Factors associated with the practice of and intention to perform female genital mutilation on a female child among married women in Abakaliki Nigeria.

BACKGROUND: Female Genital Mutilation (FGM), also known as Female Genital Cutting or Female Circumcision is the harmful excision of the female genital organs for non-medical reasons. According to WHO, approximately 200 million girls and women have been genitally mutilated globally. Its recognition internationally as human rights violation has led to initiatives to stop FGM. This study investigated factors associated with the practice and intention to perform FGM among married women. METHODS: A cross-sectional study was conducted among 421 married women from communities in Abakaliki Nigeria. The participants were selected through multistage sampling. Data were collected through the interviewer's administration of a validated questionnaire. Data were analyzed using IBM-SPSS version 25. Chi-square and logistic regression tests were employed to determine factors associated with the practice and intention to perform FGM at a p-value of ≤ 0.05 and confidence level of 95%. RESULTS: The mean age of respondents is 40.5 ± 14.9 years. A majority, 96.7% were aware of FGM. On a scale of 15, their mean knowledge score was 8.1 ± 4.3 marks. Whereas 50.4% of the respondents were genitally mutilated, 20.2% have also genitally mutilated their daughters, and 7.4% have plan to genitally mutilate their future daughters. On a scale of 6, their mean practice score was 4.8 ± 1.2 marks. The top reasons for FGM are tradition (82.9%), a rite of passage into womanhood (64.4%), suppression of sexuality (64.4%), and promiscuity (62.5%). Women with at least secondary education are less likely to genitally mutilate their daughters (Adjusted Odds Ratio [AOR] = 0.248, 95% Confidence Interval [CI] = 0.094-0.652). Women who are genitally mutilated are more likely to genitally mutilate their daughters (AOR = 28.732, 95% CI = 6.171-133.768), and those who have previously genitally mutilated their daughters have greater intention to genitally mutilate future ones (AOR = 141.786; 95% CI = 9.584-209.592). CONCLUSIONS: Women who underwent FGM have a greater propensity to perpetuate the practice but attaining at least secondary education promotes its abandonment. Targeted intervention to dispel any harboured erroneous beliefs of the sexual, health, or socio-cultural benefits of FGM and improved public legislation with enforcement against FGM are recommended.

A novel curriculum for the Same-Sex Marriage Act and Patient Right to Autonomy Act (SMPRA) module based on two new laws in Taiwan: a mixed-methods study.

BACKGROUND: The establishment of laws has had a tremendous impact on holistic medical care. The Patient Right to Autonomy (PRA) Act and the Same-Sex Marriage Act have been passed in Taiwan, and both have sparked intense societal debate. The Same-Sex Marriage Act and PRA Act (SMPRA) teaching module was created for the Gender, Medicine, and Law (GML) course of the medical curriculum. This video trigger-assisted problem-based learning (VTA-PBL) software has integrated content on the aforementioned legislative proclamations. It upends conventional beliefs and fosters reflective practices on sexual rights and the right to representation among medical students. This study examined how the SMPRA module affected the knowledge and attitudes of medical students taking up the GML course. METHODS: A simple pre-/post-test design evaluated the outcomes of the PBL module to examine the changes in knowledge and attitudes of medical students toward same-sex marriage rights. In 2019 and 2020, 126 and 49 5th-year medical students took up the GML course, respectively. The GML components included a video scenario representing advanced decision-making and a healthcare agency with a same-sex couple, a PBL discussion, and student feedback presentations. The mechanisms of feedback collection and measuring student knowledge and attitudes toward sexual rights differed between one cohort in 2019 and the other in 2020. Pre- and post-lecture tests were used in the first school year, whereas a post-lecture open-ended questionnaire survey was used in the second school year. RESULTS: In total, 90 and 39 eligible questionnaires were received in the first and second school years, respectively, which corresponded to response rates of 71% and 80%. Students showed a better understanding of and positive enhancement of proficiency in legal and ethical content and relevant clinical practice. Qualitative analysis revealed that students viewed healthcare providers as checkpoints for conflicts of interest; medical ethics as the cornerstone of clinical practice; cultural background as a significant influence on decision-making; and empathetic communication as the cornerstone of relationships between patients, family members, and doctors. CONCLUSION: The GML course of the SMPRA module fosters reflective practices on ethical and legal sexual rights issues.

