Feature
Research Conduct
No correction, no retraction, no apology, no comment: paroxetine trial reanalysis raises questions about institutional responsibility
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4629 (Published 16 September 2015)
Cite this as: BMJ 2015;351:h4629
Rapid responses
Re: No correction, no retraction, no apology, no comment: paroxetine trial reanalysis raises questions about institutional responsibility
It's Against Medical Ethics
Research results manipulated to promote a molecule at the expense of patient 's health are unethical. Paroxetine, a molecule used for depression, produced suicidal problems and self harming tendencies in teenagers; the fact that these results were hid and the molecule was promoted against medical ethics is to be highly condemned.
Competing interests: No competing interests
29 September 2015
M A Aleem
Neurologist
ABC Hospital
Annamalainagar Trichy 620018 Tamilnadu India
Tuesday, September 29, 2015
Monday, September 28, 2015
World Heart Day 29th september 2015: Heart-Healthy Environments
World Heart Day 29th september 2015: Heart-Healthy Environments
World Heart Day was founded in 2000 to inform people around the globe that heart disease and stroke are the world’s leading causes of death, claiming 17.3 million lives each year.
World Heart Day is an annual event which takes place on 29 September every year. Each year’s celebrations have a different theme, reflecting key issues and topics relating to heart health.
This year our theme is creating heart-healthy environments
The places in which we live, work and play should not increase our risk of cardiovascular disease (CVD). But individuals frequently cannot make heart-healthy choices due to environmental factors, such as the availability of healthy food or smoke-free zones.
Please spreads the news that at least 80% of premature deaths from cardiovascular disease (CVD) could be avoided if four main risk factors – tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol – are controlled.
World Heart Day was founded in 2000 to inform people around the globe that heart disease and stroke are the world’s leading causes of death, claiming 17.3 million lives each year.
World Heart Day is an annual event which takes place on 29 September every year. Each year’s celebrations have a different theme, reflecting key issues and topics relating to heart health.
This year our theme is creating heart-healthy environments
The places in which we live, work and play should not increase our risk of cardiovascular disease (CVD). But individuals frequently cannot make heart-healthy choices due to environmental factors, such as the availability of healthy food or smoke-free zones.
Please spreads the news that at least 80% of premature deaths from cardiovascular disease (CVD) could be avoided if four main risk factors – tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol – are controlled.
World Heart Day 29th september 2015: Heart-Healthy Environments
World Heart Day 29th september 2015: Heart-Healthy Environments
World Heart Day was founded in 2000 to inform people around the globe that heart disease and stroke are the world’s leading causes of death, claiming 17.3 million lives each year.
World Heart Day is an annual event which takes place on 29 September every year. Each year’s celebrations have a different theme, reflecting key issues and topics relating to heart health.
This year our theme is creating heart-healthy environments
The places in which we live, work and play should not increase our risk of cardiovascular disease (CVD). But individuals frequently cannot make heart-healthy choices due to environmental factors, such as the availability of healthy food or smoke-free zones.
Please spreads the news that at least 80% of premature deaths from cardiovascular disease (CVD) could be avoided if four main risk factors – tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol – are controlled.
World Heart Day was founded in 2000 to inform people around the globe that heart disease and stroke are the world’s leading causes of death, claiming 17.3 million lives each year.
World Heart Day is an annual event which takes place on 29 September every year. Each year’s celebrations have a different theme, reflecting key issues and topics relating to heart health.
This year our theme is creating heart-healthy environments
The places in which we live, work and play should not increase our risk of cardiovascular disease (CVD). But individuals frequently cannot make heart-healthy choices due to environmental factors, such as the availability of healthy food or smoke-free zones.
Please spreads the news that at least 80% of premature deaths from cardiovascular disease (CVD) could be avoided if four main risk factors – tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol – are controlled.
Monday, September 21, 2015
World Alzheimer’s Day ( 2015 September 21) Article in The Hindu Trichy
TIRUCHI, September 21, 2015 The Hindu
“Keep the brain active”
Nahla Nainar
Alzheimer’s disease affects not just the individual but family members also

Greater acceptance of those living with age-related dementia and learning to spot the signs of memory loss are among the goals of this year’s World Alzheimer’s Day (September 21), which is themed around the slogan ‘Remember Me.’
