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The papers on the theme in this journal issue are about using the law and the courts at the local and national level to advance abortion rights, and in a few cases from a sexual rights perspective. Papers looking at the international level focus on sexual and reproductive health and rights as a whole, written by those involved in the post-2015 sustainable development agenda and those working with young people’s issues. The papers on other themes add an enormous breadth of focus to this journal issue, ranging over the sexual and reproductive health and rights of older men and women; the limited focus of existing research on HIV and gender-based violence, primarily on women; reducing high maternal mortality rates in western China; the experience of termination of pregnancy for fetal abnormality; participatory gender budgeting in the Russian Federation; and the Ebola epidemic with lessons on how fast a virulent disease can kill off a weak public health system, in addition to its patients and many of the people working in it, and particularly women. Authors writing about using the law and the courts to seek justice and redress, and to protect and fulfil human rights, also open a window on the complicated world of politics they have encountered in doing so.
Globally, population, climate change, environment, development and sustainability are on the post-2015 agenda to determine sustainable development goals. The issues are of a life-and-death nature because the future of the planet is at stake. The papers cover the role of poverty , food security, and neoliberal globalisation; advocacy for sustainable national funding; linkages between sustainable development, demography and SRHR; population, SRHR and sustainable development; the youth population boom; fertility decline and views on contraceptive use; resilience and adapability in response to environmental shocks; the right to safe abortion and the post-2015 agenda; population policy and rights; and much more. Papers also cover conscientious objection, perceptions of unsafe abortion, policy and programmes for contraception and abortion. Non-theme papers are about the anti-homosexuality legislation in Africa, the effectiveness of HIV treatment as prevention, female genital cutting, and use of social media by adolescents. The papers reflect some of the progressive thinking on these issues, and how they need to be taken forward. They recommend broader coalitions and innovative joint projects, and show why and how sexual and reproductive health needs are essential for fulfilling a progressive population and sustainable development agenda.
Efforts to define a new post-2015 development agenda are advancing, with consultations, meetings and reports proliferating. The aim – to articulate a goal for health that includes comprehensive sexual and reproductive health and rights, and another for gender equality – needs to avoid the limitations of the MDGs and broaden the remit of responsibility and global commitment. The papers here start from the contribution of the ICPD Programme of Action 1994 and critique the Millennium Development Goals, their targets and indicators, their intended and unintended consequences, and limited definitions of accountability for taking the agenda forward. A number of papers contain country case studies that analyse national policy, budgets, expenditure and external funding. Several expose the disconnect between international agreements and country-level realities. Still others look at current and alternative development paradigms for supporting gender equality and the right to health, and sexual and reproductive health and rights within them. Using words like “transformational”, they demand a better world.
The overarching messages of this journal issue are that adolescents and young people want and need information and health care with a sex-positive approach to sex, sexuality, sexual health and relationships; those providing it need specialist training; and adolescent/youth leadership and involvement in policy and programmes are crucial. Papers cover using visual and social media; youth activism; peer support and networks; involving young people in formulating problems and solutions, running youth clubs and acting as providers of contraceptives and condoms. Papers are about sexuality education, adolescent pregnancy, abortion, sexual and gender norms, sexual violence and harassment, body image, sexuality and living with HIV, menstrual hygiene, self-efficacy and the evolving capacity of youth to take decisions about their lives, health and health care. Papers are from Australia, Bangladesh, Colombia, Guatemala, Ecuador, India, Indonesia, Mexico, Nicaragua, Rwanda, South Africa, Tanzania, Zambia, UK, USA. Young peer researchers participated in much of the research and a number of the articles were (co-)authored by young people too.
With the advent of antiretroviral therapy and with continued channelling of resources into HIV services, greater numbers of HIV-positive women are living longer, healthier lives. As a result, they are contending with a range of issues affecting their sexual and reproductive health and rights. This supplement aims to determine ways to work across disciplines and life experiences with the ultimate goal of ensuring that women living with HIV are at the centre of decision-making about their sexual and reproductive health and rights.
The supplement responds to an identified need for a stronger evidence base, drawing from biomedical, economic, political, legal and social science perspectives alike. It recognises the importance of moving beyond disciplinary silos to bring these perspectives together in order to provide more comprehensive information relevant to the lives of women and men living with HIV, as well as to create demand for appropriate services and policies.
The supplement grew out of a conference on HIV and pregnancy at the Harvard School of Public Health in March 2010, where it was noted that despite recent attention to the sexual and reproductive health concerns of HIV-positive women in some specific areas, the challenge remains to ensure the voices of HIV-positive women are heard and to address relevant issues from multidisciplinary perspectives.
We have included papers here that represent a diversity of topics, experiences, geographical areas and disciplines. Taken together these papers are intended to help drive policy, programmatic, research and advocacy efforts to promote and protect the sexual and reproductive health and rights of women living with HIV.
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