'Eventually I wanted something more': sexual self-reflections of South African women engaged in transactional sexual relationships with blessers.

The term 'blesser' emerged from social media in South Africa, typically denoting an older man who provides a younger woman with money and/or luxury items in exchange for sex. Within an increasingly consumerist culture, such transactional sexual relationships hold powerful appeal, and remain highly prevalent. An estimated one in three Black South African women have engaged in transactional sex. While these liaisons are associated with negative health outcomes for women, especially in high HIV prevalence settings, attention to how they affect Black women's sexuality is under-studied-especially with respect to emotional and sexual development-an important part of sexual rights and wellbeing. We used qualitative methods to investigate 22 women's experiences with blessers. A sexual rights framework was utilised to explore human rights dimensions. We found women's rights to engage in consensual sex, pursue sexual pleasure and ensure their bodily integrity were compromised. Many participants recognised the psychological costs and limitations of engaging in blesser relationships. Women communicated that they realised such partnerships failed to meet their emotional and relationship needs. Against the backdrop of structural gender inequality, Black South African women's narratives should inform research, programmes and educational interventions aimed at advancing women's sexual development, rights and wellbeing.

Securing sexual justice for people with intellectual disability: A systematic review and critical appraisal of research recommendations.

BACKGROUND: People with intellectual disability contend with significant restrictions to their sexual expression and partnered relationships. This review examines the types of recommendations scholars offer in their qualitative research involving participants with intellectual disability discussing sexuality and intimate relationships. METHOD: A systematic review of peer-reviewed studies published between 1972 and July 2018 yielded a sample of 26 studies. Thematic analysis was used to taxonomize scholars' recommendations. RESULTS: Six distinct forms of recommendations were identified. The most frequently offered and most strongly emphasized recommendation across studies aimed to change individuals with intellectual disability. In contrast, a minority of studies prioritized engaging individuals as informants, eliciting individuals' wishes, enabling relationships and fostering ideological change. No studies placed the greatest weight on promoting systems change. CONCLUSIONS: Recommendations in the literature have predominantly emphasized individual as opposed to environmental changes. I consider the ramifications of this and argue for a reorientation towards systems change.

Young migrants' sexual rights in Sweden: a cross-sectional study.

BACKGROUND: In national public health surveys including those assessing sexual and reproductive health, migrants generally tend to be underrepresented due to cultural, linguistic, structural and legal barriers, minimising the possibility to measure sexual rights' fulfilment in this group. This study aims to describe to what extent sexual rights of young migrants in Sweden are being fulfilled. METHODS: A self-administered questionnaire was used to collect data from 1773 young (16-29 years) migrants by post, online, and at language schools and other venues. Sexual rights were operationalised and categorised into five domains adapted from the Guttmacher-Lancet Commission's definition. These domains included the right to: 1) access sexual and reproductive healthcare, 2) access information and education about sexuality and sexual and reproductive health and rights, 3) have bodily integrity, 4) make free informed decisions about sexuality and sexual relations and 5) have a satisfying and safe sexual life. Descriptive analysis was used to assess the extent of fulfilment for each right. RESULTS: There were wide variations in the fulfilment of sexual rights between subgroups and among the five domains. Most respondents rated their sexual health as good/fair, however, 6.3% rated their sexual health as bad/very bad. While most of those who visited related services were satisfied, 17.4% of respondents refrained from visiting the services despite their needs. Around four in ten respondents did not know where to get information about sexuality and sexual health. One-fourth of respondents reported sexual violence. Another 12.7% were limited by family members or fellow countrymen regarding with whom they can have an intimate relationship. Most respondents were satisfied with their sexual life, except for 11.9%. Men, non-binary respondents, lesbians, gays, bisexuals, asexuals, those who were awaiting a decision regarding residence permit and those born in South Asia reported poor sexual health to a greater extent and fulfilment of their sexual rights to a lesser extent than other groups. CONCLUSIONS: Timely and culturally adapted information about sexual rights, gender equalities, laws and available services in Sweden should be provided in appropriate languages and formats in order to raise awareness about sexual rights and improve access to available services. Tailored attention should be paid to specific vulnerable subgroups.

A snapshot of reproductive and sexual health and rights of women living with HIV in Asia.

