Sexual health human rights and the law

14 | Sexual health, human rights and the law
health service (27). Finally, for people whose deeply
felt gender does not correspond to their sex assigned
at birth, access to hormonal treatment or gender
reassignment surgery, or other treatment, may be
needed for the protection of their health including
their sexual health.
Thus, the kinds of health services needed to
promote and protect sexual health include: sexual
health education and prevention information;
sexuality counselling; identification and referral
for victims of sexual violence and female genital
mutilation; voluntary counselling, testing, treatment
and follow-up for STIs, including HIV; screening,
diagnosis, treatment and follow-up for reproductive
tract infections, cancers and associated infertility;
diagnosis and referral for sexual dysfunction and
associated problems related to sexuality and
intimate relationships; and safe abortion and postabortion
care. Such services may be integrated as
part of primary health care or provided as standalone
services, to address the most significant sexual
health problems and concerns of the particular
country, district or region (1).
The respect, protection and fulfilment of
internationally recognized human rights, such as the
right to the highest attainable standard of health
and the right to non-discrimination, require that all
people have access to high quality and affordable
health services, including those related to sexuality
and sexual health, without discrimination (28–36).
The right to the highest attainable standard of health
has been defined and elaborated as encompassing a
variety of facilities, goods and services that must be
available, accessible, acceptable and of good quality
(28, 29). It also includes the underlying determinants
of health such as: access to safe and potable water
and adequate sanitation; an adequate supply of safe
food, nutrition and housing; healthy occupational and
environmental conditions; as well as access to healthrelated
education and information, including on
sexual and reproductive health (29, 37). Many national
constitutions, such as those of the Republic of South
Africa (38) and Portugal (39), for example, explicitly
guarantee the right to the highest attainable standard
of health and specific aspects of it.
3.2 Creating enabling legal and regulatory
frameworks and eliminating barriers to
services for sexual health
The WHO global reproductive health strategy
emphasizes that creating supportive legislative and
regulatory frameworks and removing unnecessary
restrictions from policies and regulations is likely
to contribute significantly to improved access to
services. To do this, states need to review and,
if necessary, modify laws and policies to ensure
that they facilitate universal and equitable access
to reproductive and sexual health education,
information and services (5).
In a number of countries, many laws and regulations,
or the lack of proper regulations, still present
barriers to people accessing sexual health services.
International human rights standards require that
states not only refrain from activities that interfere
with individuals’ pursuit of their own health needs,
but also remove legal and regulatory barriers to
access to sexual and reproductive health services,
such as laws or regulations that limit access to
contraceptives (28, 29, 40). States must also ensure
that both state-supported (public) and private
health services are regulated and monitored for
adherence to health and human rights standards
(29, 41, 42).
Barriers to sexual health that are susceptible to
regulation by law include: access to essential medicines,
conscientious objection by health-care providers,
availability and quality of health-care providers and
facilities, and criminalization of certain services.
3.2.1 Access to essential medicines
Essential medicines are those that satisfy the
priority health care needs of the population. They
are selected based on public health relevance and
evidence on efficacy, safety and comparative costeffectiveness
(43). Access to essential medicines
is guaranteed as part of the right to health; they
must be available within the context of functioning
health systems at all times, in adequate amounts,
in the appropriate forms and dosages, with assured
quality and at a price the individual and the
community can afford (29, 44, 45). Yet medicines