The most common type of dementia reported among people over the age of 60 years, Alzheimer’s disease affects not just the individual, but also family members who become caregivers and have the unenviable task of watching the slow decline of their loved one.
The UK-based advocacy group Alzheimer’s Disease International has reported this year that with its tally of 4.1 million, India is the third among the top 10 countries (behind China and United States) with over a million people living with dementia. According to a 2010 study by Alzheimer’s and Related Disorders Society of India, nearly 20,000 to 40,000 people are expected to be diagnosed with dementia in Tamil Nadu in the next 20 years.
“Many people refuse to acknowledge a diagnosis of mental illness,” M. A. Aleem, neurologist and epileptologist told The Hindu. “As our life expectancy improves due to the advances in technology and lifestyle, we will definitely be seeing an increase in the elderly population. So it is better to learn how to deal with the health problems common to this age group.”
There is no cure for Alzheimer’s, but its symptoms, such as memory loss can be managed with medication. Drugs that curb the breakdown of the acetylcholine chemical in the brain, which is crucial for memory and learning, are usually prescribed to manage the disease.
“It is possible for senior citizens to reduce the chance of getting the disease by avoiding brain injury, and controlling lifestyle ailments like diabetes and high blood pressure with regular medication,” said Dr. Aleem. “Keeping the brain active, with word games and puzzles; regular physical exercise is also important as you grow older,” he added.
Role reversal
For the past six years, Arun*, a resident of B. Mettur who works as a secondary school teacher in the city, has watched his septuagenarian father’s life change dramatically ever since the senior citizen slipped and hurt his head after his customary dip in the village river.
“We didn’t realise it was serious until a year later,” said Arun over the phone. “He would get fits, and we’d control it with an injection from the local doctor or give him an iron object to hold as is the practice.”
As his father began to show signs of memory loss, he became incontinent and aggressive. “It was terribly embarrassing for all of us, and at times, he would start crying at what he had become,” said Arun.
The family did the rounds of several doctors until a Tiruchi-based neurologist diagnosed vascular dementia as the root cause of the sudden behaviour change.
“My father would not be able to recognise me as recently as two years ago,” said Arun. “Today, he can spot the four generations of students he had taught at the village school because he is taking seven tablets to manage his disease. There were days when I lost all hope because my father initially refused to accept that something was wrong with him. I’m happy today that he is not suffering anymore.”
Compassion fatigue
The care of dementia patients usually becomes the responsibility of family members, mainly due to cost constraints, especially in close-knit societies.
However, care giving is a stressful experience, especially when the effort of the caregiver is neither acknowledged nor appreciated.
A study by Bishop Heber College Social Work research scholar G.S. Sangeeth and assistant professor M. Daniel Solomon on the psycho-social problems faced by those caring for dementia patients (published in ‘Indian Journal of Applied Research’, May 2014) states that caregivers suffer from body fatigue and anxiety, besides having to deal with inter-personal conflicts within the family.
“A balance between caring effort and caring capacity is critical for the future sustainability of informal care,” said Dr. Solomon.
*Name changed on request
Sunday, September 20, 2015
Keep rodents at bay to prevent leptospirosis, says TANUVAS
Keep rodents at bay to prevent leptospirosis, says TANUVAS
Gokul Rajendran,TNN | Sep 20, 2015, 02.52 PM IST
TRICHY: The Tamil Nadu Veterinary and Animal Sciences University (TANUVAS), Chennai cautioned people on the dangers of leptospirosis, an infectious bacterial disease transmitted from the urine of rodents, on Saturday on the occasion of Livestock and Poultry Farmers' Day and the Foundation day of the university.
An assistant professor from TANUVAS Dr Selvaraju explained to the visitors that disease was caused by bacteria in the urine of rats.
A person affected with leptospirosis will have symptoms like headache, severe fever, shivering, muscle cramp, vomiting, jaundice, reddish eyes, diarrhea and reddish skin.
"Such symptoms should not be taken lightly. You should test for the disease and get necessary treatment so that further damage can be prevented," he said. The next level of symptoms will be extreme fatigue, deafness, respiratory problem and dysfunction of kidneys and liver, which may ultimately lead to death. The disease can be diagnosed through Dark Field Microscope (DFM), MAT, IgM-ELISA and PCR tests.
