LAUSR

Where sexual health refers to “a state of physical, mental, and social well-being in relation to sexuality,” [1] human rights provide a path to realise the highest attainable standard of sexual health for all [2]. Jonathan Mann first described the fundamental relationship between sexual health and human rights in the early years of the global AIDS response. He traced the arc between rights abuses and HIV transmission and provided a path to see sexual health and human rights as inextricably linked [3]. The close interrelationships between sexual health and human rights led to the development of an evidence-based but rights-affirming approach to sexual health, abandoning coercive tools of public health, reducing stigma and discrimination toward key populations, and focusing on the social determinants of sexually transmitted infections (STI) [4]. Sexual health is thus seen as deeply embedded in the social and structural fabric of societies, with rights-based implications for epidemiology, intervention design, behavioral science, harm reduction, and laws and regulations governing health. Yet, many evidence-based STI interventions are unavailable because those at greatest risk hide their lives and sexual desires and practices from clinics and services. This BMC special collection focuses on the critical nexus of sexual health and human rights. This topic was chosen because of three related trends – social determinants of sexual health, human rights implications of public health programming, and limitations of sexual health approaches that exclude rights. First, there is a broad and growing literature that seeks to understand how social determinants influence STI spread. For example, policing practices such as confiscating condoms among sex workers can profoundly shape the risk environment, increasing the risk of STI transmission [5]. On the other hand, respecting, protecting, and fulfilling the rights of key populations can decrease STI risk. An ecological analysis of gay civil unions in Europe found that passing gay civil union laws was associated with a 24% reduction in reported syphilis cases [6]. Second, human rights address basic needs and frame individual entitlements, conceptualizing universal frameworks to advance justice in public health [7]. Sexual rights are inherently important to human dignity and at the same time, instrumentally important to public health. Finally, there are clear limitations to public health programs that exclude rights. Many studies have found that programs ignoring human rights or related structural issues in sexual health ultimately miss their mark. Effective sexual health interventions require integration of biomedical, social and structural insights. This special issue is a collaboration between BMC Infectious Diseases and BMC International Health and Human Rights. It includes 13 original research articles and one debate article drawing attention to human rights barriers in accessing sexual health services, as well as the need for better measures to protect human rights, minimize discrimination, and promote sexual health. Gay men and other cisgender men who have sex with men (MSM), cisgender female sex workers (FSWs), transgender populations, and other key populations face substantial stigma, discrimination and gender-based violence (GBV), which are known to influence mental health and sexual risk practices. MSM have been shown to be at high risk of HIV infection. The study by Takano et al. observes a 3% prevalence of HIV infection among MSM in Tokyo [8]. Despite extensive research on the human rights abuses underlying sexual health, limited research has characterized the types and sources of stigma. Grosso et al. analyse factors related to stigma among MSM and FSWs in Sub-Saharan Africa [9]. These includes experiences such as being arrested, verbally harassed, blackmailed, or physically abused. Stigma is linked to healthcare workers, family, friends, and the police. Healthcare related stigma includes situations where patients are denied care, provided suboptimal care, or gossiped about by healthcare workers. * Correspondence: [email protected] Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building, Chapel Hill, NC, USA Social Entrepreneurship to Spur Health (SESH), Guangzhou, China Full list of author information is available at the end of the article