Alice M. Miller

Sexuality, Human Rights, and Health

Sexuality can no longer be overlooked or ignored in work on health and human rights.1 The growing diversity of rights-based advocacy and documentation, and new initiatives in public health, health policy, and service delivery, have inevitably engaged questions of sexuality. At the international level, UN human rights bodies are increasingly taking on new norms and laws relating to sexual diversity, health, and harm.2 Local and national struggles for legal reform engage with sexuality and rights claims in the context of sexual violence, HIV/AIDS, and emerging demands for sexual non-discrimination. WHO has formulated newly revised definitions of sexual health and rights,3 and health policy-makers and planners increasingly address sexuality in their work. Health programmers recognize that effective health interventions require an understanding of complex sexualities, as well as of the constrained contexts in which many women and men exercise rights. While sexuality can no longer be ignored, it is not entirely clear what the nature or terms of its inclusion will be. In her work on global feminisms, Uma Narayan emphasizes the need to examine terms of inclusion in order to do accountable and self-reflective work.4 How will sexuality be

Advancing sexual health through human rights: the role of the law.

Since the International Conference on Population and Development, definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights.

Strategies to Prevent Cholera Introduction during International Personnel Deployments: A Computational Modeling Analysis Based on the 2010 Haiti Outbreak

Background Introduction of Vibrio cholerae to Haiti during the deployment of United Nations (UN) peacekeepers in 2010 resulted in one of the largest cholera epidemics of the modern era. Following the outbreak, a UN-commissioned independent panel recommended three pre-deployment intervention strategies to minimize the risk of cholera introduction in future peacekeeping operations: screening for V. cholerae carriage, administering prophylactic antimicrobial chemotherapies, or immunizing with oral cholera vaccines. However, uncertainty regarding the effectiveness of these approaches has forestalled their implementation by the UN. We assessed how the interventions would have impacted the likelihood of the Haiti cholera epidemic. Methods and Findings We developed a stochastic model for cholera importation and transmission, fitted to reported cases during the first weeks of the 2010 outbreak in Haiti. Using this model, we estimated that diagnostic screening reduces the probability of cases occurring by 82% (95% credible interval: 75%, 85%); however, false-positive test outcomes may hamper this approach. Antimicrobial chemoprophylaxis at time of departure and oral cholera vaccination reduce the probability of cases by 50% (41%, 57%) and by up to 61% (58%, 63%), respectively. Chemoprophylaxis beginning 1 wk before departure confers a 91% (78%, 96%) reduction independently, and up to a 98% reduction (94%, 99%) if coupled with vaccination. These results are not sensitive to assumptions about the background cholera incidence rate in the endemic troop-sending country. Further research is needed to (1) validate the sensitivity and specificity of rapid test approaches for detecting asymptomatic carriage, (2) compare prophylactic efficacy across antimicrobial regimens, and (3) quantify the impact of oral cholera vaccine on transmission from asymptomatic carriers. Conclusions Screening, chemoprophylaxis, and vaccination are all effective strategies to prevent cholera introduction during large-scale personnel deployments such as that precipitating the 2010 Haiti outbreak. Antimicrobial chemoprophylaxis was estimated to provide the greatest protection at the lowest cost among the approaches recently evaluated by the UN.

Sexual rights as human rights: a guide to authoritative sources and principles for applying human rights to sexuality and sexual health

Abstract This Guide seeks to provide insight and resources to actors interested in the development of rights claims around sexuality and sexual health. After engaging with the vexed question of the scope of sexual rights, it explores the rules and principles governing the way in which human rights claims are developed and applied to sexuality and sexual health, and how that development is linked to law and made a matter of state obligation. This understanding is critical to policy and programming in sexual health and rights, as it supports calling on the relevant range of human rights, such as privacy, non-discrimination, health or other universally accepted human rights, as well as demanding the action of states under their international and national law obligations to support sexual health. Résumé Ce Guide cherche à transmettre des connaissances et des ressources aux acteurs intéressés par le développement de revendications relatives aux droits autour de la sexualité et la santé sexuelle. Après avoir abordé la question controversée de la portée des droits sexuels, il explore les règles et les principes qui gouvernent la manière dont les revendications fondées sur les droits de l’homme sont développées et appliquées à la sexualité et la santé sexuelle, et comment ce développement est lié à la législation et devient une obligation étatique. Cette compréhension est essentielle pour définir les politiques et la programmation en matière de santé et droits sexuels, car elle soutient les actions exigeant de bénéficier de tout l’éventail des droits de l’homme, comme la protection de la vie privée, la non-discrimination, la santé ou d’autres droits fondamentaux acceptés universellement, tout en demandant aux États de prendre des mesures au titre de leurs obligations juridiques nationales et internationale de soutenir la santé sexuelle. Resumen Esta Guía tiene como objetivo brindar conocimientos y recursos a los actores interesados en la formulación de afirmaciones de derechos relacionados con la sexualidad y salud sexual. Después de abordar la controvertida cuestión del alcance de los derechos sexuales, explora las reglas y principios que rigen la manera en que las afirmaciones de derechos humanos son formuladas y aplicadas a la sexualidad y salud sexual, y cómo esa formulación está vinculada con la ley y pasa a ser cuestión de obligación del Estado. Este entendimiento es fundamental para las políticas y programación en salud y derechos sexuales, ya que apoya hacer un llamado a los diversos derechos humanos pertinentes, tales como privacidad, no discriminación, salud u otros derechos humanos aceptados universalmente, así como exigir que los Estados tomen medidas, de conformidad con sus obligaciones de derecho internacional y nacional, para apoyar la salud sexual.