A commentary by sexual and reproductive health researchers at Columbia University argues that global sexual health has largely been organized around a one-way transfer of programs, priorities and definitions of success from the Global North to the Global South. The authors say researchers, donors and international organizations have long decided which questions matter most—such as how to prevent HIV, increase contraceptive use or reduce maternal deaths—while paying far less attention to pleasure, desire and what communities themselves consider sexual well-being.
The commentary points to persistent challenges despite decades of investment: more than 374 million new cases each year of four major sexually transmitted infections, more than 1 billion people living with STIs worldwide, and an estimated 225 million women who want to avoid pregnancy but are not using effective contraception. The authors say these figures raise an uncomfortable question about whether dominant frameworks are as effective and empowering as assumed.
Drawing on their work in Kenya, Mozambique and with the United Nations Population Fund, as well as Indigenous health and policy expertise from Aotearoa New Zealand and Hauora Māori approaches, the researchers examine how colonial histories, unequal funding structures and global research hierarchies shape where knowledge is produced and whose knowledge is treated as legitimate. They argue that Global South communities are often seen as places where interventions are delivered rather than as sources of new ideas.
The commentary cites examples from Māori communities, Somalia and West Africa to show how Global South and Indigenous traditions offer different ways of understanding bodies, sexuality, well-being and knowledge. It references researcher Ngāhuia Murphy's work drawing on Māori cosmologies to challenge colonial narratives that frame menstruation and women's reproduction as shameful or impure, describing them instead as sacred and life-giving. It also discusses Minna Salami's concept of "sensuous knowledge," which contrasts dominant European traditions of "hard" knowledge with ways of knowing grounded in relationships, lived experience and the body.
In Somalia, the authors note, oral literary traditions have long shared knowledge and resisted colonial power, with poetry serving as a source of knowledge about health, bodies and well-being. Nigeria's Yoruba knowledge traditions, they add, understand knowledge as something experienced through the senses as well as reason. These traditions do not replace scientific evidence, the authors say, but capture dimensions of human experience that conventional public health methods often miss and can help researchers ask better questions and design more responsive programs.
The commentary acknowledges that global efforts to reduce HIV, expand contraception access and improve sexual and reproductive health have saved countless lives. But when interventions are designed mainly around externally defined priorities, the authors argue, success is measured narrowly through indicators such as HIV incidence or contraceptive uptake, overlooking pleasure, intimacy, bodily autonomy, reproductive choice and well-being. In some settings, they say, this narrow focus has overlooked sexual violence and sidelined local priorities in favor of donor agendas, pointing to Haiti as an example where sexual exploitation and abuse of women by U.N. peacekeepers persisted amid gaps in accountability and legal recourse. The authors note growing recognition, reflected in the recent Porto Proclamation on Sexual Health, Rights and Justice, that global sexual health requires more equitable collaboration and shared leadership, yet say the imbalance continues to shape donor priorities, funding and international policy.
The authors also highlight an evidence imbalance: in one systematic review of 33 pleasure-inclusive interventions, 25 were conducted in the United States, with very few in Global South settings. They recommend that global sexual health move beyond exporting interventions and instead work alongside communities to co-create approaches that value local knowledge, cultural traditions, pleasure and well-being. They call for putting Global South communities at the center of decision-making, supporting community-led models of care, measuring success beyond disease prevention to include joy, safety, intimacy, autonomy and belonging, and shifting funding and decision-making power toward Global South institutions.
The commentary does not argue for abandoning science, but for broadening what counts as evidence and who gets to produce it. Bringing rigorous research together with Indigenous knowledge, lived experience and community leadership, the authors conclude, can build sexual health programs that are more equitable and more effective. The future of global sexual health, they write, must depend less on teaching the Global South and more on learning from it.
Sources: Phys.org.