ABSTRACT

Over the course of the past three decades, there has been a veritable explosion of work in the field of sexuality, both conceptually and methodologically. From a relatively limited field, dominated primarily by biomedical and sexological inquiry, the study of sexuality has expanded across a wide range of social sciences. The signs of a field ‘coming of age’ are everywhere: new scholarly and scientific journals have been launched; new interdisciplinary research centres have been formed; innovative academic degree programmes have been created; established foundations and research funding agencies have made sexuality a programmatic priority; and the volume of publications reporting sexuality research findings has rapidly increased. While much of this development has taken place in leading intellectual centres of resource-rich countries, the trend is clearly global, with important new developments taking place as much in the south as in the north. Many factors have influenced the changes that have taken place. First, social science disciplines such as history, anthropology, sociology and psychology sought to find new ways of understanding a rapidly changing world in which sex and sexuality are highly visible. Second, growing attention towards sexuality – both academically and in policy terms – has been triggered by a set of increasingly visible social movements. These include the feminist, gay and lesbian and men’s movements that emerged from the 1960s but whose influence reached ascendancy in the 1970s and the 1980s. Finally, growing concern for issues such as population and development, women’s and men’s reproductive health, HIV and AIDS and young people’s rights has provided new legitimacy for work of relevance to sex, sexuality and health. As a result of these different sources of impetus, there has been growing concern to investigate and understand aspects of life that can be defined as broadly ‘sexual’. These include the social, economic, historical and cultural factors shaping sexuality in different settings, as well as the complex and often contradictory meanings associated with sexual experience both for individuals and social groups. Of special concern, at least within the fields of population science and public health, have been efforts to delineate the individual determinants of sexual behaviour and behaviour change, most usually defined in terms of demographic correlates or the variable present within psychological models of behaviour change. The focus of much of this work has been on the promotion of reproductive health – defined most usually in terms of the absence of sexually transmitted infections (including HIV) and unwanted pregnancy. In recent years, the focus has shifted yet again to engage more explicitly with other forms of explanation and a rather different set of social goals. The notion of

sexual health as ‘absence of disease’ has itself been questioned, with some researchers and policymakers calling for more affirmative understandings of the concept. The intimate relations between sexuality, sexual expression and power have been unpicked by feminist scholarship examining women’s roles and gender violence as well as by research within the fields of lesbian and gay studies and masculinity studies. Even more recently, postmodern research and queer theory have encouraged an understanding of sexuality and sexual expression as performance, linked to ‘positionality’ and location within the social structure. Increasingly, too, there have been calls for a clearer specification of the links between sexuality, sexual health and rights – including the human rights already recognised in national laws and international human rights documents and other consensus statements, but extending beyond these to include specifically sexual rights – including the right to the highest attainable standard of sexual health; the right to seek, receive and impart information related to sexuality; the right to respect for bodily integrity; the right to decide to be sexually active or not; the right to consensual sexual relations; the right to decide whether or not, and when, to have children; and the right to pursue a satisfying, safe and pleasurable sexual life. Together, these multiple sources of impetus have extended, and to some extent fractured, the terrain of what counts as sexuality – calling into question hitherto unproblematised notions of sex and sexual relations, what it might be to be sexually healthy, and what it might mean to exercise one’s sexual rights. It is against this backcloth that this Handbook has been developed, to offer in one location an authoritative introduction to key writers, key material and key debates. By far the majority of chapters take the form of original contributions, although a small number of papers have been reprinted in abridged form from elsewhere. Our goal is to offer readers an authoritative overview of current understanding within the interrelated fields of sexuality, sexual health and sexual rights. We trace the origins of big debates, describe the current state of play in particular fields and hint at where the future might be taking us. Our aim has been to offer a comprehensive yet accessible account of these and related concerns. The book is organised into eight main sections, each of which concerns both a particular historical moment and a specific set of issues. We begin with pioneering beginnings, or what might be loosely called the genealogy of the present. Here, we learn from the work of Margaret Sanger, an early pioneer for women’s reproductive rights, who was imprisoned in 1917 for distributing diaphragms to immigrant women in Brooklyn, New York. We learn, too, of the work of Alfred Kinsey whose background in biology and whose work on sexual behaviour in women and men laid the foundations for generations of research to come. Anthropology’s contribution to the developing field of sexuality has been immense through the work of scholars as diverse as E. E. Evans-Pritchard, Bronislaw Malinowksi, Claude Lévi-Strauss, Ruth Benedict and Margaret Mead, to name but a few. Finally, the contribution of historical and sociological explanation – and the seminal contribution of scholars such as Michel Foucault, John Gagnon and William Simon – needs to be acknowledged, both for its capacity to illuminate the diverse aspects of sexuality, and for the value of particular frameworks of understanding in advancing understanding of the field. The second part of the handbook moves the reader forward in time but picks up on the theme of symbolism and meaning in the work of anthropologists and sym-