OBJECTIVE: A brief review of status of sexual and reproductive health and rights of women living with human immunodeficiency virus (HIV) in Asia with a focus on their access to related services. SUBJECT(S) AND METHODS: The content has primarily emerged from several meetings, workshops and research studies that regional networks of women living with HIV have conducted in the region. We used published and unpublished literature in English after the year 2000. RESULTS: We found many hindrances to realization of sexual and reproductive rights by HIV-positive women and their access to related health services. Rampant stigma and discrimination by service providers take the form of denial of contraceptive and maternal health services, forced sterilization, breach of confidentiality and disclosure of status to others without the consent of the woman. Families blaming women for bringing HIV and male partners objecting to using condoms affect the well-being of HIV-positive women. Sexual rights specifically aspects of positive sexuality such as sexual pleasure have not received attention. CONCLUSION: Findings suggest the need to enhance capacities of HIV-positive women's organizations to meaningfully participate in decisions on positive women's sexual, reproductive health and rights and sensitize service providers to adequately address HIV-positive women's concerns.

'Transformed rights' sexual health programme evaluation for the parents and service workers of adults with an intellectual disability.

BACKGROUND: To promote sexual health in adults with an intellectual disability (ID) in Taiwan, sexual health programmes were provided to adults with ID, their parents and service workers. This study evaluates the impact of these programmes that involved the parents and service workers. METHODS: Intervention and participatory research paradigms were applied to develop, implement and evaluate programmes that address the challenges that relate to the sexual rights of adults with ID. Additionally, the programmes fostered open dialogue among the participants concerning the sexual health of people with ID. In total, 57 parents and 164 service workers were involved in the programmes. A quasi-experimental design and standardised questionnaires (Attitudes to Sexuality Questionnaire - Individuals with an Intellectual Disability), as well as in-depth interviews, were used to collect both quantitative and qualitative data on the programmes' effectiveness and participants' experiences between April 2012 and July 2015. RESULTS: The findings revealed that after the programmes were implemented, attitudes towards the sexual rights of people with ID were significantly more positive among both the parents and service workers. Participation in the sexual health programmes facilitated constructive dialogue by revealing hidden concerns and by transforming the perspectives of the parents and service workers from viewing sexuality as a social problem to understanding the sexual rights of adults with ID. CONCLUSIONS: Both the quantitative and qualitative results demonstrate that the programmes had a positive impact on the parents and service workers in terms of their attitudes towards the sexual rights of people with ID. Open dialogue and reciprocal interaction strategies caused transformations in the perspectives of parents and service workers on sexual health.

Navigating stigma, survival, and sex in contexts of social inequity among young transgender women and sexually diverse men in Kingston, Jamaica.

Social inequities, including stigma, criminalisation of same-sex practices, and poverty, elevate HIV exposure among young transgender women and sexually diverse men in Jamaica. Yet the ways transgender women and sexually diverse men in Jamaica navigate sex and HIV in contexts of social inequity are underexplored. The study objective was to explore experiences and perceptions of sexual decision-making and HIV risk among young (aged 18-30) sexually diverse men and transgender women in Kingston, Jamaica. We conducted a community-based qualitative study in Kingston that involved in-depth individual interviews (transgender women: n = 20; sexually diverse men: n = 20), 2 focus groups (transgender women: n = 8; sexually diverse men: n = 10) and 13 key informant interviews. Focus groups and interviews were digitally recorded, transcribed verbatim, and analysed with a thematic approach. Findings suggest that transgender women and sexually diverse men in Kingston are aware of, and managing survival challenges and HIV risks in contexts of social inequity. Daily survival challenges include stigma and a lack of human rights protections that contributed to barriers to employment, housing, healthcare, education, and exposure to violence. Challenges maintaining sexual relationships included the need to hide for safety, often resulting in difficulties forming lasting relationships. These survival and relationship challenges converged to lower self-esteem and self-acceptance. In the face of these challenges, participants navigated sexual risk and pleasure. Findings provide insight into agency and sexual decision-making processes in contexts of social inequities. Findings can inform multi-level strategies to promote social equity, sexual health, and HIV prevention with young transgender women and sexually diverse men in Jamaica.

Drivers of Sexual Inactivity Among Women Living with HIV and AIDS: Findings of the GENIH Study in São Paulo, Brazil.

