Cornell et al's “Sexualities, social justice and sexual justice” (2018, 2023)
“Sexualities, social justice and sexual justice”
Mainstream global public health research into sexualities is rooted within the biomedical paradigm, focusing on risk factors and negative health outcomes associated with sexuality (Mitchell et al. 2021). In some ways, this body of research has played a vital role in addressing health inequalities and promoting sexual health. However, the tendencies toward essentialist and deficit-focused bias in much mainstream public health research have produced binary and often pathologizing understandings of sexuality that ignore questions of power, context, and sexual diversity (Corrêa et al. 2008; Mitchell et al. 2021).
As Tiefer (2018, p.188) reminds us: “Because sexuality is a contested political terrain where various ideological forces struggle for legitimacy and cultural authority, all discourse about sexuality, including scientific and clinical discourses, represents some worldview and political agenda.”
Non-Christian religions have their own complex relations to sexuality, often also highly controlling, but also sometimes acknowledging, even incorporating, sexual and gender diversity within their corpus. For example, same-sex sexualities figure in some early Hindu texts and depictions, and with its embedded polythesism numerous Hindu deities could be said to be genderfluid (Chakraborty and Thakurata 2013), even while there are dangers of placing such forms into Western categorizations. Despite most formal interpretations of the Quran, there is also a long history of same-sex, nonheteronormative, and homoerotic acts and desires within some Muslim societies, however often without individual sexual self-identification in these terms (Schmidtke 1999). There are also innumerable examples of diverse gender and sexual forms in non-Western and indigenous societies, such as hijras, muxes, and various “third sexes” and “third genders” (Herdt 1994).
Kinsey’s work was greatly influential in terms of challenging dominant assumptions around what constituted “abnormal” sexual activity. He demonstrated that many sexual practices that had been labeled perverse by earlier scholars were, in fact, widespread and commonplace (Bullough 1998; Tiefer 2018; Todd 2021). Kinsey’s work upended the widely held view that the private sexual behavior of the general US public adhered to “official cultural sex norms,” (i.e., no masturbation, adultery, or premarital sex) (Tiefer 2018, p. 13; see also Kinsey et al. 1975, 1978).
Tiefer (2018) contends that the weight placed within sexology on the naturalness of sexuality was rooted in the desire by these scholars to justify and legitimize the study of sex and, in turn, their own respectability as scholars.
In the broadest terms, the “sexology paradigm” that emerged through much of the work of these early scholars centered on the pursuit of: a “scientific” explanation of sexual behavior; the medicalization and psychologization of sexuality (i.e., the disciplines of medicine and psychology/psychiatry exercising authority and control over sexual behavior); and the promotion of essentialist understandings of sexuality (Corrêa et al. 2008; Tiefer 2018). Regardless of the diversity and variability in the range of sexual preferences and behaviors these early sex researchers documented, they still assumed sexual categories were universal (Tiefer 2018). The essentialism underlying this founding body of sexological work has come to provide the prevailing framework for wider societal understandings of human sexuality (Parker 2009).
[E]arlier sexological approaches repressed and ignored the knowledge of many of the people whose sexual behaviors and identities they sought to classify (Weeks 2015). As Jeffrey Weeks (2015, p. 1095) suggests, “the subjects of scientific investigation and definition have their own voices, and are not prepared to simply accept what they are told.”
African countries were the focus of a great deal of this [HIV/AIDs] research as many Western researchers and international development organizations descended upon the continent (Patton 1990; Tamale 2015). Sylvia Tamale (2015) suggested that HIV/AIDs became, in turn, a multibillion dollar industry, which led to the commodification of sexual health. The majority of this body of research was epidemiological and neglected the sociopolitical dynamics of the epidemic, engendering a “profound re-medicalization of African sexualities” (Tamale 2015, p. 25). Western science consolidated around the construction of “African AIDS” (Patton 1990), which was homogenizing, pathologizing, and rooted in colonial understandings of African sexualities (Patton 1990; Tamale 2015). Within this body of research, sexuality in Africa was often viewed as “insatiable, alien and deviant” (Tamale 2015, p. 25) and the bodies of African people were constructed as diseased and “other” (Patton 1990).
However, there was at the same time, particularly by gay activists and places like South Africa (Mbali 2013; Singer 1994), a surge of pioneering activism and research around HIV/AIDs which advocated for more effective and nuanced interventions and scholarship around sexuality and health and drew attention to the need to consider local knowledge and local practices for understanding sexuality (Boyce et al. 2007; Corrêa et al. 2008; Plummer 2020). Crucially, this scholarship and activism highlighted the contestation, fluidity, and variability of sexual practices and behavior, and illustrated how constructions of sexuality and epidemiologies are context dependent (Boyce et al. 2007; Plummer 2020). As Weeks (2015, p. 1095) suggests, an essentialist/constructionist split “still cuts across the global response to HIV/AIDS, posed as a separation betweenmedicalized interventions and social, cultural, and political responses.”
[M]any contemporary medical, psychiatric, and psychological texts in the main continue to classify sexual behaviors and predilections that fall outside of a “procreative model for sex” as abnormal, including, for example, the desire for pain during sex and the preference for masturbation or oral sex over penetrative sex (Tiefer 2018, p. 11).
