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How sexual health programs could be more effective

Each year, billions of dollars are spent on sexual and reproductive health and rights (SRHR) programs around the world. These programs, usually funded by governments, often aim to change people’s attitudes and behaviors so that they are more likely to practice safe sex. However, the education and programming usually stress the dangers and risks of unprotected sex instead of highlighting the potential pleasure to be gained from sexual behaviors that are safe.

In a research paper published today in the open access journal PLOS ONE, scientists from Oxford University, The Pleasure Project and the World Health Organization report on a systematic review they made of public health interventions and their effectiveness. They included 33 unique interventions (18886 participants) described in published literature, all of which involved education programs to reduce the risks of HIV and STI infection. In addition, the researchers conducted a meta-analysis of eight of these intervention programs (6634 participants). Their aim was to establish whether incorporating considerations of sexual pleasure into education programs resulted in better outcomes in terms of sexual behavior.

Their analysis showed that acknowledging that sex is pleasurable and encouraging people to find pleasure in safe sexual behavior, such as condom use, had a significant positive effect on outcomes related to attitudes, knowledge and behavior in a sexual health context. They find that too many interventions make no reference at all to the fact that sex is pleasurable and this is a key driver of why people have sex in the first place. The researchers call for a fundamental rethink of how programs are oriented.

“Pleasure has been over-looked and stigmatized in health promotion and sex education, despite its obvious connection to sexual health and well-being,” wrote the study authors. “Our systematic review and meta-analysis, the first of its kind, shows that including sexual pleasure considerations in sexual and reproductive health services improves condom use and so may also improve sexual and reproductive health outcomes.”

The team argues that continuing to avoid the factor of pleasure in sexual health and education risks misdirecting or ineffectively using resources. They recommend that agencies responsible for developing sexual and reproductive health interventions need to affirm human sexuality and the reasons why people have sex in order to ensure that future sexual health interventions are effective. 

This recommendation comes at a time when governments are striving to implement the United Nations’ 2030 Sustainable Development Goals, particularly goals 3.7 and 5.7, that target universal access to sexual and reproductive health, and reproductive rights. 

“With fewer than ten years to go, and many countries not on track to meet these SRHR goals, interventions that incorporate pleasure may prove an important strategy to ensure that positive outcomes are obtained,” said the study authors.

“Policymakers and program managers should more readily acknowledge that pleasure is a key driver of sexual behavior, and that incorporating it in sexual and reproductive health services can reduce adverse outcomes.”

“Eight years out from the Sustainable Development Goal deadline, innovative strategies that can accelerate progress towards SRHR targets, including for STI and HIV prevention, are urgently needed. Programs adopting a sex-positive and pleasure-inclusive approach is one such innovation that should be urgently considered.”

By Alison Bosman, Staff Writer

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