with young women learning more from their mothers on menstruation than young men learned from their fathers on puberty and issues such as wet dreams. In these contexts where parental shame and embarrassment may underpin silence, boys and young men may see the silence in their parental relationships as problematic. With other issues however, such as sexual pleasure, relationships and attraction, youth themselves preferred privacy and silence with parents (describing potential conversations as ‘awkward’) and desired conversation instead with their peers. Youth framed this silence as maintaining boundaries and a particular image they wished to uphold with their parents. This paper complicates meanings and understandings of silence in child-parent sex communication, illustrating how silence can at times perpetuate harm while at other times maintain family harmony and youths’ privacy.

Other papers in this collection also take up the dimensionality of agency in enacting sexual rights. For example, Suarez et al. (2020) discuss individual and collective resilience processes among young gay cisgender and trans persons in Peru. They framed self-esteem as produced by both self-acceptance and community acceptance, with different experiences between rural and urban participants, also suggesting the importance of contextual resources for realising self-worth. This article conceptualises collective unity and resilience as avenues to advance sexual rights, while also signalling how relationships between self and community vary between rural and urban locations. Contextual complexity provides insight into the different individual and collective resources that cisgender gay youth had access to in comparison with trans youth, precluding a single narrative of what LGBTQ+ persons’ need to access sexual rights.

Mahendru (2020) discusses the entanglement between agency and community through examining the cultural practices of bride price, child marriage and acceptance of intimate partner violence as phenomena constraining Afghan women’s sexual agency. Women found it challenging to negotiate sex, including safer sex, and lived-in contexts where it was important to uphold expectations of family and community honour. When girls and women were raped and became pregnant, they often experienced social and familial ostracism and violence. Other ways in which women’s sexual agency was constrained was through limited access to reproductive health services. For instance, many women were not permitted to access reproductive health services by their husbands and in-laws. Healthcare providers described conducting non-consensual ‘virginity tests’, often when women attempted to leave situations of violence. Community in this example upheld harmful traditions and local systems of justice in ways that constrained women’s sexual rights and left little room for agency.

This complexity in the role of community is also emphasised by Broqua et al. (2020), who describe gay community connections as the conduit between Senegal and Mauritania. Gay friends and social networks provide information and material resources for initial resettlement while seeking asylum in Mauritania. Yet experiences were shaped by the visibility of sexual and gender identities. Gender non-conformity was punished by community violence and disapproval from gay men concerned about harmful repercussions of the heighted visibility of gay men on their own lives. Gay men from Senegal also experience marginalisation when visible as foreigners. The intersection of stigma toward Black ethnicity, same-sex sexuality, HIV serostatus and the liminality of non-citizenship converge to reduce opportunities for solidarity and compromise the realisation of health in ways that reflect ‘queer necropolitics’ that produce ‘slow deaths’.

Several papers in this collection (i.e. Camellia et al., 2020; Ruzibiza, 2020) underscore that acts of silence should not be understood as passive, but rather can be used as a tool for negotiating rights and space, aligning with constructions of agency in highly marginalised settings. For instance, Logie and Daniel’s (2016) study with internally displaced women in post-earthquake Haiti highlighted agency as multi-level, spanning intrapersonal, interpersonal, relational, and collective arenas of life. This dynamic conceptualisation of agency as incremental, multi-level and non-linear has also been developed by others (Ahmed, 2010; Campbell & Mannell, 2016; Madhok, 2013) to amplify the processes of persisting, resisting and survival that may be overlooked in a traditional empowerment framing of action, influence, and control. Suarez et al. (2020) further point to the interlocking nature of individual and collective resilience, emphasising that social processes of exclusion experienced by gay and trans youth in Peru inhibit self-acceptance while also sparking collective unity, resilience and, at times, activism. The same access to collective resilience was not available for gay asylum-seeking Senegalese men in Mauritania, whose ethnicity, immigration status, sexuality and HIV status produced social and economic exclusion both within Senegal and Mauritania. Silence as protection can thus at times underpin agency (such as in the Rwandan example of teen mothers) and can also be used as a survival strategy (e.g. in the case of Senegalese gay men in Mauritania).

