Every year hundreds of millions of new sexually transmitted infections are recorded, and more than a billion people live with one, yet the systems built to address these realities have long been designed far from the communities they serve. Two researchers writing for The Conversation hold that decades of exported programmes, shaped by northern priorities and funded by distant institutions, have measured success narrowly through disease and contraceptive numbers while leaving intimacy, pleasure and self-determined wellbeing unexamined. Their argument is less an indictment than an invitation: t
Global Sexual Health Must Move Beyond Exporting Interventions to Learning From Communities
Over one billion people live with STIs and an estimated 225 million women who want to avoid pregnancy lack effective contraception; sexual violence by UN peacekeepers in Haiti left survivors without justice.
Less teaching the global south, more learning from it
Mark
What's the core claim here?
Mimi
That sexual health programmes have mostly been designed in the north and delivered in the south, with success defined by outsiders, usually through things like HIV incidence or contraceptive uptake.
Mark
And the numbers back that up?
Mimi
They use the numbers to raise a question: 374 million new cases of four major STIs a year, over a billion people living with an STI, 225 million women not using effective contraception despite wanting to avoid pregnancy.
Luke
Careful, though. Those figures show the problems persist. They don't show the dominant frameworks caused that or that another approach would do better. The authors pose it as a question.
Mark
Is there any evidence for the pleasure-focused alternative?
Mimi
They cite a review of 33 pleasure-inclusive interventions, 25 of them in the United States. So the evidence is thin in the global south, which is part of their point.
Luke
It's also a reason to be cautious. Few trials in the places they care about means we can't say yet how well it works there. The claim that it improves outcomes is framed as a possibility.
Mark
What about the Haiti example?
Mimi
It's used to show what happens when accountability is weak: UN peacekeepers' abuse of women persisted and survivors had little recourse.
Luke
That's one illustration. The piece doesn't say how widespread the pattern is. And this is an opinion piece by researchers arguing a position, so the recommendations are proposals, not findings.
Il Polso
- Hundreds of millions of new infections each year and hundreds of millions of women without effective contraception make the scale of the problem impossible to ignore.
- Decades of externally designed programmes have met their targets while communities report needs that the targets never measured.
- Sexual violence by UN peacekeepers in Haiti left survivors with little access to justice, exposing how accountability gaps follow power imbalances.
- Researchers are pushing to widen the evidence base beyond disease prevention to include pleasure, autonomy and belonging, drawing on Indigenous and African ways of knowing.
- The authors call for community-led services, funding shifted toward southern institutions, and a reckoning by donors with their own power, and the outcome now depends on whether money actually moves.
Every year hundreds of millions of new sexually transmitted infections are recorded, and more than a billion people live with one, yet the systems built to address these realities have long been designed far from the communities they serve. Two researchers writing for The Conversation hold that decades of exported programmes, shaped by northern priorities and funded by distant institutions, have measured success narrowly through disease and contraceptive numbers while leaving intimacy, pleasure and self-determined wellbeing unexamined. Their argument is less an indictment than an invitation: to let knowledge rooted in the global south, and in older traditions of listening to the body, help define what sexual health is and what it is for.
Every year more than 374 million new cases of four major sexually transmitted infections are recorded, more than a billion people live with an STI, and an estimated 225 million women who want to avoid pregnancy still lack effective contraception. Madison Moore and Laura Gemmell-Sinnott, researchers affiliated with Columbia University, argue that decades of investment have not resolved the field's largest problems, and that the frameworks guiding that investment need close scrutiny.
Their central concern is the direction of travel. Programmes on contraception, abortion, maternal care, HIV, sexuality education and sexual violence have largely moved from the global north to the global south, carrying with them the questions that count and the definitions of success. Pleasure, desire and what communities themselves mean by wellbeing have received far less attention. The authors draw on their own work in Kenya and Mozambique, and on Indigenous expertise from Aotearoa New Zealand, to show how colonial history and unequal funding shape whose knowledge is treated as legitimate.
The existing approach has saved lives, and the authors do not deny it. But when success is counted only in incidence and uptake, intimacy and bodily autonomy go unrecorded. In Haiti, sexual abuse by UN peacekeepers went largely unanswered, leaving survivors without real recourse. The evidence base mirrors the imbalance: of one review's 33 pleasure-inclusive interventions, 25 were run in the United States.