Water polluted by rat urine has the biggest chance of reaching humans during monsoon and floods. The bacteria can also affect animals, through which it can enter the human body.
"Cases of leptospirosis were previously reported from some parts of Trichy . The decrease in the number of farms and grain warehouses in houses caused rodents to disappear from the rural parts. Even then, people should be more cautious and keep rodents at bay," said former vice principal of KAP Viswanatham Government Medical College Dr M A Aleem, while also assuring that it was an easily treatable disease if diagnosed at the right time.
TANUVAS advised people to create hygienic conditions, drink boiled water, take immediate treatment in case of symptoms, vaccinate pet animals, prevent sewage from mixing with drinking water supply and avoid wading through the stagnant water.
The public health and preventive medicine department expected doctors to take a serious note of such symptoms and provide appropriate treatment.
"The primary health centres (PHCs) in the rural areas witnessed sporadic cases of leptospirosis. If fever persists for more than a week, the patient will put through a series of tests to check for dengue, chikungunya and leptospirosis," said deputy director of health services (DDHS) Dr I Raveendran in Trichy.

Gokul Rajendran,TNN | Sep 20, 2015, 02.52 PM IST
TRICHY: The Tamil Nadu Veterinary and Animal Sciences University (TANUVAS), Chennai cautioned people on the dangers of leptospirosis, an infectious bacterial disease transmitted from the urine of rodents, on Saturday on the occasion of Livestock and Poultry Farmers' Day and the Foundation day of the university.
An assistant professor from TANUVAS Dr Selvaraju explained to the visitors that disease was caused by bacteria in the urine of rats.
A person affected with leptospirosis will have symptoms like headache, severe fever, shivering, muscle cramp, vomiting, jaundice, reddish eyes, diarrhea and reddish skin.
"Such symptoms should not be taken lightly. You should test for the disease and get necessary treatment so that further damage can be prevented," he said. The next level of symptoms will be extreme fatigue, deafness, respiratory problem and dysfunction of kidneys and liver, which may ultimately lead to death. The disease can be diagnosed through Dark Field Microscope (DFM), MAT, IgM-ELISA and PCR tests.
Water polluted by rat urine has the biggest chance of reaching humans during monsoon and floods. The bacteria can also affect animals, through which it can enter the human body.
"Cases of leptospirosis were previously reported from some parts of Trichy . The decrease in the number of farms and grain warehouses in houses caused rodents to disappear from the rural parts. Even then, people should be more cautious and keep rodents at bay," said former vice principal of KAP Viswanatham Government Medical College Dr M A Aleem, while also assuring that it was an easily treatable disease if diagnosed at the right time.
TANUVAS advised people to create hygienic conditions, drink boiled water, take immediate treatment in case of symptoms, vaccinate pet animals, prevent sewage from mixing with drinking water supply and avoid wading through the stagnant water.
The public health and preventive medicine department expected doctors to take a serious note of such symptoms and provide appropriate treatment.
"The primary health centres (PHCs) in the rural areas witnessed sporadic cases of leptospirosis. If fever persists for more than a week, the patient will put through a series of tests to check for dengue, chikungunya and leptospirosis," said deputy director of health services (DDHS) Dr I Raveendran in Trichy.

Saturday, September 19, 2015
Friday, September 18, 2015
Aleem M A .Health of Women, Children and Adolescents as Migrants and Refugees. BMJ 2015;351:h4414
Analysis
Women’s, Children’s, and Adolescents’ Health
Towards a new Global Strategy for Women’s, Children’s and Adolescents’ Health
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4414 (Published 14 September 2015)
Cite this as: BMJ 2015;351:h4414
Rapid Response


Health of Women, Children and Adolescents as Migrants and Refugees
The health of women, children and adolescents is important for a healthy future generation in each and every country. They are living in an environment in which the hidden dangers of electromagnetic radiation due to household electrical items and due to cell phone usage for longer periods of time are high. This may also affect their health.
Recently the intake of junk food may also act as a slow killer in these populations. Stress and mental worries also affect their mental and physical health.