An emphasis on risk factors and adverse sexual health outcomes has dominated research in this area, overshadowing other aspects of sexuality within public health (Mitchell et al. 2021; Epstein and Mamo 2017). Sexual health, for example, has often been framed purely in terms of disease prevention and surveillance rather than the quality of sexual experience, with concepts such as agency or pleasure all too frequently 8 J. Cornell et al. ignored (Epstein and Mamo 2017; Wellings and Johnson 2013; Shefer 2019). This narrow and deficit-focused perspective limits the possibility of adequately comprehending and addressing everyday sexual issues and experiences (Mitchellet al. 2021).
In South Africa, for example, public health scholarship has frequently reproduced colonial, pathologizing, deterministic, and raced representations of sexuality (Ratele 2022; Shefer 2019) that position Black women as victims and Black men as violent in relation to sexuality (Boonzaier and Kessi 2018; Ratele 2018; Shefer 2019).
[C]ritical approaches to sexuality do not discard biological perspectives, but rather view biology as one of many interconnected ways of comprehending sexuality (Marzullo 2021). Furthermore, sexuality is always shaped by a range of other intersecting identities, such as class, race/racialization, gender, ability, religion, nationality, and age and cannot be understood in isolation from these other subjectivities (Crenshaw 1991; Plummer 2020).
As Fahs and McClelland (2016, p. 408) suggest, it is vital to consider “the ways that sex and power collide and, ultimately, who is asked to pay for this collision.”
How sexual health and sexual rights are experienced, for example, is inconsistent across historical periods, nations, and between people of different intersecting identities within the same contexts (Corrêa et al. 2008; Tamale 2015). Although there are a number of common trends that have shaped the understanding of sexualities over time, the dynamics of contemporary sexualities manifest differently in different countries (Plummer 2020: 168).
David Bell and Jon Binnie (2000, p. 4) consider “the city as a stage” and underscore that urban contexts are asymmetrically organized geographies produced by inclusions and exclusions depending on gender, sexual identity, race, and further social relations (p. 84), with clear implications for health and public health.
The problem of coloniality and how it shapes researchers’ questions and interpretations has received almost no attention from Whitestream Western public health. So have racism and capitalism been relatively disregarded. In addition, at the level of epistemology and method, the essentialist, empiricist, and behavioralist bias in much mainstream public health research has meant that traditionally sexualities research has tended to ignore the researchers’ positionality and influence. Scientific “objectivity” has been the principal argument for this inattention and bias. Teunis and Herdt (2007, p. 22) suggest that this drive for objectivity can be seen as an attempt by some to keep control within the academy over the disruptions from queer, feminist, and decolonial scholarship on sexuality. Indeed, in keeping with traditions of feminist theory and research, critical work on sexualities must “go beyond apologizing for a lack of objectivity” and directly acknowledge that researchers’ subjectivities are “precisely what make sexuality research possible and insightful” (Teunis and Herdt 2007, p.17).
This emphasis on self-reflection and critique (both of individual researchers and the discipline more broadly) is particularly crucial for public health–orientated work in light of the way that much mainstream public health research has been responsible for perpetuating harmful and stigmatizing representations of sexuality (Boonzaier and Kessi 2018; Ratele 2018; Shefer, 2019). This is also especially important for research projects, in which scholars from the Global North may be studying sexualities within the context of the Global South or in collaboration with researchers from the Global South.
Assumptions around heteronormativity, for example, are evident in the narrow emphasis on “sex as intercourse, sex within the context of heterosexual marriage, sex as necessarily penetrative (and risky), and sex as producing orgasm” within much mainstream research on sexualities which ignores a wide range of sexual practices, identities, and experiences (Fahs and McClelland 2016, p. 394).
Decoloniality recognizes “the continuities in the decimation, destruction and dispossession wrought by colonialism” and seeks to address lingering colonial relations of power (Boonzaier and van Niekerk 2019, p. 2). At times, however, work drawing on a decolonial lens has prioritized racialized subjectivities over other intersecting categories of identity such as gender and sexuality (Boonzaier & van Niekerk 2019). Maria Lugones’ (2008) work on the coloniality of gender seeks to bridge that gap by linking the biological, patriarchal, and heterosexual arrangement of the modern/colonial gender system to racialized systems of oppression. This is evident in Alexander’s (2005) observations on gendered violence in the Bahamas where Black women’s sexual agency was seen by the neocolonial state as a threat to the heterosexual family and the nation
The sexualities of certain kinds of bodies have frequently been ignored and silenced on the one hand or marked as “abject,” fetishized, and pathologized on the other (Fahs and McClelland 2016). Scholars working within critical approaches to sexualities in public health should bring marginalized bodies to the center in ways that emphasize agency, pleasure, and sexual justice.
The dominance of the medical model of disability has meant that “the diverse sexual and reproductive health needs of disabled people” have often been ignored within mainstream public health research and practice. Sexuality is frequently neglected as a legitimate area in disability services (Hunt et al. 2021; Shuttleworth and Mona 2021). People with disabilities are often stereotyped as lacking sexual desire, having “perverted” sexual desires, or unable to have sex. These infantilizing myths around the sexuality of people with disabilities “represent social barriers excluding people with disabilities from full participation and enjoying fully sexual lives” (Hunt et al. 2021, pp. 3–4).
As Tiefer (2018, p. 124) urges: “We live in a time of intensely competing sexual discourses, and sexuality is one of the arenas for struggle against oppression and injustice. There is really no way to be apolitical as a sexologist – every action supports some interests and opposes others.”
As Asencio (2019, p. 2) asserts “sexuality is not just about identity and behaviors; it is a portal to understand society and issues of power.”
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