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Subscribe Top Menu Current Issue. Like this article? The current article seeks to briefly evaluate some of these important changes. It suggests that recent advances have decelerated or become more timid, while emphasizing the continued importance of seeking to address sexuality as a central issue within the context of HIV and AIDS.

Although such developments may have been unintended, the ways we respond to the epidemic can have a significant impact for better or worse on how issues related to sexuality and sexual health are addressed. For more than 25 years now, the HIV epidemic has had a profound impact on the ways in which we think about, talk about, and carry out research about sexuality. In the wake of the epidemic, a profound transformation took place in the field of sexuality research, with new space opening up for a wide range of approaches and methodologies, and it is impossible to imagine the current state of knowledge in the field of sexuality studies without taking account of the impact that the epidemic had in relation to this field of research.

This, in turn, has helped to stimulate a new openness for public discussion and debate concerning sexuality, sexual values and sexual norms. Sexuality became one of the key contested spaces of public discourse in a way that would have been previously unimaginable, and both conservative and progressive forces entered into the debate in ways that have had a lasting impact on sexual politics over the past two decades. This article seeks to briefly evaluate some of these important changes. Yet it also suggests that in recent years these advances seem to have slowed or become more timid, and it emphasizes the continued importance of seeking to address sexuality as a central issue within the context of HIV and AIDS.

It suggests that even though these developments have perhaps been unintended consequences of the evolving epidemic, the ways in which we respond to it can have an important impact, for better or worse, on how issues related to sexuality and sexual health are addressed more broadly.

The impact of HIV on sexuality research. Among the most immediate consequences of the growing HIV epidemic in the s was the massive increase in sexuality research activity that it brought about. It quickly became apparent that the long-term neglect of investment in research focusing on sexuality over the course of the 20 th century had left us with an exceptionally limited knowledge base about many of the key issues that needed to be understood in order to respond to an inevitably fatal disease that was transmitted primarily through sexual contact.

The urgent need to respond to the HIV epidemic through social and behavioral research provided the justification for a massive increase of investment in available research funding on sexuality and sexual behavior among diverse population groups. New resources became available relatively quickly, especially for the collection of behavioral data perceived to be necessary both for an understanding of the epidemiology of HIV infection as well as for the development of prevention programs and interventions 1,2,3,4.

Driven, at least at first, by epidemiological concerns, research on sexuality in relation to AIDS emerged within medical and public health institutions and frameworks. Much of the research activity in response to AIDS in the mids therefore focused on the knowledge, attitudes and practices that might be associated with the risk of HIV infection. Most studies sought to collect quantifiable data on numbers of sexual partners, specific sexual practices, sexually transmitted diseases, and a range of similar issues understood to contribute to the spread of HIV.

On the basis of this documentation, research sought to point the way for prevention policies and intervention programs aimed at reducing the behavioral risk of infection 1,5,6,7. The demand for quantitative data on sexual behaviors that might exacerbate the risk of HIV infection provided the justification for a wave of survey research on sexual practices - first among specific populations, such as gay and bisexual men or commercial sex workers, who were identified as potential "high risk groups", and then increasingly among the broader population in countries like the USA, the UK and France, in the North, as well as in a range of countries in the global South.

Agencies such as the US National Research Council and the Institute of Medicine played a key role in underscoring the urgent need for such research in order to more fully understand, monitor, and respond to the evolving epidemic. Researchers took advantage of these opportunities in order to develop a wide range of studies addressing different surveys, both on specific population groups as well as representative samples from the general population.

Ultimately the downsized NHSLS was only made possible through the intervention of a coalition of private foundations headed by the Robert Wood Johnson Foundation 10, What is perhaps most significant about these surveys carried out in response to HIV is that they seem to represent a " new model for the study of sexual behavior understood as an epidemiological problem " 13 p.

When compared with earlier sex research - such as the famous Kinsey et al.

HIV Infection and AIDS

Yet because of the importance of HIV and AIDS, they did place significant emphasis on seeking to document and understand sexual diversity, placing significant emphasis on homosexual and bisexual behavior as well as normative heterosexual practices 4, In some cases this was done simply by adding a set of questions on sexual behavior to existing surveys, such as the demographic and health surveys, and in some cases by developing new survey instruments and studies focused exclusively on HIV and AIDS-related risk.