bolic interactionist sociologists. Its focus is on language, discourse and sexual categories, examining the different ways in which sexuality has been constructed linguistically and discursively. All the chapters here highlight the ways in which sexual acts take their meaning from particular cultures, norms and beliefs about the self and the world. Sexual practices are socially produced, having little meaning outside the context in which they take place or are enacted. The same is true for self-understandings in general and sexual self-understandings in particular, with language being central to the construction of sexual identities. Chapters examine the ways in which tombois and their girlfriends understand and construct their sexuality in Indonesia, the growth and proliferation of minority sexual identities in Thailand, and the social identities of same-sex attracted men in Senegal. Because all constructions of sexuality have a past that must be appreciated in order to understand the present, history and context are given centre stage. By analyzing the experiences of goor-jigeen (man-woman) in Senegal, hijra (an indigenous transgender category) in India and modern day ‘gay men’ in Thailand, contributors reveal how political power, religious and spiritual influence, colonialism and globalisation, all have a role to play in shaping individual lives and sexual communities. The impact of biopower and the biomedical gaze is also explored in relation to intersexuality and gender determination, as well as in public health practice. A rather different set of issues is explored in Part III, which focuses on the emergence of, first, reproductive and, later, sexual health. Paralleling interest in language, discourse and meaning were efforts by researchers, policymakers, activists and practitioners to intervene in sex. Many early interventions – particularly within the field of sexology but also in relation to childhood sexuality – aimed to normalise the ‘abnormal’, eradicate the ‘unacceptable’ and improve sexual function. Autoeroticism and childhood masturbation were a focus for much early intervention, as were efforts to ‘cure’ homosexuality and same-sex activity. But also of importance were efforts to prevent unplanned pregnancies through family planning and population control. In their earliest incarnations, these different concerns (albeit in different ways) sought to constrain the expression of sexuality to reproduction. Masturbation and same-sex activity were wrong because they misdirected sexual energies away from their ‘natural’ ends. Intervention was necessary to correct these deviations. Increasingly, biomedicine was thought to provide the answers, giving rise both to sexology and to demography as ‘scientific’ disciplines, firmly encompassing sexuality within the field of health. Both sought both to normalise and to control – with sexology focusing on the individual and demography the population as a whole. With the passage of time, however, and under the influence of diverse forces of feminism, technological development, libertarianism and lesbian and gay activism, a growing concern with pleasure and rights emerged. This caused both an expansion of what hitherto had been understood as the ‘sexual’ (radically decoupling its links with reproduction), and a growing concern with responsibilities and rights. Sex broke free from narrow confines the reproductive, giving rise to a diversity of expression. Pleasure seeking and sexual enjoyment were placed centre stage, being viewed as central to any understanding of how sexual life is lived and organised. In their different ways, chapters within Part III engage with these themes, highlighting concern with childhood sexuality, the growth of sex ology, concern for reproductive health and the emergence of sexual health. They highlight, too, the importance of social factors in influencing understandings of sexuality both negatively or more

