Book Reviews
Sexual Health: An Australian Perspective
Meredith Temple-Smith and Sandra Gifford (eds)
ISBN: 0-975237-41-1 2005 335 pp pages Melbourne: IP Communications
Lorraine Yap
National Centre in HIV Social Research, University of New South Wales, NSW
If ever a search was made for the holy grail of a unified field theory of sexual health, medicine and social sciences, then this book comes close to it. No longer is sexual health the exclusive domain of the physical and biological, an activity that takes place 'between the sheets' or to be privately discussed between patient and doctor. Sexual health is multi-faceted, viewed in an all-encompassing framework that involves the complex and interdependent relationships between biology, psychology and socio-historical-cultural factors.
The book sets out this multi-dimensional and multi-disciplinary framework in five parts. Part 1 offers a concise history and selected studies on sexual health in Australia, ; Part 2 discusses male and female biological functions and provides psychological and anthropological perspectives on sexual health; Part 3 discusses sexually transmissible infections found commonly in Australia and talks about factors affecting sexual functioning; Part 4 evaluates sexual health inequalities in Indigenous and other marginalised populations; and Part 5 is a review of Australian health promotion and sexual health policy. Experts from various fields including medicine, reproductive biology, microbiology, public health, criminal justice, law, anthropology, psychology and health services have all contributed to the collection, giving each of the nineteen chapters a different outlook on sexual health.
I was fascinated by Meredith Temple-Smith's historical account of Indigenous and non-Indigenous sexual health in pre- and post-convict settlement in Australia. She argues that attitudes towards race, class and gender, molded by the prevailing moral culture of the day, have produced inequalities in sexual health services and care for people with venereal disease. The chapter races through the time periods, from sexual health prior to colonisation, to the decades in between, and then to modern day Australia. Unfortunately, the overview gives a somewhat disjointed historical account of contraception in Australia, the discussion sometimes swinging unexpectedly between venereal disease and contraception without linking them to each other except through the a time period. 'Contraception' would have been better placed in its own section in the chapter.
Another highlight is the results of the first large-scale sexual health and behavioural survey undertaken in Australia by Anthony Smith et al. Some 19,307 Australians between 16 and 59 years participated in the study. Did you know that the onset of sexual activity declined from 18 to 16 years among Australian men born between 1981 and 1986 and from 19 to 16 years among women, that 15.6% of Australian men and 0.1% of women had paid for sex at some time in their life, and that 4.8% of men and 21.1% of women had been forced or frightened into unwanted sex in their lifetime? Like the research conducted by the famous zoologist and sexologist Alfred Kinsey, this chapter explains in detail the sexual behaviours of Australian men and women and what they get up to behind closed doors.
Part 4 is a special section on marginalised and stigmatised populations and their poorer sexual health outcomes compared with the general population. This section will raise the reader's awareness of race, class, gender, youth and physical disability. It features essays by Kate Senior on gender, policy and practice on sexual health in Indigenous cultures, Christine Harcourt on legal and social issues confronting commercial sex workers, Michael Levy on consensual and non-consensual sexual activity in Australian prisons, Shelley Mallett on the sexual practices of homeless young people, and Alexa Rosengarten on the impact of illness and/or disability on a person's sexual health. Some of the discussions focus on the attitudes of health care providers and policymakers and on their impact on the quality and scope of sexual health services and care provided.
Other chapters in the book are no less interesting. Readers who do not specialise in the medical sciences or legal disciplines will appreciate chapters introducing these subjects. As a medical anthropologist in sexual health research, I was especially interested in Stuart Aitken's 'Pathology and sexual functions' and in learning more about how psychology, culture and physical wellbeing can affect sexual functioning, and also Roger Magnusson's chapter on the controversial role of law in promoting sexual health.
The book will appeal to a wide audience. Readers with little grounding in the social sciences will appreciate the introduction to psychology and sexual health by Susan Moore in 'Sexuality: psychological perspectives', Doreen Rosenthal and Colette Browning in 'Sexual wellbeing and life transitions', and the anthropological perspective by Sandra Gifford and Meredith Temple-Smith in 'Diversity and difference: The cultural shaping of sexual health'. For those with only a smattering of biology or medicine, I recommend the chapters by Elizabeth Brown and Stuart Aitken. Or if you would like an introduction to sexual health promotion, take a look at 'Sex education for young people' by Anne Mitchell and 'Health policy for sexual health?' by Di Tibbits.
As readers will now have realised, parts of the book will present nothing new to experts in a particular discipline. Nonetheless, those starting out in the field with little or no sexual health knowledge will quickly acquire a general overview of the area in Australia. It can be used as a textbook for tertiary-level students in health disciplines or as a reference for sexual health practitioners, counsellors and policymakers. The book literally offers something for everyone. Did I also mention the useful key messages and references printed at the end of each chapter for anyone intending to do some further reading?
Overall, the collection is well structured, the editors have done a fine job in dividing the different chapters into sections making it easier for readers to follow one topic to another. I however thought that the book could be improved with more cross-referencing between chapters. For example, different authors in chapters 5 and 7 discuss the model of sexual wellbeing but make no reference to each other.
Beyond the main theoretical constructs, the book represents a unique contribution to the sexual health literature. Few academic texts have dealt with sexual health issues purely from an Australian standpoint, and this book presents a valuable resource for those studying or working in sexual health and who want to know more about sexual health in Australia.
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