The advances on HIV/AIDS diagnosis and treatment have enabled people living with HIV/AIDS (PLHA) better quality of life. However, the persistence of HIV-related stigma and discrimination, and the risks triggered by HIV disclosure, may be a barrier to the sexual exercise of PLHA. We investigated the prevalence of sexual inactivity and the reasons given for it among a representative sample of women of reproductive age living with HIV/AIDS (WLWHA) in the municipality of São Paulo, Brazil. We surveyed 918 WLWHA with probability proportional to average number of visits in each of the 18 referral HIV/AIDS services. Sexual inactivity was defined as not having had vaginal sexual intercourse in the year prior to research. Statistical modeling of the factors associated with sexual inactivity was carried out by way of bivariate and multivariate analysis. In all, 22.2% (n = 200) of the women did not have sexual relations in the year prior to the interview. The majority reported a reduction in desire (64.5%) and sexual activity (68%). Among the women not in a relationship, the predictors of sexual inactivity were: being older (35-49) (ORa = 2.25); not being Catholic (ORa = 2.91); having kept the diagnosis secret from their partner (ORa = 2.45); having had up to five sexual partners throughout life (ORa = 3.81). The diagnosis of HIV seems to have more of an effect on the desire for and frequency of sexual activity than on its interruption. Sexual inactivity was influenced by the stigma of HIV/AIDS, by age, and by moral-religious values.

The political dimension of sexual rights. : Commentary on the paper by Chandra-Mouli et al.: a never-before opportunity to strengthen investment and action on adolescent contraception, and what we must do to make full use of it.

BACKGROUND: The recent commentary article in this journal by Chandra-Mouli et al. speaks of a never-before opportunity to strengthen investment and action on adolescent contraception. We endorse the positive 'can-do' tone of the article, but noticed that at least four issues, which in our view are crucial, merit a comment. MAIN BODY: First of all, the article suggests that there is some sort of shared interest, based on a presumed global consensus around the use of contraceptives by adolescents - which is not the case: sexual rights are controversial. Secondly, for real progress in adolescent contraception to occur, we believe it is critical to thoroughly investigate and mention the factors, including political ones, that would need to be overcome. Thirdly, new avenues need to be explored that allow for accurate and positive teaching of adolescents about contraception in socio-cultural and political environments that are ambivalent about the issue. Fourthly, barriers at the global level that we already know of should not be silenced. There is sufficient evidence to call upon donors and international agencies to choose position and stop obstructing women's - including young women's - access to a broad range of contraceptives. The 'She Decides' movement is a heartening example. CONCLUSION: It is crucial to acknowledge the political dimension of sexual rights. It requires solutions not only at national levels, but also at the global level.

The sexual and reproductive rights and benefit derived from sexual and reproductive health services of people with physical disabilities in South Africa: beliefs of non-disabled people.

There is a body of theoretical work, and some empirical research, which suggests that non-disabled people assume people with physical disabilities are not suitable romantic partners, do not have sexual drives or desires, or are not sexually active. It has also been proposed that people with physical disabilities face barriers to sexual healthcare access which are structural as well as social. The present paper explores non-disabled South Africans' beliefs concerning the degree to which non-disabled respondents enjoy sexual and reproductive rights, and benefit from sexual and reproductive healthcare, compared to people without disability. Using a survey, we asked 1989 South Africans to estimate the degree to which people with physical disabilities and people without disability have sexual rights, and benefit from sexual and reproductive healthcare services, respectively. Respondents were more likely to support the idea that the population without disability were deserving of sexual rights compared to people with physical disabilities. Respondents were more likely to rate the degree to which people with physical disability benefit from sexual and reproductive healthcare as less than that for people without physical disabilities. These findings provide some of the first empirical support that non-disabled people perceive people with physical disabilities as having fewer sexual and reproductive rights, and deriving less benefit from sexual and reproductive health services, than the population without disability. To have diminished sexual rights, and benefit less from sexual and reproductive healthcare, we suggest, evinces a negation of the sexual and reproductive needs and capacity of people with physical disabilities.

The paradox of recognition: hijra, third gender and sexual rights in Bangladesh.

