Global sexual health: Why communal knowledge about pleasure and well-being matters

Global discussions on sexual health have traditionally flowed from wealthier nations towards poorer regions, with researchers, donors, and international organizations dictating priorities and defining success metrics. However, this imbalance has resulted in limited attention to pleasure, desire, and community-defined notions of sexual well-being. Despite significant investments, numerous sexually transmitted infections persist, and a substantial portion of women still lack access to effective contraception.

Our team, comprising researchers from Columbia University and diverse backgrounds, including Indigenous expertise from New Zealand, has witnessed these global disparities firsthand. We argue that the dominant frameworks guiding global sexual health may not be as effective or empowering as presumed, due to limitations in knowledge production and recognition of local voices.

Colonial histories, unequal funding structures, and global research hierarchies have shaped knowledge dissemination in ways that often marginalize Global South communities. Instead of treating these regions as mere recipients of interventions, we advocate for co-creation of new approaches that incorporate local knowledge, cultural traditions, pleasure, and well-being as integral components of sexual health.

Global health initiatives have achieved notable successes in reducing HIV, expanding contraception access, and improving sexual and reproductive health outcomes. However, when interventions are primarily guided by externally defined priorities, they risk overlooking community-specific needs. Success should be measured beyond narrow metrics like HIV incidence or contraceptive uptake, encompassing factors such as pleasure, intimacy, bodily autonomy, reproductive choice, and overall well-being.

In Haiti, for instance, sexual exploitation of women by U.N. peacekeepers persistently occurred due to inadequate accountability and legal recourse. This example underscores the importance of collaborative efforts with target populations to develop new indicators of success that genuinely reflect community priorities.

Acknowledging the reasons behind sexual behavior, rather than solely focusing on risk avoidance, could enhance intervention relevance and health outcomes. While surveys, clinical trials, and epidemiological data remain crucial, they are not the sole means of understanding sexuality, bodies, and well-being. Researcher Ngāhuia Murphy, drawing on Māori cosmologies, reinterprets menstruation and women's reproduction as sacred and life-giving, challenging colonial narratives that portray them as shameful or impure.

Feminist researcher Minna Salami advocates for "sensual knowledge," contrasting it with dominant European traditions of "hard" knowledge rooted in relationships, lived experience, and embodied practices. In Somalia, oral literary traditions have historically served as a means of sharing knowledge and resisting colonial power. These examples demonstrate that local knowledge, cultural traditions, and pleasure can offer valuable insights that complement, rather than replace, scientific evidence in understanding health, bodies, and well-being.