The most vulnerable population currently affected by war and terrorist activities are women, children and adolescents. They are sexually abused and used as human shields.
These populations are also much affected by migration due to internal conflicts, terrorism and war. Their health is much affected, and many have lost their lives.
So each and every country should care about the health of these people. Universally all countries should adopt and follow a common minimum program for the health care of women, children and adolescents during migration and as refugees.
Competing interests: No competing interests
18 September 2015
M A Aleem
Neurologist
ABC Hospital
Annamalainagar Trichy 620018 Tamilnadu India
Women’s, Children’s, and Adolescents’ Health
Towards a new Global Strategy for Women’s, Children’s and Adolescents’ Health
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4414 (Published 14 September 2015)
Cite this as: BMJ 2015;351:h4414
Rapid Response


Health of Women, Children and Adolescents as Migrants and Refugees
The health of women, children and adolescents is important for a healthy future generation in each and every country. They are living in an environment in which the hidden dangers of electromagnetic radiation due to household electrical items and due to cell phone usage for longer periods of time are high. This may also affect their health.
Recently the intake of junk food may also act as a slow killer in these populations. Stress and mental worries also affect their mental and physical health.
The most vulnerable population currently affected by war and terrorist activities are women, children and adolescents. They are sexually abused and used as human shields.
These populations are also much affected by migration due to internal conflicts, terrorism and war. Their health is much affected, and many have lost their lives.
So each and every country should care about the health of these people. Universally all countries should adopt and follow a common minimum program for the health care of women, children and adolescents during migration and as refugees.
Competing interests: No competing interests
18 September 2015
M A Aleem
Neurologist
ABC Hospital
Annamalainagar Trichy 620018 Tamilnadu India
Monday, September 7, 2015
Aleem M A . Beware of Excessive Antibiotic Usage . BMJ 2015;351:h4697
Views & Reviews
No Holds Barred
Margaret McCartney: Blaming doctors won’t reduce antibiotic overuse
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4697 (Published 01 September 2015)
Cite this as: BMJ 2015;351:h4697
Rapid response
Re: Margaret McCartney: Blaming doctors won’t reduce antibiotic overuse
Beware of Excessive Antibiotic Usage
Self medications and treatment with quacks are the two important reasons in poor and developing countries for the excessive use of antibiotics.
This is more dangerous in neonates, infants, children and elders. This attitude is also very dangerous in patients with many co-morbid conditions.
So doctors should be very cautious in choosing the antibiotics and the duration of antibiotic therapy.
Doctors should also follow the standard guidelines to use antibiotics for prophylaxis or treatment to prevent inappropriate and excessive usage of antibiotics.
Competing interests: No competing interests
04 September 2015
M A Aleem
Neurologist
ABC Hospital
Annamalainagar Trichy 620018 Tamilnadu India
No Holds Barred
Margaret McCartney: Blaming doctors won’t reduce antibiotic overuse
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4697 (Published 01 September 2015)
Cite this as: BMJ 2015;351:h4697
Rapid response
Re: Margaret McCartney: Blaming doctors won’t reduce antibiotic overuse
Beware of Excessive Antibiotic Usage
Self medications and treatment with quacks are the two important reasons in poor and developing countries for the excessive use of antibiotics.
This is more dangerous in neonates, infants, children and elders. This attitude is also very dangerous in patients with many co-morbid conditions.
So doctors should be very cautious in choosing the antibiotics and the duration of antibiotic therapy.
Doctors should also follow the standard guidelines to use antibiotics for prophylaxis or treatment to prevent inappropriate and excessive usage of antibiotics.
Competing interests: No competing interests
04 September 2015
M A Aleem
Neurologist
ABC Hospital
Annamalainagar Trichy 620018 Tamilnadu India
Thursday, September 3, 2015
World Sexual Health Day 2015 September 4 “Sexual Health for a Fairer Society”
World Sexual Health Day 2015
“Sexual Health for a Fairer Society”
World Sexual Health Day 2015 will focus on Sexual Health and Justice, Sexual Rights and Human Rights.
The definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights.
Gender, Sexuality and Reproductive Justice

Sexuality and the right to reproductive health are fundamental to the human experience; all women and men should be able to exercise these rights free from coercion and violence.