Hijra, the iconic figure of South Asian gender and sexual difference, comprise a publicly institutionalised subculture of male-bodied feminine-identified people. Although they have existed as a culturally recognised third gender for a very long time, it is only recently that hijra have been legally recognised as a third gender in several South Asian countries. This paper focuses on the transformation of this long-running cultural category of third gender into a legal category of third gender in Bangladesh, showing that the process of legal recognition has necessitated a simultaneous mobilisation of a discourse of disability in the constitution of hijra as citizens worthy of rights. While the international community views the recognition of a third gender as a progressive socio-legal advance in the obtaining of sexual rights in a Muslim majority Bangladesh, locally, hijra are understood as a special group of people born with 'missing' or ambiguous genitals delinked from desire. Furthermore, what was previously a trope of disfigurement based on putative genital status has now been transformed into a discourse of disability, a corollary to which several interest groups, namely the civil society, the state, international community and hijra themselves, have all been party.

Sexuality and individual support plans for people with intellectual disabilities.

BACKGROUND: Sexual rights and sexuality are important aspects of quality of life, also for people with intellectual disabilities (IDs). However, providing support in this area to people with ID poses some challenges. In this study, the content of individual support plan (ISP) documents was analysed to determine the extent to which sexuality and sexual rights are addressed in part of the ISP documents. METHOD: Content analysis was carried out on a sample of 187 ISP documents from seven different service provider organisations in the Netherlands. First, we conducted a lexical search using terms related to sexuality and sexual health. The retrieved segments were then analysed. RESULTS: A total of 159 ISP documents (85%) of 60 men and 99 women contained some reference to aspects of sexuality. However, these references were mostly descriptive and offered little guidance in terms of providing support. Moreover, these notations mostly described negative or problematic aspects of sexuality. References to sexual education, treatment, intervention programs or support strategies were rarely found in the ISP documents. CONCLUSIONS: Although sexuality is addressed in most ISP documents, there is little information available about the provision of professional support in this area that would give people the opportunity to exert sexual rights. As sexuality and exerting sexual rights are important for people with ID as well as for other people, it is recommended that issues surrounding proactive sex education, shared decision-making and the implementation of sexual healthcare plans are addressed in the ISP.

Sexual rights in Uganda and the struggle for meaning in community.

Drawing on lessons from the experiences of women who exchange same-sex erotic energies, this article suggests that advocates of same-sex human rights should take into account epistemic erasures colonized people experience when activism and policies regarding sexual freedom ignore various linguistic and community structures that create spaces for diverse ways of knowing and being. Since the late 1990s, the discourse on homosexuality in Uganda has motivated important debates concerning human values of sovereignty, rights, and family, and has expanded freedoms of sexual expression while at the same time conditioning these freedoms to be experienced in colonial ways of self-knowledge. The language that frames these debates continues to locate human rights for Ugandans who exchange same-sex erotic energies outside the locales-family, history, and language-of intelligible episteme for them. To make sense of this claim, I draw "exchange of same-sex erotic energies" from a saying in Rukiga language spoken by Bakiga in southwestern Uganda, okugira omukago mukika nikwokunywaana oruganda, to think about family and community in which same-sex erotic energies are lived and experienced. This article attempts to redirect attention from colonial constructions of homosexuality to indigenous and decolonial perspectives in relation to women in Uganda who exchange same-sex erotic energies in their struggle for meaning in community. I argue for pedagogies and epistemologies of place and memory in the struggle for human rights and sexual rights.

Gender norms as health harms: reclaiming a life course perspective on sexual and reproductive health and rights.

Despite their demographic significance and the lifetime impact of gender disparities on their health and rights, women considered older than reproductive age are excluded from most investments in global public health. While development policies linking human rights with access to sexual and reproductive healthcare have yielded progress towards improving the status of women and girls, older women have not benefited from these initiatives. Yet as women grow older, they experience a range of health conditions rooted in their reproductive biology - from ageing with fistula, to cervical and breast cancers. Current approaches to global women's health ignore these serious conditions, harming older women through the perpetuation of gender norms that construe women's health through a narrow reproductive lens. Meanwhile, older women are generally absent from global ageing discourse, which lacks a gender perspective, creating a dual invisibility as the field of global women's health presumes ageing women are accounted for. Reclaiming the sexual rights framework suggested by the International Conference on Population and Development and the Beijing Platform for Action, we call for the revision of global health policies to incorporate a life course approach to women's health as a matter of human rights.

Sexual rights but not the right to health? Lesbian and bisexual women in South Africa's National Strategic Plans on HIV and STIs.

