Content uploaded by Gary Dowsett
Author content
All content in this area was uploaded by Gary Dowsett on Apr 29, 2019
Content may be subject to copyright.
SEXUAL HEALTH: AUSTRALIA
III
S
ex and sexuality have
long occupied centre
stage in western dis-
course, yet until recently,
sexual health has been a
public-health Cinderella. If
attention was paid to sexual health, it was cast as a disease,
with a small band of medical specialists--venereologists in
particular--charting and attempting to reduce the
prevalence and incidence of sexually transmissible
infections (STIg). Meanwhile, sexologists, in the wake of
Richard von I4,rafft-Ebing, Henry Havelock Ellis, and
Alfred Kinsey, counted and recounted
the behaviours of sex, establishing
sexual "norms" and an ever-growing
list of deviant exceptions to them.
After World War II, there was a
shift to a broader consideration of
sexuality, in part driven by a concern
over world population growth.
Subsequently, we began to focus on
sexuality within the context of
women's and men's health--a result,
in part, of the development of second-
wave feminism and gay-liberation
politics. The move was exemplified in
the broadened agenda of the
International Conference on Popul-
ation and Development in 1994 (the
Cairo Conference). There, a new
approach to sexual and reproductive
health focused attention on previously
ignored and socially sensitive issues
such as gender relations, male
involvement in fertility, contraception
and abortion, and the sexual and
reproductive health needs of young
,pe0ple, including sex education.
An even bigger impetus for
broadening the sexual-health agenda
has come from the HIV/AIDS pandemic. Just as fertility
cannot be separated from women's and men's broader
sexual interests, HIV/AIDS cannot be seen merely as a
dangerous viral infection. The social, economic, and
cultural forces that frame people's lives powerfully
influence sex practices, sexual cultures, and individual and
group responses to preventive-health messages. For
example, to understand why young women use condoms
less frequently with casual than with regular male partners,
we need to take into account the dynamics of gender and
power. If we want to understand why young men are
encouraged to seek sexual experience (whereas young
women remain virgins), we need to consider how historical
and social forces produce and sustain this difference in the
face of HIV/AIDS and STIs. Similarly, we now know that
the western classification of the "homosexual" as a type of
person is not easily transferred to most less-developed
countries (even if the same sexual practices occur). This
has challenged western science's culturally bound
sexological categories and forced recognition that sexual
health, in this instance, is not merely about correcting
sexual "pathology".
The increased interest in the social determinants of
sexual health has reduced medical hegemony in this area.
Many research centres now have social and behavioural
researchers working collaboratively with clinicians and
epidemiologists, in recognition that there needs to be a
The changing perceptions of
collective
cross-disciplinary
understanding of sexual health
and
|_mJL__
sex
sexuality
and how to achieve a sexually
healthy population. In pursuing
Doroon Rosenthal, Gary Oowsett this goal, Australia (like the
Teaching about sexual health
Cover of a booklet distributed to Australian
adolescents.
UK) is now developing a
national sexual-health strategy. However, the Australian
strategy is based on an extant national HIV/AIDS strategy,
which is currently in its fourth version. Since Australia's
first strategy was produced in 1989, we have learned a
great deal about collaborative partnerships between
government, communities, researchers, and those with a
legitimate voice, including people
living with HIV infection and AIDS.
There has also been a balance
between resources spent on treatment
of illness and disease, and that spent
on prevention and health promotion.
The successive strategies supported
multisectoral parmerships across
government departments, a multi-
disciplinary biomedical and social
research agenda, cooperation between
clinicians and affected communities,
and involvement of the private sector.
The success of Australia's HIV/AIDS
strategies has prompted the
application of similar principles to the
development of a national sexual-
health strategy. An effective strategy
will need to include the health sector
and a realignment of existing
resources, but also welfare, justice,
and education. For example, it must
grapple with the sensitive issue of sex
education in schools. Despite sub-
stantial evidence for the positive
effects of sex education, there is still
some reluctance to grasp this
particular nettle. Or, if sex education
is introduced, the emphasis is on abstinence (as in the
USA) rather than harm reduction, despite compelling
evidence that many young people are sexually active by
their early teens and express strong ownership of their
sexual interests.
Finally, a comprehensive
have to take into account
not only the culturally
sensitive concepts of sex and
sexuality, but also recognise
the impact of sexual global-
isation. By this we mean
that today's sexual reality
includes frequent and
readily shared images of sex
via the intemet, music
videos, films, magazines,
and so on. Sex is not just
socially produced--social
life is increasingly sexual. ~
While the rapid spread of
drug-resistant STIs and
HIV threatens to refocus,
attention on diseases, a
return to a narrow
biomedical vision will not
enhance sexual health.
sexual-health strategy will
The Lancet Perspectives ° 356 • December ° 2000 s58