To imagine something different, the authors look to other traditions. Ngāhuia Murphy reframes menstruation as sacred rather than shameful through Māori cosmology, Minna Salami advocates a sensuous knowledge rooted in the body, Somali oral poetry has carried health understanding and resistance for generations, and Yoruba thought treats knowing as something felt as well as reasoned.
Their recommendations centre southern communities in decisions, widen success to include joy, safety and belonging, support locally led services, and shift funding and authority toward southern institutions. None of this rejects science, they insist; it widens what counts as evidence and who produces it. The closing thesis is simple: the future of global sexual health should rely less on teaching the south and more on learning from it, and the real test is whether donors follow through.
Every year, more than 374 million new cases of four major sexually transmitted infections are recorded worldwide. More than one billion people are living with an STI. And an estimated 225 million women who want to avoid pregnancy are still not using effective contraception. Those figures open an argument made by two Columbia University-affiliated researchers, Madison Moore and Laura Gemmell-Sinnott, who say decades of investment have not resolved the field's biggest problems, and that the frameworks behind that investment deserve scrutiny.
Their starting point is the direction in which decisions have travelled. Choices about contraception, abortion, maternal healthcare, HIV prevention and treatment, sexuality education, gender equity and protection from sexual violence have largely moved from the global north to the global south. Researchers, donors and international organisations have exported programmes, defined what success looks like, and decided which questions matter. How can HIV be prevented? How can contraceptive uptake rise? How can maternal deaths fall? Questions about pleasure, desire, or what communities themselves mean by sexual wellbeing have received far less attention.
The authors write from experience. Their team has worked on HPV vaccine implementation in Kenya and HIV prevention in Mozambique, and with the United Nations Population Fund and academic, governmental and nongovernmental partners on sexual rights, pleasure and health. The team also includes Indigenous health and policy expertise from Aotearoa New Zealand, including research grounded in Hauora Māori approaches. Their recent commentary examines how colonial histories, unequal funding and global research hierarchies shape where knowledge is produced and whose counts as legitimate. In their account, global south communities are treated as places where interventions are delivered rather than places where ideas originate.
They acknowledge what the existing approach has achieved: global efforts on HIV and contraception have saved countless lives. But when programmes are built around externally set priorities, they argue, they can miss what people need. Success gets measured through HIV incidence or contraceptive uptake, while intimacy, bodily autonomy, reproductive choice and pleasure go uncounted. In some settings, they say, this focus has overlooked sexual violence and pushed local priorities aside for donor agendas. Their example is Haiti, where sexual exploitation and abuse of women by UN peacekeepers persisted amid major gaps in accountability and legal recourse, leaving many survivors without meaningful routes to justice.
The evidence base carries the same imbalance. In one systematic review of 33 pleasure-inclusive interventions, 25 were conducted in the United States, and very few in the global south. The authors suggest that acknowledging why people have sex, and not only the risks they want to avoid, could make interventions more relevant and improve health outcomes. They note growing recognition, reflected in the recent Porto Proclamation on Sexual Health, Rights and Justice, that the field needs more equitable collaboration and shared leadership, and that some programmes are now being developed with affected communities.
To show what other ways of knowing look like, they point to several traditions. Researcher Ngāhuia Murphy draws on Māori cosmologies to challenge colonial narratives that cast menstruation and women's reproduction as shameful or impure, describing them as sacred and life-giving. Feminist author Minna Salami argues for "sensuous knowledge," grounded in relationships, lived experience and the body, in contrast to the "hard" knowledge of dominant European traditions. In Somalia, oral poetry has long carried knowledge and resisted colonial power, and scholars have argued it can inform understanding of health and bodies, not by replacing scientific evidence but by capturing what conventional methods miss. Nigeria's Yoruba traditions likewise treat knowledge as something experienced through the senses as well as reason.
Their recommendations are specific. Put global south communities at the centre of decision-making. Measure success beyond disease prevention to include joy, safety, intimacy, autonomy and belonging. Embed anti-racist, feminist, LGBTQ+ and indigenous perspectives. Support community-led services, where local organisations help decide what is offered, how it is delivered and how success is defined. Shift funding and decision-making power toward global south institutions, and have researchers and funders examine how their own positions and institutional power shape the work.
The authors stress that none of this means abandoning science; it means widening what counts as evidence and who produces it. Their closing line states the thesis plainly: the future of global sexual health should depend less on teaching the global south and more on learning from it. Whether donors move money and authority accordingly is the thing to watch.
Citazioni salienti
None of this means abandoning science; it means broadening what counts as evidence and who gets to produce it.— Madison Moore and Laura Gemmell-Sinnott, authors
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