Other articles in the collection described opportunities for collective unity and activism to increase access to sexual rights and linked to the contextual histories of activism and mobilisation within which sexual rights are shaped. The deep-rooted history of LGBTQ+ activism, social movements, and purported international rights protection for LGBTQ+ persons in Peru provides a roadmap for persons in this context to access their state enshrined rights. The example of gay men in Senegal journeying to Mauritania – both contexts where homosexuality is criminalised – to apply for refugee status to resettle in a third context with LGBTQ+ rights does not start from the same foundation of LGBTQ+ rights as in Peru. For pregnant refugee youth in Rwanda, and youth in urban Bangladesh, there is not the same history of social action and no clearly defined community with which to build a movement. The sexual rights being constrained for pregnant and sexually active youth are tied to patriarchal and hegemonic masculinities; perhaps unsettling these gender inequities and the ways in which they limit sexual agency among adolescent girls and young women requires different tactics than LGBTQ+ activism. Mahendru (2020) discusses the long-lasting women’s rights activism by the Revolutionary Association of the Women of Afghanistan (RAWA) who target state-misogyny, even in highly constrained contexts such as Afghanistan under Taliban control. Their activism however has not gone unpunished, evidenced by the murder of Meena Keshwar Kampal, an Afghan revolutionary feminist who founded RAWA. RAWA’s radical approach aims to create ‘a new form of feminist citizenship to create a radically free and egalitarian society based on political values rather than identity’ (Mahendru, 2020, p. 5).

Attention to sexual pleasure and consent

There was less attention overall to sexual pleasure and choice in the special issue articles, despite this being explicitly emphasised in the call for papers. One article (Singh et al., 2020) explicitly focused on strategies for integrating pleasure into comprehensive sexuality education, while other authors offered an analytic lens that showed the ways that persons can experience sexual pleasure and have agency for sexual consent even in contexts of sexual rights constraints.

The predominant focus of sexual health research with displaced persons focuses on fear and danger – sexual and gender-based violence, sexually transmitted infections (STIs), unmet reproductive health needs that span contraception to safe abortion access, and maternal and children’s mortality. Singh et al. (2020) discuss in “‘I tell them that sex is sweet at the right time’ – A qualitative review of ‘pleasure gaps and opportunities’ in sexuality education programmes in Ghana and Kenya” the importance of recognising that sexual pleasure stimulates sexual behaviour. Their article underscores sexual pleasure, alongside sexual satisfaction and uptake of safer sex practices, as core components of sexual rights. Yet sexual pleasure research and sex-positive sexual scripts have primarily focused on the Global North. Authors report findings from a qualitative pilot study in Ghana and Kenya conducted to develop a pleasure audit tool that could be operationalised in sex-positive sexuality education. This study’s conceptual framework was informed by the ‘Pleasuremeter’ (Castellanos-Usigli & Braeken-van Schaik, 2019), a sexual history tool for healthcare providers, that considers satisfaction, self-determination, consent, safety, privacy, and negotiation. By selecting comprehensive sexuality educators with higher and lower sex-positive approaches, authors aimed to explore differences within sex education styles. Key findings included the need to support sex-positive sex educators, the importance of providing youth with sex-positive information as they would seek this information from porn and other sources, and the recognition that sex educators face pervasive socio-cultural resistance to providing sex-positive education. Religious values and beliefs produced significant barriers for sex educators, notably regarding discussions of masturbation, pre-marital youth sexual activity, and sexual diversity. Personal experiences of sexually fulfilling and happy relationships – as well as unplanned teen pregnancies and sexual violence – helped sex educators to unpack traditional and inequitable gender norms and expectations. Additionally, sex educators voiced the need for ongoing and repeated sex-positive comprehensive sexuality education trainings, alongside support from peers and supervisors. Sex-positive education for youth living with HIV and sexually and gender diverse youth – and those at the intersection of social identities and practices – are key considerations for advancing intersectional sexual rights.

