Sexual health human rights and the law

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12 | Sexual health, human rights and the law Table 1: Core international human rights treaties and their optional protocols (and date of entry into force) relevant to the protection of human rights in the context of sexual and reproductive health 2 Treaty (date of adoption) International Covenant on Economic, Social and Cultural Rights (ICESCR) (1966) Optional Protocol to the International Covenant on Economic, Social and Cultural Rights (2008) International Covenant on Civil and Political Rights (ICCPR) (1966) Optional Protocol to the International Covenant on Civil and Political Rights (1966) Second Optional Protocol to the International Covenant on Civil and Political Rights, aiming at the abolition of the death penalty (1989) International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) (1965) Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) (1979) Optional Protocol to the Convention on the Elimination of All Forms of Discrimination Against Women (1999) Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) (1984) Optional Protocol to the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (2002) Convention on the Rights of the Child (CRC) (1989) Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornography (2000) Monitoring body Committee on Economic, Social and Cultural Rights Committee on Economic, Social and Cultural Rights Human Rights Committee 2 Human Rights Committee Human Rights Committee Committee on the Elimination of Racial Discrimination Committee on the Elimination of Discrimination Against Women Committee on the Elimination of Discrimination Against Women Committee Against Torture UN Subcommittee on Prevention of Torture and other Cruel, Inhuman or Degrading Treatment or Punishment Committee on the Rights of the Child Committee on the Rights of the Child Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict (2000) International Convention on the Protection of the Rights of all Migrant Workers and Members of their Families (ICRMW) (1990) Convention on the Rights of Persons with Disabilities (CRPD) (2006) Optional Protocol to the Convention on the Rights of Persons with Disabilities (2006) Committee on Migrant Workers Committee on the Rights of Persons with Disabilities Committee on the Rights of Persons with Disabilities 2 The Human Rights Committee is sometimes also referred to as the Committee on Civil and Political Rights.
Sexual health, human rights and the law | 13 III. Health services for the promotion and protection of sexual health 3.1 Introduction Ill health related to sexuality represents a significant disease burden throughout the world. This includes: morbidity and mortality related to HIV (18) and other STIs (19); morbidity and mortality linked to lack of access to contraception and safe abortion services (20); erectile dysfunction; the sequelae of sexual violence and female genital mutilation; and sexual and reproductive cancers (1). 3 For example, sexually transmitted infections (STIs) are a significant cause of acute illness, infertility, long-term disability and death, with serious medical and psychological consequences for millions of men, women and adolescents. For people aged 15–49 years, an estimated 448 million new cases of four curable STIs (chlamydia, gonorrhoea, syphilis and trichomoniasis) occurred in 2005 (19), and these numbers are not diminishing. An estimated 35 million people in 2013 were living with HIV, a largely sexually transmitted infection (18), and while the incidence of HIV continues to fall, this is still a huge burden related to sexual health. Globally, the proportion of women living with HIV has remained stable at 50% of all those living with HIV, although women are more affected in sub-Saharan Africa and the Caribbean (18). Since the beginning of the HIV epidemic in the 1980s, men who have sex with men and transgender people have been disproportionately affected by HIV. The few existing epidemiological studies among transgender people have shown disproportionately high HIV prevalence, ranging from 8% to 68% depending on the context and the type of study carried out (21). 3 Some of the dimensions of sexual health overlap with what is classically included under reproductive health. Contraception and abortion in particular are frequently counted as part of reproductive health. They are included in this report on sexual health precisely because they are about NOT reproducing, but they are directly connected to sexuality and sexual activity. The continuing increase in the use of contraception since the 1960s (22) has contributed to a reduction in maternal mortality, and it is estimated that one in three deaths related to pregnancy and childbirth could be avoided if all women had access to contraceptive services (23). The increased use of modern contraceptive methods could not have been possible without the provision of services, whether public or private, through dedicated services or primary health care. Evidence shows that for adolescents, increased access to modern contraception, and particularly emergency contraception, protects them from negative health outcomes, and does not lead to unwanted sexual intercourse, unprotected intercourse, decreases in condom use, increased STIs or increased pregnancy rates (24–26). It has been estimated that a doubling of the current global investments in contraceptive and fertility regulation services – so that more women have better access to needed services – would reduce unintended pregnancies by more than two thirds, from 75 million to 22 million. But it would also reduce unsafe abortions by almost three quarters, from 20 million to 5.5 million, and deaths from unsafe abortion by more than four fifths, from 46 000 to 8000 (20). Thus, the provision of sexual and reproductive health services enables women to exercise control over their bodies in the case of unwanted pregnancies and helps to preserve their health. Being able to be screened, counselled, diagnosed and treated appropriately for aspects of sexual health such as erectile dysfunction, the sequelae of sexual violence, female genital mutilation, reproductive tract infections that are not sexually transmitted, and sexual and reproductive cancers, is also critical for the protection and promotion of sexual health, as is having access to information and counselling related to sexuality (1). In addition, other health conditions such as cardiovascular disease, diabetes and cancer, all have a detrimental effect on the sexual and reproductive health of both men and women. For example, testicular cancer can threaten a young man’s sexual and reproductive future, and prostate cancer can affect a man’s mid- and later-life chances for a sexual life. Sexual dysfunction resulting from such conditions can be ameliorated through different approaches, usually requiring an interaction with the
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