Why It Matters
Around the world, discussion of human sexuality and reproductive health and rights has often been considered too socially and politically sensitive or too personal for serious exploration or public debate.
At the same time, governments implement laws and programs that have direct or unanticipated impacts on these human freedoms with little or no input from those most affected. As a result, healthy development, autonomy and personal agency in these areas have often been compromised.
The Focus of Our Work
Our work is dedicated to strengthening sexual and reproductive health and rights, and encouraging comprehensive sexuality education and evidence-based public discourse on sexuality.
We support those working to ensure that young people are empowered to have access to the information and services they need. Our efforts focus particularly on young women from poor and excluded communities because they bear the greatest burden of violence and disease. We support sexual and reproductive health policies, innovative programs and research that address the social, cultural and economic factors that undermine improved outcomes for girls and women.
All of this work is motivated by the belief that a deeper understanding of human sexuality is an essential element of human rights and healthy social relationships. Those most affected must be at the fore of efforts to ensure that sexual and reproductive health and rights are addressed as a cornerstone of individual, family and community health
Advancing sexual health through human rights: The role of the law
The International Conference on Population and Development (ICPD) Programme of Action (POA) defined reproductive health and reproductive rights. Sexual health, ‘the purpose of which is the enhancement of life and person relations, and not merely counselling and care related to reproduction and sexually transmitted diseases’, was included as part of reproductive health (UN, 1994). And while the POA also enjoined governments and others to give full attention to meeting the ‘educational and services needs of adolescents … to deal … with their sexuality’ and to the promotion of ‘mutually respectful and equitable gender relations’, it did not elaborate on the various dimensions of sexuality, sexual health and sexual rights. In 1995, international consensus was reached at the Fourth World Conference on Women that ‘the human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality’ (UN, 1996), a very important recognition, but still limited in scope and content.
Since then, dramatic developments have occurred in the global understanding of sexuality and sexual health. While it encompasses some aspects of reproductive health such as contraception and abortion, many aspects of sexual health – including sexual pleasure, intimacy and the sexual health consequences of violence and female genital mutilation, as well as the complexities of sexual dysfunction – are not directly associated with reproduction. Sexual health extends beyond the reproductive years and cannot be adequately supported without a broadened understanding of sexuality. Further, social mobilisation on HIV and AIDS beginning in the early 1990s forced attention to the taboos, stigma and discrimination related to sexuality, while public health leaders and research, alongside these social movements, raised awareness of the importance of human sexuality and sexual behaviour, including people's ability to have fulfilling and pleasurable sexual relationships (World Health Organization [WHO], 2006).
There is now increasing recognition that sexual health cannot be achieved without the respect, protection and fulfilment of all human rights and that meeting human rights obligations is essential for social justice, sustainable development and public health (International Planned Parenthood Federation [IPPF], 2008; WHO, 2004, 2010a; World Association for Sexual Health [WAS], 2014). For example, an intergovernmental Latin American and Caribbean review of 20 years of ICPD implementation concluded that states must:
promote policies that enable persons to exercise their sexual rights, which embrace the right to a safe and full sex life, as well as the right to take free, informed, voluntary and responsible decisions on their sexuality, sexual orientation and gender identity, without coercion, discrimination or violence, and that guarantee the right to information and the means necessary for their sexual health, and reproductive health. (United Nations Economic Commission for Latin America and the Caribbean [UNECLAC], 2013)
A strong claim has also been made in the context of the post-2015 development agenda that due recognition should be given to sexual and reproductive health and rights in the sustainable development goals, since sexual and reproductive health and rights are critical dimensions of development and are a critical component of health and wellbeing of individuals (Temmerman, Khosla, & Say, 2014).
While there is currently no formal political international consensus on the term ‘sexual rights’, the work of WHO and international organisations such as World Association for Sexual Health (WAS) and the International Planned Parenthood Federation (IPPF), among others, has led to an understanding that sexual rights are grounded in universal human rights that are already recognised in international and regional human rights documents and in national constitutions and laws (IPPF, 2008; WAS, 2014; WHO, 2010a). This conceptual understanding takes into account the significant development over the past two decades of human rights laws and standards relating to sexuality.