positively – in moral panic over teenage pregnancy or in struggles for the rights of all people to sexual autonomy, sexual integrity and sexual freedom. The fourth part of the Handbook looks at the profound impact that HIV has had on sexuality research and practice. Social science research attention to issues of sexuality had begun to gradually increase during the 1970s, and international research was almost completely dominated by demography and population studies, when AIDS was first recognised in the early 1980s. Not surprisingly, the initial research response to the epidemic, in North America, western Europe and the countries of the global south, was shaped by the concerns of behavioural medicine and population sciences, and tended to focus on surveys of sexual behaviour with the goal of both better understanding the behavioural dynamics of sexual transmission and providing information on cognitive and behavioural interventions to reduce the risk of infection. From the very beginning of the epidemic, however, serious questions were raised – often by the members of affected communities – about the kinds of knowledge that would be necessary to respond positively to HIV and AIDS. Indeed, this section of the Handbook takes its title from a well-known book, How to Have Sex in an Epidemic: One Approach, co-authored by AIDS activists, Michael Callen and David Berkowitz, together with Joseph Sonnabend, which outlined the tenets of safe sex from a gay community-based perspective long before public health officials or institutions had begun to come to terms with the need for explicit and detailed approaches to the epidemic. Over the course of the 1980s and the 1990s, in work carried out by social researchers such as Dennis Altman, Herbert Daniel, Cindy Patton, Paula Treichler and Simon Watney, with strong links to community activism around HIV and AIDS, a critical alternative approach to HIV and AIDS research began to emerge that has shaped much of the most important work being carried out on these issues over the course of the 1990s and up to the present day. This work has raised important and ongoing questions that are explored in this part of the Handbook about the epistemological assumptions that have guided HIV and AIDS research, as well as about the political dynamics that have shaped the ways in which narrow approaches developed in resource rich settings have often been exported to and uncritically imposed in often strikingly different social and cultural environments. As these selections suggest, the complex interplay between sexual risk and other health-related and recreational practices has become an important focus for research, as have been the forms of sexual practice engaged in by people living with HIV as well as those living in affected communities. One of the important consequences of increased research attention given to sexuality and sexual practices in the wake of HIV and AIDS was new attention to the social organisation of sexual performances. This emphasis had important precursors or antecedents in some of the earliest work on the sociology of sexuality, particularly in the work of John Gagnon and William Simon on sexual scripts. While the metaphor of sexual scripts has had major impact, in seeking to document and interpret the structure of sexual practices much recent work has shifted attention from the dramaturgical language of scripts and performances to more multidimensional and sensual metaphors of dance, as exemplified in the fifth part in this Handbook. Work along these lines has sought to characterise the unfolding of sexual meanings and interactions in their materiality and corporality not merely as a script but as a kind of enactment, a kind of complex dance in which both predetermined steps and unexpected improvisations can take place. As the chapters in this part suggest,

the notion of choreography can be taken quite literally, as in chapters focusing on the social universe of exotic or erotic dancers or on the interactions of urban minority youth in hip-hop clubs and related venues. But it can also be far more metaphorical, as a way of thinking about the symbolic ‘mating’ and ‘partnering’ dances that play themselves out in the social and sexual interactions of young people, male sex workers and their partners, gay and bisexual men and others who cannot be neatly characterised by any of these labels – and in settings as different as the cities of contemporary Iran, the beaches and resort towns of tropical Dominican Republic, the gay communities of current day Australia and the erotic urban landscapes of urban Brazil. It should be clear from what has been said that both sex and sexuality hold both empowering and destructive possibilities, and it is to the darker side of sex that Part VI turns. In both rich and poor world contexts, so much of sex ties not to autonomy, reciprocity and mutuality but to the expression of power and control. We can see this in extreme forms in the case of gender violence, sexual abuse and rape. But other more subtle forms of expression take place in everyday relationships – in name calling, harassment and verbal abuse; in stereotyping and discrimination; and in general unwillingness to accept the rights of sexual minorities such as lesbian, gay, bisexual and trans individuals. Many of these negative actions have their origins in deeper structures of gender, age, class and race but give rise to damaging forms of misogyny, sexism and homophobia. Part VI of the Handbook engages with a broad range of relevant concerns focusing first on sexual and intimate partner violence with a particular focus on women’s experience globally. In explaining welldocumented patterns of abuse, it is important to look at structural factors influencing women’s and men’s roles, expectations and behaviours, including the importance of social reputation and opportunity structure determining sexual misbehaviour, unfaithfulness and abuse. The mass media have an important role to play in promoting negative stereotypes and practices as well as positive ones, establishing a taken for granted sense of normalcy that influences both women’s and men’s actions. Yet the ‘normal’ carries with it a darker side. Some of the least talked about forms of sexual abuse take place in family settings – in the form of incest, sexual exploitation and gender violence. Difficulty talking about these makes them appear unusual, abnormal and strange, yet they may constitute the normative experience of many young women and men all over the world. In all-male environments such as the military and prisons, sex may be used both as a weapon and as a commodity, turning some men into ‘women’ and reasserting in the male perpetrators of sexual violence and rape a misplaced sense of their own masculinity. Finally, in contexts where legal, political and religious systems provide legitimacy for sexual violence and abuse, practices such as the ‘corrective rape’ of lesbians may prevail, being sanctioned both by the local community and society at large. These are but a few of the issues examined here. Each on its own is major cause for concern. Collectively, they demonstrate the necessity for wider struggles for justice and sexual rights. It is precisely because of such concerns that among the most significant developments in work focusing on sexuality during recent decades has been the growing attention that has focused on issues of sexual rights. As we emphasise throughout this Handbook, it is important to understand that this recent work has deep roots and important historical antecedents – many of the very earliest figures in sexology and