In ‘“Men don’t have patience”: Sexuality, pleasure and danger in displacement settings in Northcentral Nigeria’, Aham-Chiabuotu et al. (2019) explore sexuality, relationships and natality with internally displaced women in Nigeria affected by the Boko Haram insurgency. Their key finding was that normative gender roles were disrupted by the insurgency, and women were more likely to become breadwinners in contexts of displacement than men. This in turn challenged notions of ideal masculinity that constructs men as breadwinners and contributed to women’s frustration and men’s violence and substance use. Yet women also demonstrated solidarity and support for male partners for multi-fold reasons, including securing future social standing, survival and stability for communities. Findings illustrated that women desired sexual pleasure, as well as reproductive agency with pro-natal perspectives for having children. This was intricately linked with wanting to replace children, family and community members lost in the insurgency. Community survival, sexual and reproductive rights were therefore interlinked; pregnancy in this context can also be seen as resistance and ‘solidarity with both the living and the dead’ rather than only stemming from oppression and unmet contraceptive needs. Dismissing sexual pleasure and pro-natal perspectives among displaced women contributes to their dehumanisation through policies and programmes that focus on family planning and birth control, and subsequently diminish women’s sexuality and sexual agency to a biomedical issue. This article signals the need to foreground pleasure and context rather than limit the focus to legal and policy reform to advance -sexual and reproductive health and rights.

While presenting sexual relationships between Haitian women and girls with UN peacekeepers as largely transactional and driven by gendered economic inequities, Vahedi et al. (2019) complicate the narrative that Haitian women and girls are automatically exploited and without sexual agency in these contexts. In this way, their study builds on prior work on agency with internally displaced women in post-earthquake Haiti that requires looking at the multi-faceted, non-linear ways persons negotiate power in extreme settings (Logie & Daniel, 2016). This article also complicates the concept of consent, differentiating between the absence and presence of consent. Sexual consent was provided in the context of expectations, promises and implicit ‘unwritten rules’ with peacekeepers, such as future promises of care and socio-economic mobility. Although the UN declares these relationships as inherently exploitative, only a minority of participants perceived them this way. This raises the tension between who we view as vulnerable, and how framing persons (such as Haitian women and girls) as vulnerable can remove our belief that they can practice agency (Kippax et al., 2013). Women in this study identified children and motherhood as ‘stuff of their social and cultural lives’ that brought strength, motivation, and resilience. While women’s agency was bounded by the socio-economic hardships in their lives, they perceived themselves as able to provide sexual consent and to balance the pros and cons of sexual relationships with peacekeepers.

A similar dynamic can be found in the article by Camellia et al. (2020) exploring the ways in which youths’ silence on sexual issues with parents is accompanied by alternate strategies of acquiring information on sex and sexual pleasure through Google, Facebook, YouTube, and other internet platforms. Mobile phones, social media and the internet were tools that increased youths' agency for accessing sexual information autonomously. The information acquired online also challenged sexual conservatism of prior generations on issues such as consent, sexual pleasure, virginity, porn, masturbation and same sex relationships. The youth defined themselves as the Facebook generation, distinct from their parents who were seen as the television generation. Connecting with global discourses on sexual agency opened up new possibilities with regard to pre-marital sex, love and sexuality in ways that framed ‘sexual pleasure as an entitlement both for boys and girls’.

Together, these examples suggest the need for exploring pleasure even in situations where sexual rights are constrained. This includes women’s sexual desire and choice of intimate partnerships in contexts of gender inequity and power imbalances. Reading women as only victims, whether displaced in Nigeria or Haiti or elsewhere, overlooks aspirations and the complexity of sexual desire and consent in precarious living conditions. This also signals Singh et al.’s (2020) call for gender transformation and attention to sexual pleasure in comprehensive sexuality education to advance sexual rights. Youth in Bangladesh accessed online environments to learn about sexual pleasure and consent in the face of silence from parents (Camellia et al., 2020), and youth in Kenya and Ghana looked for sexual pleasure information online from porn and other sites because of the dearth of sex-positive education. These examples signal the need to celebrate youth’s agency and desire to learn about sex, to integrate the erotic into sexual education (Singh et al., 2020), and to create online spaces that make acquiring information on sexual liberation possible in otherwise sexually conservative environments.

Moving forward: understanding pleasure outside of risk and danger

In seeking to better understand any area of work, discursive silences may often be as instructive as what is more clearly articulated in the texts – and these silences can also help us to think more effectively about future areas of work that might be important in order to move the field forward. With this goal in mind, we reflect on some of the areas that, while perhaps not entirely absent from the articles included in this special issue, nonetheless receive noticeably less attention. As a starting off point to invite further dialogue, we have identified the following issues that we think are especially important to call attention to: the concept of and power in pleasure, solidarity efforts to build alliances across movements, and the multicultural conceptions of sexual rights.