Considerable progress has been made in changing or enacting laws affecting sexual health, in line with human rights standards, although the opposite has been also observed. This is important because harmonising laws with human rights standards can foster the promotion of sexual health across and within various populations, while the negative health impact of laws that are in contradiction with human rights standards has been increasingly documented. Laws matter because they set the rules of social interactions (at macro- and inter-personal levels) and can provide the framework for implementation of sexual health-related policies, programmes and services. They can provide human rights guarantees, but they may also create limitations on health and rights. Either way, laws and regulations have an impact on the enjoyment of the highest attainable standard of sexual health. For example, laws that foster the dissemination of objective, comprehensive sexuality information, if implemented for all, contribute to people's knowledge of what protects or damages their sexual health, including where and how to seek further information, counselling and treatment if needed. On the other hand, laws that restrict access to health services by requiring third party authorisation for services for women and adolescents, for example, and laws that criminalise certain consensual sexual behaviour, effectively exclude or deter people from seeking and receiving the information and services they require and to which they have a right.
While actions are needed across many sectors, it is vital that people in the health sector understand how health, human rights and law interact, and their relevance to both individual and public health. In this paper, we examine some of these interactions, presenting concrete examples of legal changes and new standards related to a few key aspects: non-discrimination, criminalisation and access to information and services, and we point to how governments can and should be shaping the legal environment to meet their human rights obligations and improve sexual health.
Human rights law is codified in international and regional treaties such as the Covenant on Economic, Social and Cultural Rights and the European Convention on Human Rights, and in national constitutions and laws. Treaties become legally binding through ratification and incorporation into national constitutions and laws. A decision of international courts such as the International Criminal Court, and regional courts such as the European Court of Human Rights, is binding on the nation that receives the decision. Such decisions are also authoritative interpretations of what the treaty means and other countries often adjust their laws to conform. Human rights standards include not only law but also norms and principles which can be used to guide state action and which are derived from a variety of sources such as the statements of United Nations treaty monitoring bodies (e.g., the Committee of the Rights of the Child that monitors state compliance with the Covenant on the Rights of the Child). These authoritative bodies have produced key views, findings and recommendations that constitute human rights standards for the protection of human rights related to sexuality and sexual health as demonstrated throughout this article.
Law and its role in countering discrimination
Inequality among and between persons and groups is a strong predictor of ill health, including sexual health (see the paper by Snow, Laski, & Massy, 2014). Inequalities, manifested in people's differential access to services and resources, ability to participate in the making of laws and policies and the ability to seek remedies for abuses committed against them, are often the result of discrimination (WHO, 2010a).
Discrimination is understood in international human rights treaties to mean any adverse distinction, exclusion, restriction or preference which is based on any ground such as ‘race, colour, sex, language, religion, political or other opinion, national or social origin, birth or other status’ and which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise of rights (United Nations [UN], 1966).
Recent developments in international human rights standards make clear that the grounds on which discrimination is prohibited are non-exhaustive and include disability, age, marital and family status, sexual orientation, gender identity and health status (e.g., HIV) (UN Committee on Economic, Social and Cultural Rights [CESCR], 2009; UN Committee on the Elimination of Discrimination against Women [CEDAW], 2010) all of which are closely associated with sexual health. Several countries have recently made some of these grounds explicit in their legislation (Council of Europe, 2011). Among other examples, the anti-discrimination law in Serbia recognises equality of people and includes, among the grounds for non-discrimination, gender, gender identity and sexual orientation as well as health, marital and family status (National Assembly of the Republic of Serbia, 2009).
Discrimination often encompasses more than one form of exclusion or stigma and states are responsible for having laws in place to prevent and address such discrimination (Council of Europe, 2011; Organization of American States General Assembly, 2013). Poor women and girls belonging to ethnic minorities, for example, are often burdened by both gender and race or socioeconomic-linked discrimination and exclusion (CEDAW, 2011). Denial of access to safe and legal abortion affects all women, but poorer or minority women and girls are more likely than others to face the health consequences, including mortality, of unsafe abortion, and they and their families face more difficulties in obtaining redress and remedies (CEDAW,
.
“Sexual Health for a Fairer Society”
World Sexual Health Day 2015 will focus on Sexual Health and Justice, Sexual Rights and Human Rights.
The definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights.