But over the course of the s, sexological and social demographic approaches increasingly merged in a new wave of surveys specifically focused on HIV and AIDS in resource poor settings 7.

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Important large scale studies began to be carried out in countries like Brazil that moved beyond the focus on fertility that had dominated traditional demographic survey in order to explore the full range of diverse sexual practices 16, The growing number of available studies both North and South , in turn, ultimately made possible a range of cross-national comparisons, both on a regional level 18 , as well as globally.

In one recent comparison, for example, findings from as many as 59 countries have been compared, with representation from every major region of the world While the descriptive data emerging from such large scale surveys has highlighted both cross-national similarities and differences in terms of sexual behavior, knowledge and information, and risk-related behavior change, it has also called attention to the extent to which social context shapes sexual practice and is a crucial consideration in relation to the possibilities for intervention aimed at health promotion Never before has such extensive social and behavioral research data been available, making one of the unquestionable impacts of the HIV epidemic a new level of empirical information about sexual practices around the world.

This, in turn, has also led to a level of public discussion of sexuality and sexual behavior - in the mass media as well as in academic settings and public health debates - that surpasses anything even remotely comparable in the years before HIV and AIDS emerged as major concerns 4. From sexual practices to the social context of sexuality. Just as quantitative survey research received significant new attention in the wake of the HIV epidemic, more qualitative studies, focused less on sexual practices per se than on their social meaning, and on understanding the complex social contexts in which they are shaped, also took on new urgency and scientific legitimacy as the response to the epidemic evolved.

If an emphasis on the social context of sexual behaviors appears to have been a relatively recent discovery in much of the survey research carried out in response to HIV, however, this understanding has long been one of the key insights to emerge from more qualitative and ethnographic research developed in response to the epidemic. By the early s, as behavioral research and behavioral interventions began to be developed in a growing range of diverse social and cultural settings, the relative effectiveness of both the research instruments and intervention strategies came to be questioned.

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The difficulties of translating or adapting research protocols for cross-cultural application quickly became apparent in the face of often radically different understandings of sexual expression and practices in different societies and cultures - and even in different subcultures within the same society 2. The efficacy of behavioral interventions based on information and reasoned persuasion as a stimulus for risk reduction became evident almost immediately As the range of broader social forces shaping the HIV epidemic began to be perceived as centrally important, the limitations of traditional behavioral research approaches also became more apparent.

Influenced by concurrent developments in relation to the social construction and production of sexual relations, research in response to HIV and AIDS began to draw on approaches from interactionist sociology and cultural anthropology, as well as on moves to radicalize social psychology, in seeking to focus on the broader social and cultural structures and meanings that were increasingly understood as shaping or constructing sexual experience in different settings Stimulated by such concerns, an important shift of emphasis began to take place from a focus on individual psychology to a new concern with "inter-subjective" cultural meanings related to sexuality, and their shared and collective qualities as the property not of atomized or isolated individuals, but of social persons integrated within the context of distinct, and diverse, cultures.

Over the course of the s, this emphasis on the social organization of sexual interactions, on the contexts within which sexual practices occur, and on the complex relations between meaning and power in the constitution of sexual experience, has led to a new focus on the investigation of diverse "sexual cultures". Research attention has thus moved increasingly from sexual behavior, in and of itself, to the cultural settings within which it takes place - and to the cultural rules which organize it.

Special emphasis was given to analyzing the cultural categories and the systems of classification that structure sexual experience in different social and cultural contexts 20,24,25, While this emphasis on culture marks an important advance in broadening the focus of research on sexuality, by the mids it had also become increasingly evident that the range of factors influencing the construction of sexual realities in relation to HIV and AIDS is in fact far more complex than had previously been perceived.