Although our original call for papers for this special issue of Global Public Health emphasised the issue of pleasure as central to the concerns that we hoped to examine, most of the papers that were submitted in response to the call nonetheless focused much more on danger rather than on pleasure. The relative absence of deeper discussions about pleasure, especially outside of or independent from questions of risk and danger parallel an ongoing gap in the existing literature. By extension, delving into sexual pleasure raises the importance of focusing not only on negative rights, but also on positive rights within the broader discussion of sexual rights (Correa et al., 2008; Parker, 1997). Sexual pleasure has emerged as ‘the newest arrival to the sexual health and sexual rights policy landscape, [yet it is] the least developed and potentially the most open to interpretation’ (Gruskin et al., 2019, p. 31). In fact, Gruskin and colleagues (2019) refer to sexual health, sexual rights and sexual pleasure as the ‘perfect triangle’. Indeed, the move towards a ‘positive’ conception of sexual rights foregrounds respect for the expression of sexual diversity, sexual pleasure, and self-expression as fundamental to human dignity and principles of equality (Petchesky, 2000).

The diverse set of authors included in this collection showcase how the ranging definitions of sexual rights, its enactment and its expressions are inextricably entangled with the local context and cultural systems that underpin people’s lived experience. While the articles collected here engage with these tensions across very different substantive sites of research, there is an urgent need for deeper understandings of how to build bridges between and across otherwise distinct communities and populations (whether those identities are self-determined or externally imposed). Cross-identity coalitions are critical to progressive social change (Carroll, 2017) yet, various solidarity efforts advancing sexual rights are too often siloed by categories of identity rather than the larger structural factors that produce and reproduce oppression and violence. We believe it is fruitful to have scholars from these distinct sexual rights solidarity movements engage with one another and look closely at the ways they address similar issues using different frames and to consider underlining structural constraints and the ways people resist across different social locations. For instance, activists for intersex rights, reproductive rights, women’s rights, HIV rights, LGBTQ+ rights, and refugee rights could share strategies to address shared oppression rooted in patriarchy while also examining intersectionality and different experiences shaped by race, gender, class and other social categories.

How do aspirations for sexual rights vary across majority world contexts and differ from Western templates? There is a continued need to think critically and reflexively about Western hegemony in relation to much research, writing and conceptual work on sexual rights, and the need to build truly multicultural frameworks and literatures within this field. This is also true in the field of sexual pleasure, where the Global South has been underrepresented (Singh et al., 2020). Indeed, exploring how sexual rights are understood by diverse groups of people mobilising through grassroots activism can help us to address these knowledge gaps and understand the intersection of the personal – experiences of marginalisation and denial of rights – and the political, including an understanding of sexual rights and engagement in activism (Correa et al., 2008).

Individuals at the grassroots understand and relate their sexual and reproductive experiences to the concept of rights and the discursive construction of such rights on the global level. While the geographic scope of these special issue articles is varied, there is still much to be done to open spaces for truly multicultural approaches to sexual rights. Brazilian educator Paulo Freire underscores the liberatory potential of working with the everyday language used by people themselves. This reflects vernacular knowledge – local, regional and constructed knowledge from ‘everyday social interactions, skills, practices, social networks and institutions’ (Freire, 1970). Explicit efforts are needed to not only unite across sexual rights movements but to also learn from Indigenous rights, anti-racism, and other liberation movements to more fully understand vernacular rights as a point of departure for building stronger and intersectional social movements for sexual rights. #BlackLivesMatter provides an example of how to expand our vision to re-imagine the liberatory potential of sexual rights: ‘We are expansive. We are collective of liberators who believe in an inclusive and spacious movement … . We must ensure we are building a movement that brings all of us to the front’ (https://blacklivesmatter.com/about/).

While these topics are of course not the only issues that we could identify that perhaps receive less attention in the articles included in this special issue of Global Public Health, they are clearly key areas of concern for future research and analysis. The articles collected here focus on the complexities, tensions, and contradictions at the intersection of sexuality, gender, human rights, and global health. Jointly they help to give us a sense of a rapidly growing and highly innovative field of research and intervention within the broader universe of global health and human rights. They also help us to map some of the key challenges that this field must continue to seek to confront as it moves into the future, especially in such trying times of global attacks on human rights.

Disclosure statement

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

Additional information

Funding

This work was supported by the Social Sciences and Humanities Research Council of Canada [grant number SSHRC IDG].