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Research shows that framing sexual and reproductive health counselling around sexual pleasure has a positive effect on safe sex practices

Antón Castellanos-Usigli is the director of prevention programs at Wyckoff Heights Medical Center in Brooklyn, New York, and a member of the Global Advisory Board for Sexual Health and Wellbeing

One of the first clients to whom I ever gave an HIV+ diagnosis told me that he had not used a condom with half of his sexual partners. When I asked him why not, he said: “I am ugly, so when a guy wants to have sex with me without a condom I will just let him do whatever he wants.”

His words opened the door for a conversation in which we talked about confidence, consent, safety and communication, all touching on issues of sexual health, rights and pleasure. These types of conversations, however, are uncommon between clients and healthcare providers, who usually emphasise risks associated with sex, such as HIV, STIs and unwanted pregnancy, during sexual history-taking and counselling

Some healthcare providers assume that clients have sex without condoms because they are unaware of the risks. However, poor communication skills and confidence can lead even risk-aware clients to engage in condomless sex. The desire for sexual pleasure is also a major factor when some people decide not to use condoms.

Research has shown that framing sexual and reproductive health (SRH) counselling around sexual pleasure has a positive effect on safe sex practices.

It is time to shift from risk-focused healthcare to a comprehensive version that examines the complexities of sexual health and wellbeing. Capacity-building is the solution for healthcare providers to deliver better SRH counselling, recommendations and care.

For instance, the Global Advisory Board for Sexual Health and Wellbeing (GAB) has developed an innovative toolkit entitled “Sexual pleasure: The forgotten link in sexual and reproductive health and rights” to strengthen the skills of future health care professionals to provide quality SRH services. The toolkit is based on the GAB’s triangle approach linking sexual pleasure, sexual health, and sexual rights.

We also face the global challenge of reforming damaging policies and laws based on sexual taboos that impact people’s health in a variety of ways. For example, laws that criminalise homosexual acts, prevent LGBT+ people from accessing life-saving health services and commodities (such as condoms, lubricants and vaccines) and create an environment of stigma, violence, and persecution.

If for many people it is already difficult to go to a convenience store to buy a condom or lubricant or to enter a sexual health clinic for HIV/STI testing because of the social stigma associated with sexuality, imagine having to do this in a place where you can get imprisoned because you are gay or trans.

Laws that criminalise the possession of condoms deter sex workers from using them as protection against HIV and STIs. And policies forcing intersex people to undergo corrective genital surgeries violate their right to bodily integrity and may cause long-lasting negative effects in terms of their sexual wellbeing.

The fulfilment of sexual rights allows people to achieve and maintain a healthy, pleasurable sex life, and linking sexual health, pleasure and rights together provides a framework through which we can bring sexual justice and health for all.

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