In particular, it became clear that not just cultural, but also structural, political and economic factors shape sexual experience and hence constrain the possibilities for sexual behavior change. Such factors have thus been responsible for many of the most complex barriers to effective AIDS prevention programs. Just as cultural analysis had emerged as an important corrective to the perceived limitations of earlier behavioral approaches, a new focus on historical and political-economic analysis of the structural factors associated with the increased risk of HIV infection and barriers to risk reduction likewise emerged as central to the evolving response to the epidemic 27,28,29,30, Indeed, poverty, more than any other single socio-economic factor, was identified as perhaps the key driving force of the epidemic, and the synergistic effects of poverty, when linked to other forms of social inequality, instability and discrimination, have been highlighted in virtually all the research conducted on structural and environmental factors associated with the epidemic 29, Linked to poverty, in much important research, was the issue of gender and gender power inequalities.

This growing interest in understanding the role of gender and sexuality structures in promoting HIV vulnerability particularly among heterosexually-active women and men has increasingly generated a number of impressive analyses that are attentive to both cultural and political economic factors 4. Although less research focusing on structural factors has been carried out on individuals involved in same-sex relations, at least as compared with the quantity of work focusing on heterosexual women, recent findings nonetheless suggest structures of gender inequality are typically replicated in relation to transgender and other gender non-conforming persons, who often have few options for earning a living other than sex work, and who are in many instances subject to socially sanctioned forms of physical violence.

The extension of gender power inequalities together with pervasive heterosexism have thus also increasingly been understood as interacting with other forms of structural violence, including both poverty and racism, in creating situations of extreme vulnerability in relation to gender non-conformity, transgender and male sex work, gay men from ethnic minority groups, and among young men who have sex with men generally 32, A greater awareness and a fuller understanding of the synergy that exists between sexuality and multiple forms of social inequality and exclusion - especially poverty and class oppression, gender power inequity, racial and ethnic discrimination, but also less obvious power differentials related to age, to the destabilization of dislocation, and similar social factors - is surely one of the most important long-term results of the research that has been carried out in recent decades on the social dimensions of HIV and AIDS.

By shifting paradigms, and moving from the kinds of epistemological frameworks that that have dominated more mainstream behavioral and epidemiological research on sexuality and sexual conduct in relation to the epidemic, critical social science research has highlighted both the cultural and the structural forces shaping the epidemic, helping to open the way for a fuller understanding not only of the social and cultural context, but also of the political and economic factors that impact on the sexual interactions and relationships that have been so intimately linked to AIDS since it emerged in the early s 4, Like the massive expansion of survey research that has taken place in response to HIV and AIDS, then, over the course of the past two and a half decades, significant new attention has also focused on a range of social science approaches to the social, cultural, political and economic contexts that shape sexual experience.

Like the results of survey research, the findings from these studies have stimulated important new debates in the public arena about sexual diversity, relations of power, the importance of social inequalities, and the most effective means of addressing sexual stigma and discrimination. The impact of HIV and AIDS has simply been astounding in opening up new forms of knowledge and new fields of debate in relation to sexuality and sexual conduct.

HIV & AIDS - signs, symptoms, transmission, causes & pathology

The de-sexualization of the epidemic? For some years now, a number of social investigators have raised concerns about a tendency to disregard the bodily experience - the corporeality of sex - in much contemporary HIV-related research I have also written elsewhere of what I fear may be a growing "sanitization" of the field of sexuality research more generally, independent of whether or not it is linked to the investigation of HIV and AIDS, in which our growing concern with issues of social context may inadvertently be drawing attention away from the lived experience of sexual practice in much recent social science research These developments are certainly not absolute, and my concern about them should not be read as in any way a rejection or condemnation of the important effort to broaden our understanding of the social and cultural contexts in which sexuality takes place - and through which it is shaped.

At the same time, it is a note of caution that I think is worth pausing on and examining in greater detail. In particular, I think that there are at least three important tendencies emerging from both research and practice over the course of the past decade that may be responsible for a reduced emphasis on sex and sexuality as part of the broader response to the HIV epidemic. In particular, I think that it is an important coincidence that growing concern with the social context of sex, with the political and economic factors that shape and condition it, has taken place at the same time that there have been significant advances in available treatments for HIV infection.

At least since , when combination antiretroviral therapies began to become available, and many of us involved in advocacy related to HIV and AIDS began to focus heavily on the struggle for access to treatment in resource poor settings, attention previously given to sexuality may have shifted and even waned.