Sexual health human rights and the law

Sexual health, human rights and the law | 17
information. At the same time, health workers are
often entrusted with this private information by
their patients, such that respect for confidentiality
and privacy is essential. If individuals fear that
confidentiality and privacy are not guaranteed in
the health-care environment, they may avoid
seeking services, thus putting their health in
jeopardy (28, 84–88).
The right to privacy means that individuals should
not be subject to arbitrary or unlawful interference
with their privacy and should enjoy protection of
the law in this respect (89). Many constitutions,
national laws and regulations guarantee the
right to privacy and confidentiality. However, in
practice this may not be applied to the provision
of sexual health services (59, 60, 85, 90). In line
with human rights commitments, and in order to
promote the health and development of all, states
are encouraged to strictly respect the right to
privacy and confidentiality, including with regard
to advice, counselling and services related to sexual
health. Health-care providers have an obligation
to keep medical information confidential – both
written records and verbal communications. Such
information may only be disclosed with the consent
of the patient (28, 29, 40, 59, 60, 65, 84, 91).
3.3.2 Fostering informed decision-making
Because many of the decisions relating to sexual
health may have an impact on people’s ability
to have a safe and satisfying sexual life and to
have or not have children, informed decisionmaking
– which includes informed refusal of
certain interventions or medicines – is particularly
important. Individuals have the right to be fully
informed about any treatment, intervention or other
health services they may seek or undergo. In the
area of sexual health, informed decision-making
includes fully understanding and accepting (or
declining) a particular service, such as a diagnostic
test for an STI or HIV, or intervention, such as
sterilization or abortion (92). Informed decisionmaking
invokes several elements of human rights
that are indivisible, interdependent and interrelated.
In addition to the right to health, these include the
right to self-determination including reproductive
self-determination, freedom from discrimination,
security and dignity of the human person, and
freedom of thought and expression (93). In order
to make a free and fully informed decision, the
individual concerned must have adequate reasoning
faculties and be in possession of all relevant facts at
the time consent is given (59, 60, 93).
People should not be pressured, forced, coerced or
in any other way persuaded to undergo treatment or
interventions against their will. Certain populations,
such as people with disabilities, indigenous and
minority people, women living with HIV, sex workers,
drug users, and transgender and intersex people,
may be particularly vulnerable to coercion or to
being persuaded to undergo certain procedures,
such as intrauterine device (IUD) insertion or
sterilization, without their free and fully informed
choice and consent (91). Children in particular may
be subjected to certain procedures that have an
impact on their future sexuality and sexual health,
such as children with intersex conditions receiving
medically unnecessary, so-called sex normalizing
surgery before they are old enough to participate in
the decision (91), and young girls undergoing genital
mutilation (94) (see also Chapter 5). States have an
obligation to protect these individuals from coercion
and discrimination (29) and to ensure that rights to
autonomy, bodily integrity and dignity, as well as the
principle of acting in the child’s best interests, are
protected (40).
The right to informed decision-making, including
the requirement for informed consent, may be
recognized in national laws and is often covered
in medical ethical codes, but many states’ laws or
policies fail to explicitly recognize it. Nonetheless,
states have the legal duty to ensure that services
are provided in a way that presents information in
a clear and understandable way, including the likely
benefits and potential adverse effects of proposed
procedures and available alternatives (28), so that
clients can make a choice. Censoring, withholding
or intentionally misrepresenting information about
sexual and reproductive health services can result
in a lack of access to services or delays, which, in
the case of abortion services for example, increase
health risks for women (59). International and