The `sexual citizen' is a new phenomenon in the erotic world, and a new player in the political and cultural arena, a product of the new primacy of sexual subjectivity in contemporary societies. Living at the fateful juncture of private claims to space, self-determination and pleasure, and public claims to rights, justice and recognition, the sexual citizen is a hybrid being, who tells us a great deal about the pace and scale of cultural transformation and new possibilities of the self (...) and identity. Consideration of the sexual citizen also offers a new angle on recent debates about citizenship in all its complex dimensions, bringing to the fore issues that have often been occluded in these debates. The article explores these issues through the prism of three significant social developments: the democratization of relationships; the emergence of new subjectivities; and the proliferation of new `stories' about the body, the erotic and intimate life which both signal and encourage the growth of social and cultural capital, and in turn lead to new demands on the institutions of political life. (shrink)

In this paper, I argue that health plays a special role in the promotion of well-being within the capabilities approach framework. I do this by first presenting a scenario involving two individuals, both of whom lack access to only one capability. The first cannot secure the capability of bodily health due to an unhealthy lifestyle, whilst the second lacks access to bodily integrity due to a life of celibacy. Second, I explore these scenarios by assessing the nature of disadvantage suffered (...) in both instances. I suggest that corrosive disadvantage (or the type of disadvantage that adversely impacts one’s ability to secure other valuable things) is what leads us to conclude that health is of special moral importance in the promotion of justice and the endorsing of well-being. (shrink)

The last few years have seen dramatic progress in the development of HIV pre-exposure prophylaxis (PrEP). These developments have been met by ethical concerns. HIV interventions are often thought to be ethically difficult. In a context which includes disagreements over human rights, controversies over testing policies, and questions about sexual morality and individual responsibility, PrEP has been seen as an ethically complex intervention. We argue that this is mistaken, and that in fact, PrEP does not raise new ethical concerns. Some (...) of the questions posed by PrEP are not specific to HIV prophylaxis, but simply standard public health considerations about resource allocation and striking a balance between individual benefit and public good. We consider sexual disinhibition in the context of private prescriptions, and conclude that only unjustified AIDS-exceptionalism or inappropriate moralism about sex supports thinking that PrEP raises new ethical problems. This negative conclusion is significant in a context where supposed ethical concerns about PrEP have been raised, and in the context of HIV exceptionalism. (shrink)

Eudaimonistic theorists of welfare have recently attacked conative accounts of welfare. Such accounts, it is claimed, are unable to classify states normally associated with physical and emotional health as non-instrumentally good and states associated with physical and psychological damage as non-instrumentally bad. However, leading eudaimonistic theories such as the self-fulfillment theory and developmentalism have problems of their own. Furthermore, conative theorists can respond to this challenge by dispositionalizing their theories, i.e., by saying that it is not merely the realization of (...) one’s values that is non-instrumentally good for one, but that the disposition to realize one’s values is also non-instrumentally good for one. This approach, properly elaborated, can accommodate the idea that, in many cases, states normally associated with physical and psychological health (or unhealth) are non-instrumentally good (or bad). It also preserves the many well-known advantages of conative theories. (shrink)

The ethics of safe sex in the gay community has, for many years, been focused on debates surrounding the responsibility regarding the use of condoms to prevent HIV transmission, once the only tool available. With the development of Truvada as a pre-exposure prophylaxis for HIV, for the first time in the history of the HIV/AIDS epidemic there is the potential to significantly reduce the risk of HIV transmission during sex without the use of condoms. The introduction of PrEP necessitates a (...) renewed discussion about the politics and ethics of safe sex for men who have sex with men. We present the arguments of authors who hold radically opposite positions with regard to the ethics of condom use by gay men, but who currently both criticize the use of PrEP. We offer a critique of their arguments and advance the position that the use of PrEP, even without condoms, can be acceptable and part of a safe sex ethics framework for MSM. (shrink)

Published data show that new HIV prevention strategies including treatment‐as‐prevention and pre‐exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV‐based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment‐as‐prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment‐as‐prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment‐as‐prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV‐based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

The concept of ‘empowerment’ is used frequently in a number of professional areas, from psychotherapy to social work. But even if the same term is used, it is not always clear if the concept denotes the same goals or the same practice in these various fields. The purpose of this paper is to clarify the discussion and to find a plausible and useful definition of the concept that is suitable for work in various professions. Several suggestions are discussed in the (...) paper, for example control over life or health, autonomy, ability, self-efficacy, self-esteem, and freedom, and it is concluded that there are two plausible complementary uses, one as a goal and one as a process or approach. Empowerment as a goal is to have control over the determinants of one’s quality of life, and empowerment as a process is to create a professional relation where the client or community takes control over the change process, determining both the goals of this process and the means to use. (shrink)

A paradigm shift in public health and medicine has broadened the field from a singular focus on the ill effects of negative states and psychopathology to an expanded view that examines protective psychological assets that may promote improved physical health and longevity. We summarize recent evidence of the link between psychological well-being and physical health, with particular attention to outcomes of mortality and chronic disease incidence and progression. Within this evolving discipline there remain controversies and lessons to be learned. We (...) discuss measurement-related challenges, concerns about the quality of the evidence, and other shortcomings in the field, along with a brief discussion of hypothesized biobehavioral mechanisms involved. Finally, we suggest next steps to move the field forward. (shrink)