Gender, Sexuality and Reproductive Justice

Sexuality and the right to reproductive health are fundamental to the human experience; all women and men should be able to exercise these rights free from coercion and violence.
Why It Matters
Around the world, discussion of human sexuality and reproductive health and rights has often been considered too socially and politically sensitive or too personal for serious exploration or public debate.
At the same time, governments implement laws and programs that have direct or unanticipated impacts on these human freedoms with little or no input from those most affected. As a result, healthy development, autonomy and personal agency in these areas have often been compromised.
The Focus of Our Work
Our work is dedicated to strengthening sexual and reproductive health and rights, and encouraging comprehensive sexuality education and evidence-based public discourse on sexuality.
We support those working to ensure that young people are empowered to have access to the information and services they need. Our efforts focus particularly on young women from poor and excluded communities because they bear the greatest burden of violence and disease. We support sexual and reproductive health policies, innovative programs and research that address the social, cultural and economic factors that undermine improved outcomes for girls and women.
All of this work is motivated by the belief that a deeper understanding of human sexuality is an essential element of human rights and healthy social relationships. Those most affected must be at the fore of efforts to ensure that sexual and reproductive health and rights are addressed as a cornerstone of individual, family and community health
Advancing sexual health through human rights: The role of the law
The International Conference on Population and Development (ICPD) Programme of Action (POA) defined reproductive health and reproductive rights. Sexual health, ‘the purpose of which is the enhancement of life and person relations, and not merely counselling and care related to reproduction and sexually transmitted diseases’, was included as part of reproductive health (UN, 1994). And while the POA also enjoined governments and others to give full attention to meeting the ‘educational and services needs of adolescents … to deal … with their sexuality’ and to the promotion of ‘mutually respectful and equitable gender relations’, it did not elaborate on the various dimensions of sexuality, sexual health and sexual rights. In 1995, international consensus was reached at the Fourth World Conference on Women that ‘the human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality’ (UN, 1996), a very important recognition, but still limited in scope and content.
Since then, dramatic developments have occurred in the global understanding of sexuality and sexual health. While it encompasses some aspects of reproductive health such as contraception and abortion, many aspects of sexual health – including sexual pleasure, intimacy and the sexual health consequences of violence and female genital mutilation, as well as the complexities of sexual dysfunction – are not directly associated with reproduction. Sexual health extends beyond the reproductive years and cannot be adequately supported without a broadened understanding of sexuality. Further, social mobilisation on HIV and AIDS beginning in the early 1990s forced attention to the taboos, stigma and discrimination related to sexuality, while public health leaders and research, alongside these social movements, raised awareness of the importance of human sexuality and sexual behaviour, including people's ability to have fulfilling and pleasurable sexual relationships (World Health Organization [WHO], 2006).
There is now increasing recognition that sexual health cannot be achieved without the respect, protection and fulfilment of all human rights and that meeting human rights obligations is essential for social justice, sustainable development and public health (International Planned Parenthood Federation [IPPF], 2008; WHO, 2004, 2010a; World Association for Sexual Health [WAS], 2014). For example, an intergovernmental Latin American and Caribbean review of 20 years of ICPD implementation concluded that states must:
promote policies that enable persons to exercise their sexual rights, which embrace the right to a safe and full sex life, as well as the right to take free, informed, voluntary and responsible decisions on their sexuality, sexual orientation and gender identity, without coercion, discrimination or violence, and that guarantee the right to information and the means necessary for their sexual health, and reproductive health. (United Nations Economic Commission for Latin America and the Caribbean [UNECLAC], 2013)
A strong claim has also been made in the context of the post-2015 development agenda that due recognition should be given to sexual and reproductive health and rights in the sustainable development goals, since sexual and reproductive health and rights are critical dimensions of development and are a critical component of health and wellbeing of individuals (Temmerman, Khosla, & Say, 2014).
While there is currently no formal political international consensus on the term ‘sexual rights’, the work of WHO and international organisations such as World Association for Sexual Health (WAS) and the International Planned Parenthood Federation (IPPF), among others, has led to an understanding that sexual rights are grounded in universal human rights that are already recognised in international and regional human rights documents and in national constitutions and laws (IPPF, 2008; WAS, 2014; WHO, 2010a). This conceptual understanding takes into account the significant development over the past two decades of human rights laws and standards relating to sexuality.
