Social determinants of sexual health

Abstract

Byline: T. Sathyanarayana Rao, Rajesh. Gopalakrishnan, Anju. Kuruvilla, K. Jacob Sexual health can be defined as 'a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. [sup][1] Many complex issues including sexual behavior and attitudes, societal and cultural factors, biological risk and genetic predisposition, mental and physical illness influence sexual health. The limited data from India are from nonsystematic surveys and opinion polls, which explore a limited and superficial range of issues. [sup][2],[3],[4],[5],[6],[7],[8],[9] Social, cultural, economic, psychological, and genetic factors, which affect desire, attitude, behavior and practice are rarely investigated. The silence of the Indian culture on issues related to sexuality compound many issues including help seeking related to neurotic and anxiety disorders (e.g., Dhat syndrome), the HIV epidemic, reproductive tract infections, sexual violence, contraception, abortion services and female genital mutilation. Despite the Kama sutra, Indian society is extremely conservative about sex and is ambivalent about sex education in high schools. The barriers to sexual well-being include issues related to individual empowerment and choice, access to educational and clinical services, social stigma, discrimination and sexual violence. Even professional medical education does not transfer skill and confidence related to sexual health and sexual medicine. [sup][10],[11],[12],[13] The resultant vacuum is often exploited by healers who also propagate sexual misconceptions and misinformation. The cultural ambivalence and manifest conservatism result in a lack of political will to improve sex education in schools and formulate and implement policies related to sexual health. Existing Policies, Plans and Practice The National AIDS Control Program, with its focus on educating the general population about responsible sexual behavior, safer sex and condom use has had a significant impact. The reduction in the rate of HIV transmission in the country suggests success. [sup][14] The extensive treatment provision for HIV and AIDS is also an achievement. On the other hand, the National Family Welfare and the Reproductive and Child Health Care programs have focused on antenatal care, hospital deliveries, immunization and contraception with an emphasis on postpartum sterilization. Sex education in schools has met with resistance and has had a restricted impact across the country. Although India has some policies on paper, the approach is fragmentary. In addition, the principal thrust based on health, makes it one-dimensional and much less effective. Addressing Social Determinants Countries, which have accepted the need for a national policy, approach the task from a broad base employing multisectoral perspectives. The World Health Organization (WHO) has developed a framework, identified opportunities and challenges and recognized the need for contextualization and adaptation to cultural contexts in order to help promote appropriate, affordable, and accessible sexual health programs of high quality. [sup][15],[16] The WHO has argued for a broader context to sexual health going beyond fertility and reproduction and including sexual dysfunction, disability, sexual violence and sexuality. It has grounded the framework within international human rights and affirmed a rights-based approach to sexual health. The framework has argued for social determinants and includes: (i) law, policies and human rights, (ii) education, (iii) society and culture, (iv) economics, and (v) health systems. [sup][15],[16],[17] Legal mechanisms are crucial in introducing health intervention, protecting human rights and guaranteeing promotion, protection and provision of sexual health information and services. Laws can also help prevent discrimination related to sexuality and lifestyle. …