sexological medicine viewed themselves as social reformers and progressive advocates for sexual freedoms. These longstanding historical precursors were also reinforced in important ways by many of the leading figures in the social science of sexuality that took shape in the 1970s and the 1980s – many of the first historians, anthropologists and sociologists who began to carry out research on sexual topics during this period were participants in progressive political movements, and frequently had to work outside the structures of traditional academic life as independent scholar/activists. As work on sexual health began to take on growing importance over the course of the 1980s and the 1990s, both in relation to the fields of population and reproductive health and in relation to HIV and AIDS, growing concern began to focus on the ways in which gender and sexuality are frequently implicated in, and impacted by, the most horrific forms of abuse and violence – not only through the kinds of action and circumstance discussed in chapters included in Part VI, but also through the very structures and practices of medicine, science and other contemporary social institutions. In both the field of reproductive health and of HIV and AIDS, by the early 1990s leading thinkers and activists had become convinced of the need to move from a focus on health, in and of itself, to a new emphasis on rights – and on the relationship between health and rights. In the field of reproductive health and rights, this new turn became especially evident in the build-up to the global conferences of the mid-1990s, the United Nations Conference on Population and Development held in Cairo in 1994 and the Fourth World Conference on Women held in Beijing in 1995, as the global women’s movement mobilised around efforts to move reproductive and sexual rights from the periphery to the centre of meaningful debate. In very similar fashion, in work focusing on HIV and AIDS, what initially began as a defence in the face of widespread stigma and discrimination was increasingly transformed into proactive efforts first on the part of activists and civil society advocates, but increasingly also on the part of official agencies and governmental institutions to make health and human rights the overarching conceptual architecture for approaching sexuality. As articulated in Part VII of the Handbook, this framework has increasingly been expanded over the course of the past decade and a half, through efforts to defend the rights of young people (among others) to information and education about sexuality, the rights of those who fall outside the strictures of normative patterns in relation to gender and sexuality, and of all those who suffer abuse and violence for any reason linked to gender or sexuality. But these chapters also explore the political limits of ‘victimisation’ as a strategy for social protection and the complex nuances of assuming (or not) specific sexual identities in relation to both health and sexuality. They tell a compelling story of the long struggle, at a global level, to move beyond reproductive rights to a more all-encompassing conception of sexual rights. And they tell a perhaps somewhat surprising (at least for some) story of how much some supposedly well-to-do and advanced societies can learn in this regard from work on sexual rights that is being carried out at the local level by frontline, community-based organisations even in some of the most resource-poor or resource-constrained settings. Finally, in Part VIII, the chapters that have been included to round out this collection focus on a range of the most cutting edge struggles for erotic justice that are currently underway in diverse communities around the world in defence of sexual rights and sexual citizenship on the part of people at the grassroots seeking to build

better sexual lives for themselves and their communities. While these battles are often waged at a very local level, far from the transnational networks and the formal spaces of rights discourses, they offer clear evidence of the broad relevance and that deep power that values such as equity and justice can have in the most diverse settings. In the lives of Ugandan sex workers, young people living with HIV in Brazil, queer South Africans, sexual immigrants from Latin America seeking asylum in the USA, Cuban queers in the black diaspora and black lesbians struggling with normative social and cultural structure of both mainstream society and alternative lesbian and gay communities, we find examples of struggles for sexual freedoms that vividly characterise life in the early twenty-first century. In bringing together the contributions that make up this Handbook, we have worked hard to develop a text that offers a scholarly yet accessible overview of the diverse and rapidly developing field of sexuality studies today. In doing so, we have sought not to privilege any one particular perspective but rather to offer an up-todate overview of the field of sexuality, health and rights. By describing past origins, present trends and future possibilities, we want to offer readers insight into an area of work that has captured our own imaginations for many years now. We hope you find this book helpful and a useful source of reference for many years to come.