Considerable progress has been made in changing or enacting laws affecting sexual health, in line with human rights standards, although the opposite has been also observed. This is important because harmonising laws with human rights standards can foster the promotion of sexual health across and within various populations, while the negative health impact of laws that are in contradiction with human rights standards has been increasingly documented. Laws matter because they set the rules of social interactions (at macro- and inter-personal levels) and can provide the framework for implementation of sexual health-related policies, programmes and services. They can provide human rights guarantees, but they may also create limitations on health and rights. Either way, laws and regulations have an impact on the enjoyment of the highest attainable standard of sexual health. For example, laws that foster the dissemination of objective, comprehensive sexuality information, if implemented for all, contribute to people's knowledge of what protects or damages their sexual health, including where and how to seek further information, counselling and treatment if needed. On the other hand, laws that restrict access to health services by requiring third party authorisation for services for women and adolescents, for example, and laws that criminalise certain consensual sexual behaviour, effectively exclude or deter people from seeking and receiving the information and services they require and to which they have a right.
While actions are needed across many sectors, it is vital that people in the health sector understand how health, human rights and law interact, and their relevance to both individual and public health. In this paper, we examine some of these interactions, presenting concrete examples of legal changes and new standards related to a few key aspects: non-discrimination, criminalisation and access to information and services, and we point to how governments can and should be shaping the legal environment to meet their human rights obligations and improve sexual health.
Human rights law is codified in international and regional treaties such as the Covenant on Economic, Social and Cultural Rights and the European Convention on Human Rights, and in national constitutions and laws. Treaties become legally binding through ratification and incorporation into national constitutions and laws. A decision of international courts such as the International Criminal Court, and regional courts such as the European Court of Human Rights, is binding on the nation that receives the decision. Such decisions are also authoritative interpretations of what the treaty means and other countries often adjust their laws to conform. Human rights standards include not only law but also norms and principles which can be used to guide state action and which are derived from a variety of sources such as the statements of United Nations treaty monitoring bodies (e.g., the Committee of the Rights of the Child that monitors state compliance with the Covenant on the Rights of the Child). These authoritative bodies have produced key views, findings and recommendations that constitute human rights standards for the protection of human rights related to sexuality and sexual health as demonstrated throughout this article.
Law and its role in countering discrimination
Inequality among and between persons and groups is a strong predictor of ill health, including sexual health (see the paper by Snow, Laski, & Massy, 2014). Inequalities, manifested in people's differential access to services and resources, ability to participate in the making of laws and policies and the ability to seek remedies for abuses committed against them, are often the result of discrimination (WHO, 2010a).
Discrimination is understood in international human rights treaties to mean any adverse distinction, exclusion, restriction or preference which is based on any ground such as ‘race, colour, sex, language, religion, political or other opinion, national or social origin, birth or other status’ and which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise of rights (United Nations [UN], 1966).
Recent developments in international human rights standards make clear that the grounds on which discrimination is prohibited are non-exhaustive and include disability, age, marital and family status, sexual orientation, gender identity and health status (e.g., HIV) (UN Committee on Economic, Social and Cultural Rights [CESCR], 2009; UN Committee on the Elimination of Discrimination against Women [CEDAW], 2010) all of which are closely associated with sexual health. Several countries have recently made some of these grounds explicit in their legislation (Council of Europe, 2011). Among other examples, the anti-discrimination law in Serbia recognises equality of people and includes, among the grounds for non-discrimination, gender, gender identity and sexual orientation as well as health, marital and family status (National Assembly of the Republic of Serbia, 2009).
Discrimination often encompasses more than one form of exclusion or stigma and states are responsible for having laws in place to prevent and address such discrimination (Council of Europe, 2011; Organization of American States General Assembly, 2013). Poor women and girls belonging to ethnic minorities, for example, are often burdened by both gender and race or socioeconomic-linked discrimination and exclusion (CEDAW, 2011). Denial of access to safe and legal abortion affects all women, but poorer or minority women and girls are more likely than others to face the health consequences, including mortality, of unsafe abortion, and they and their families face more difficulties in obtaining redress and remedies (CEDAW,
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