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If You Can't Talk About Sex You Can't Improve Public Health

As primal as sleep, as intimate as a bared soul, as essential as air, sex demands a special place in human consciousness. When we think about sex (which research shows we do a lot), it evokes descriptive superlatives: the most wondrous, most pleasurable, most fantasized, most intense of human endeavors.

Yet sex—what Sophocles described as a "fierce and frenzied master"—also has its shadows. For procreation or recreation, sex carries risks. A convenient means of pathogenic transport, sex can exchange a host of viruses and bacteria between humans, with consequences that range from inconvenient to lethal. Pregnancy in many parts of the world puts women's lives at grave risk. And the darkest parts of human nature can transform sex's intimacy into violation.

Further complicating the issue: cultural inclinations to make sex taboo. Human societies have long shrouded sexuality in myth, ritual, secrecy and occasionally ill-considered legislation. One of the most common of human activities, sex is also one of the most uncomfortable topics of discussion. And that is dangerous for the public's health. When human sexuality is involved, rational discourse seems tragically difficult. Warring segments of society struggle to suppress or dominate the discussion. And some prefer the political agenda in mind to the evidence at hand. The result? Science is too often set aside, and the most elemental public health strategies are branded as suspect.

Yet, in a world riven by desire and disease, you cannot secure human health worldwide without acknowledging one fact: People have sex.

The ramifications of this simple fact—and the related work of public health researchers trying to save lives—comprise this special issue of Johns Hopkins Public Health magazine.

As we commenced working on this issue, we were guided by the wise words of a senior faculty member who told us, "What you don't want to end up with is another catalog of crappy things that happen to you when you have sex." What we found instead (and have tried to present here) is a surprisingly diverse compendium of ways to preserve human health. We learned about scientists discovering new alternatives for contraception, gleaning reproductive secrets from cricket testes, and coaxing antibodies from alpacas that may one day help protect women from HIV infection. We met researchers helping sex workers survive the shattered margins of societies in Asia, Africa and the Americas. We spoke with social scientists quantifying the devastating physical toll of child marriage and then with practitioners devising programs to reverse the practice. We interviewed experts helping teens make personal choices that will not derail their dreams.

At the combustible intersection of science, politics and sex, we found discovery, controversy and hope.