This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility: For decades, discussions and decisions about access to contraception, abortion, maternal health care, HIV prevention and treatment, comprehensive sexuality education, gender equity and protection from sexual violence have largely flowed in one direction: from the Global North to the Global South. Researchers, donors and international organizations have exported programs, defined success and determined which questions matter most.
How can HIV be prevented? How can contraceptive uptake be increased? How can maternal deaths be reduced?
Far less attention has been paid to questions about pleasure, desire or what communities themselves define as sexual well-being. And despite decades of investment, many of the world's biggest sexual health challenges remain. Every year there are more than 374 million new cases of four major sexually transmitted infections.
More than 1 billion people are living with sexually transmitted infections worldwide. Furthermore, an estimated 225 million women who wish to avoid pregnancy are still not using effective contraception. These numbers should prompt an uncomfortable question.
What if the dominant frameworks guiding global sexual health are not as effective or as empowering as many researchers, donors and policymakers assume? That question also emerges from our own experiences as sexual and reproductive health researchers at Columbia University. Our work has taken us across diverse global settings, including substantial engagement in Africa: from research on HPV vaccine implementation in Kenya and HIV prevention in Mozambique to work with the United Nations Population Fund and academic, governmental and nongovernmental partners on sexual rights, sexual pleasure and sexual health.
Our team also brings Indigenous health and policy expertise from Aotearoa New Zealand, including research grounded in Hauora Māori approaches to sexual and reproductive health. These experiences helped motivate our recent commentary, in which we examine how colonial histories, unequal funding structures and global research hierarchies shape where knowledge is produced and whose knowledge is considered legitimate. We argue that Global South communities are treated as places where interventions are delivered rather than where new ideas emerge.
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