Edited by Jasmine Gideon
Chapter 31: Sexual health or rights? USAID-funded HIV/AIDS interventions for key populations in Ghana
In the anticipated post-2015 development agenda many Western governments, their development agencies and a range of non-governmental organizations (NGOs) seek to advance an integrated sexual and reproductive health and rights (SRHR) framework. The SRHR framework serves as a bold new paradigm for the work of human rights-informed global health. However, the same development actors behind the SRHR framework have scarcely acknowledged the theoretical and practical tensions that their development efforts have posed for sexual rights. This chapter analyzes these tensions by asking, ‘How has the provision of sexual health impacted sexual rights?’ In answering this question, focus is placed on the logic and strategies of United States Agency for International Development (USAID)-funded HIV/AIDS interventions over ten years (2004–2014) in Ghana for ‘key populations’ (those populations most at risk to HIV). This chapter argues that Western-funded sexual health organizations, and a changing socio-political context in Ghana, facilitated a paradox between sexual health and sexual rights in Ghana. In this predicament, the strategic choices of coordinators and implementers of HIV/AIDS interventions with the aim of maximizing uptake of sexual health services among sexual minorities had the effect of: (1) co-opting sexual rights efforts; (2) silencing their public activism; and (3) incentivizing gender conformity and ‘African’ conceptions of sexuality among its clients and leadership. The chapter concludes by summarizing the findings and applying them to the SRHR framework to offer suggestions for its implementation in international development and how misconceptions of sexuality led to these problems.
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