1. PROMOTING THE HEALTH OF MEN WHO HAVE SEX WITH MEN WORLDWIDE A training curriculum for providers

2. Module 2: Sexuality and Health 2

3. Learning Objectives 3 1 2 3 Define basic concepts and terms concerning male sexuality Describe the anatomy and physiology of male sex organs Understand the importance of sexual health among gay men and other MSM

4. Module Overview 4 1 2 3 4 5 Key sexuality and gender-related terms Basic male reproductive anatomy Commonly-reported sexual practices of gay men and other MSM Importance and relevance of sexual health for gay men and other MSM Sexual and reproductive rights for gay men and other MSM

5. Introduction ‘Sexuality’ is the way a person expresses themselves sexually Gay men and other MSM express their sexuality in part through activities with other men Same-sex behavior is a normal expression of human sexuality 5 1 2

6. Sexual Health According to the World Health Organization, sexual health is: “…a state of physical, emotional, mental and social well-being in relation to sexuality: it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free from coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” 6

7. Sexual Health Rights Sexual health cannot be achieved and maintained without respect for other human rights, including the right to: 1.Equality and non-discrimination 2.Be free from torture 3.Privacy 4.The highest attainable standard of health and social security 5.Marry and found a family 6.Decide the number and spacing of one’s children 7.Information and education 8.Freedom of opinion and expression 9.An effective remedy for violations of rights 10.Assembly 7

8. Group Activity Perceptions of Sexual Health 8

9. Sexual Identity Sexual Orientation Sex Key Terms 9 Emotional, romantic, or sexual attraction felt toward another individual of any sex or gender Gay Bisexual Straight Chromosomes Hormones Internal/external sex organs

10. Gender Expression Gender Identity Gender Key Terms One’s sense of oneself as male, female, or transgender The way a person expresses their gender through dress, hairstyle, mannerisms, or other behaviors Attitudes, feelings, and behaviors associated with a person’s sex 10

11. Male Sex Anatomy

12. Group Activity Erogenous Zones 12

13. Sexual Practices of MSM 13 1. Penetrative anal sex 2. Kissing and hugging 3. Dry sex or rubbing 4. Frottage 5. Masturbation (self/mutual) 6. Oral sex (fellatio) 7. Anal stimulation (rimming or fingering) 8. Thigh sex 9. Sex toys 10. Group sex 11. Watersports 12. Bondage, discipline, dominance, submission, sadism, masochism

14. To respect the human rights of gay men and other MSM Gay men and other MSM are at increased risk for: HIV Due to biological, social, structural, and behavioral factors Why talk about sexual health? STIs and other infections Syphilis, gonorrhea, chlamydia, viral hepatitis A/B, herpes simplex virus, HPV, MRSA STIs are associated with increased risk for HIV infection Health of gay men and other MSM is not only related to HIV or STIs o Must include intimacy, relationships, sexual pleasure 14

15. The Larger Context 15 2 3 4 Social determinants of health greatly influence health inequities Negative attitudes about homosexuality harm the health of gay men and other MSM health Internalized homophobia compounds other areas of people’s lives where they experience discrimination Evolving and new approaches to gay men’s sexual health are necessary 1

16. Sexual and Reproductive Rights 16 2 3 4 Access to the highest attainable standard of health is a human right Gay men and other MSM are often neglected through silence, denial, or outright exclusion Criminalization of same-sex behavior violates the International Covenant on Civil and Political Rights (ICCPR) Direct and respectful engagement with gay men and other MSM is necessary to design appropriate programs and policies 1

17. Summary 17 2 3 4 5 Sexuality, including same-sex activities, is a natural component of being human Sexual health is physical, emotional, mental, and social well-being in relation to sexuality Sexual identity, attraction, behavior, gender, gender identity, and gender expression are fluid and may not align Social determinants of health greatly influence health inequities Understanding the factors that undermine sexual health for gay men and other MSM forms the basis for robust programming and policy responses 1