Editorial Sexuality and Health - Health Sociology Review

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Editorial

Sexuality and Health

Contributions from Sociological Insights

Victor Minichiello
School of Health, University of New England, Armidale NSW, Australia

David Plummer
School of Education, University of the West Indies, Trinidad

Article Text

Sigmund Freud turned 150 on May 6^th this year. Yet despite the advancing of years, his life's work continues to have profound significance - not least for the social sciences. While much of the world remembers Freud as the 'Father of Psychoanalysis', the significance of his work for the social sciences is deep and broad.

Freud developed his research methodology - qualitative interviewing - to a high level of sophistication and opened the way for some highly original interpretations of people and our relationships with society. His writings reveal an inescapable and growing consciousness of the role that society plays (largely in his view through repression) in the construction of human sexuality, sexual identity and sexual praxis, both in health and in illness (Freud 1977).

Meanwhile, Michel Foucault has a key birthday this year too: he would have turned 80 in October. Foucault too contributed enormously to the social sciences and while there are great differences between them, Foucault also added tremendously to the literature on the social construction of sexuality as well as to social sciences methodology (Foucault 1990).

It is therefore fitting that this year Health Sociology Review hosts a special issue on sexuality and health: a theme which lies at the nexus of three great domains of social construction and social control: sexuality, gender and health. But increasing awareness of the constructed nature of sexuality, gender and health does not seem to have tamed our tendency for personal sexual neuroses and collective moral panics. Moreover research into sexuality and gender and their relationships with health continues to focus particularly on transgressive boundaries. This raises a key question for all of us: as researchers who play an important role in documenting, inventing and regulating the discourses of sexuality, gender and health, to what extent do we police sexuality, gender and health?

Another paradox, which has become increasingly apparent thanks to historical analyses, is that deep social themes - most notably the taboos - continue to be profoundly influential despite the extraordinary technical advances since the birth of Freud and Foucault. Perhaps the most significant difference in the past 500 years has been the substitution of the acronym HIV for the central character of Frascotoro's poem: the shepherd named Syphilis (for example, see Davenport-Hines 1991, Hester 1992).

Not surprisingly, the papers in the present edition also illustrate our contemporary pre-occupations. While not overtly about social boundaries, it is significant that in one edition we have a smorgasbord of social neuroses and transgressions: castration anxiety, drugs, underage sex, incest, sexual assault, sexual violence and the perennial problem of how to classify homoerotic praxis.

Questions arising from the papers

Each article does however raise some interesting sociological issues. The article by Couch and Pitts makes a most important sociological question: why is there still an obsession to conceptualise men who have sex with men in terms of their sexually transmissible diseases and taboo sexual practices? Perhaps the answer partially lies in funding bodies more willing to provide research money to address public health surveillance and control issues. As a result researchers pay less attention to the everyday lives of men who have sexual intimacy with other men. The content analysis of published studies spanning 14 years does reveal one important fact: men do form intimate relationships (including sexual ones) with each other and perhaps it is now time to focus on what these relationships mean to men and their significant others (including families). Equally important to study are the social changes required to ensure that these relationships are positive experiences for all concerned, including a concern over the health and wellness of this group of men. While some would argue that risk discourse of HIV-related studies has been a negative focus, the presence of research on 'men who have sex with men' (MSM) has made visible a previously hidden topic. A new acronym (MSM) has appeared in our vocabulary and this word is changing the boundaries of sexuality and relationships, creating a new sociological research agenda. It will offer new insights into masculinity and how sexuality is moving beyond the traditional understanding of gender.

The articles by Richters, and Crisp and her colleagues, discuss 'men's business', so to speak, that has largely escaped public scrutiny. Whether the argument for circumcision goes beyond the medical and public health debate is a question that needs to be asked. There are few studies that discuss the social relevance of circumcision, at least in contemporary Western settings. Perhaps this is because until recently the male body has not been seen as a sexual commodity and few researchers have seen the knowledge value of asking questions about what it means sexually, culturally and socially to have the 'penis' as a 'socially imagined sexual body', to use Richters' own words. Yet there can be no doubt that the male penis has become a highly sexualised product and that it has important implications for males in terms of their identity and self-worth. Likewise, the article by Crisp and her colleagues investigates the issue of sexual assault experienced by males, a topic normally reserved for women. It highlights the need to understand how widespread the occurrence of sexual assault against males is and what consequences it has on their health, well-being, identity and behaviour. Such research also unearths the reality that males are also victims of violent crimes of sexual exploitation.

Interestingly, the article by Kamau and her colleagues, that draws on the experience of how high school boys and girls from Kenya make sense of their sexual experiences, provides some powerful insights into how boys experience circumcision and the meaning they give to it within the context of sexual desire and attraction. There can be little doubt of the connection between circumcision and manhood and how culture here gives meaning to these complex concepts. But what is even more significant about the sociological contribution of this article is that in a country that is deeply challenged by HIV, insights into how young people are living and constructing their sexual identities, and negotiating the dilemmas arising from their relationships with their peers and parents, offers hope for informing effective HIV interventions. The article by Worth and Henderson focuses on AIDS in Papua New Guinea. They demonstrate the value of a sociological analysis that discusses how AIDS is impacting at a societal level as opposed to its impact on individual sexual behaviour. We learn that a ten per cent HIV prevalence rate among adults within the context of a fragile economy and poor infrastructure (including health and education) will result in further impoverishment and trauma for the citizens of Papua New Guinea. This is also a society that privileges males and where women have one of the highest prevalence of rape, both inside and outside marriage, in the world. Identifying effective preventive strategies to curb the spread of HIV in the society, within the social context described by Worth and Henderson, will be a challenge and sociological insights will be critical here.

That the discourse about sexuality and sexual pleasure is changing for both men and women is clearly evident in the work of Joanne Bryant. Female heterosexual participants in this study voice their rights as citizens to express sex as pleasure and desire and in challenging the 'hegemonic masculinity' paradigm. Many women take the view that they have a right to 'sexual consumption' and should equally have the ability and support to enjoy 'sexual intimacy' and under conditions that are favourable to them. This brings about changes in gender relations and further studies need to investigate how both the intimate and sexual lives of men and women will mature as a result of these new discourses and expectations. Without a doubt, as deeply entrenched notions about women's sexual passivity are challenged, women may expect to exercise greater control over their intimate lives and their sexual health and safety.

Drawing on her work experience as a children's worker in a family violence refuge, Sharon Brennan deals with an important social issue - that of child abuse within families. There is no doubt that researching issues associated with the sexuality of children and sibling incest is a difficult topic, but as Brennan argues these are issues of considerable public and academic interest. These issues reflect a reality found in our society and the lived reality of some of us. Showing how sexual identity is not 'a finished product of adulthood' but instead an identity that begins in childhood can shed important insights into people's worldviews and relationships.

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