Synergies between securing sexual rights and the right to health have been pursued where there are clear public health gains to be made, such as lowering incidence of HIV and other sexually transmitted infections (STI). South Africa's 1996 Constitution outlawed discrimination on the basis of sexual orientation and promoted the right to health. This qualitative health policy analysis sought to understand why and how interventions to improve sexual health of lesbian and bisexual women and address sexual violence were initially proposed in the HIV & AIDS and STI Strategic Plan for South Africa 2007-2011 and why and how these concerns were deprioritised in the National Strategic Plan (NSP) on HIV, STIs and TB 2012-2016. A conceptual framework considered several determinants of political priority for the inclusion in NSP development in 2007 and 2011 around sexual health concerns of women who have sex with women. This article presents findings from 25 in-depth key informant interviews and document review and highlights results of application of categories for a framework on determinants of political priority for lesbian and bisexual women's issues to be included in South Africa's NSP including: actor power, ideas, political context and issue characteristics. The article demonstrates how the epidemiological and structural drivers of lesbian and bisexual women's vulnerability to HIV and STIs, including sexual violence and other violations of their sexual rights, have been expressed in policy forums and whether this has made an impact on lesbian and bisexual women's ability to claim the right to health.

Sound and Fury--engaging with the politics and the law of sexual rights.

Although past resistance to sexual rights in global debates has often been grounded in claims to culture, nation and religion, opposition voices are now using, rather than rejecting, the frame of international human rights. This Commentary argues that, despite opponents' attempts to defeat sexual rights with other rights claims, a careful understanding of the principles of international human rights and its legal development exposes how the use of rights to oppose sexual rights should, and will ultimately, fail. The Commentary briefly takes up three kinds of "rights" claims made by opponents of sexual rights: limiting rights to protect rights, textual basis, and universality, and explores the rationales and impact of their application to countering sexual rights. Because sexuality and reproduction intersect as well as diverge in the opposition they face, this struggle matters intensely and plays out across advocacy, programmatic and policy worlds. Underpinning this Commentary is the understanding that opposition to sexual and reproductive health rights uses common arguments about rights principles that must be understood in order to be countered.

Sexual rights as human rights: a guide to authoritative sources and principles for applying human rights to sexuality and sexual health.

This Guide seeks to provide insight and resources to actors interested in the development of rights claims around sexuality and sexual health. After engaging with the vexed question of the scope of sexual rights, it explores the rules and principles governing the way in which human rights claims are developed and applied to sexuality and sexual health, and how that development is linked to law and made a matter of state obligation. This understanding is critical to policy and programming in sexual health and rights, as it supports calling on the relevant range of human rights, such as privacy, non-discrimination, health or other universally accepted human rights, as well as demanding the action of states under their international and national law obligations to support sexual health.

Advocating for sexual rights at the UN: the unfinished business of global development.

Twenty years ago, governments agreed that the right to have control over and decide freely and responsibly on all matters related to one's sexuality, free from coercion, discrimination and violence, is a fundamental human right. Since then, many aspects of sexual rights have been agreed by consensus at the global level, but the term "sexual rights" itself continues to be removed from negotiated outcomes and left out of international agreements, often at the last stages of negotiations. This commentary represents our point of view on the unfinished business of the UN with regards to the fight for sexual rights. Our perspective draws from lessons learned in cross-movement organizing in various regional UN spaces and outlines some of the tactics by conservative forces to push sexual rights to the periphery. The article reaffirms the position that broadening the debate and concepts surrounding sexual rights to be more inclusive, has enormous transformational potential and should inform collective advocacy efforts moving forward.

Gender-based violence and HIV across the life course: adopting a sexual rights framework to include older women.

It is widely known that older women are at lesser risk for sexual violence than younger women, but current inattention to older women in the gender-based violence (GBV) field has minimized the experiences of older women survivors at great detriment to their health and rights. For example, health providers seldom ask older women about their sexual activity and relationships, a neglect that leads to older women being excluded from necessary HIV testing and care as well as support services for abuse. This oversight is increasingly worrisome given the rise in new HIV infections among adults age 50 and older in recent years, with the majority of transmissions stemming from individuals unaware of their HIV-positive status. Building on sexual rights scholarship, this paper argues for an approach to public health interventions for GBV and HIV that acknowledges older women--their sexuality, sexual agency, and activity-- so that health providers and advocates acknowledge and serve older survivors.