Sexuality, disability and human rights: strengthening healthcare for disabled people.

1 by the World Health Organization and the World Bank marks a watershed in the history of how disability should be understood by healthcare practitioners. Along with a special issue of the Lancet, 2 this report marks recognition by organised healthcare that healthcare practitioners acted paternalistically towards disabled people, often deciding on their behalf what is in their best interests. 3 South Africa favours a human rights approach to disability, where the Constitution mentions non-discrimination on the grounds of disability, and globally through the promulgation of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). 4 Historically, health practitioners have underestimated the capacities of disabled people and from clinical encounters view disability as an illness, whereas in reality most disabled people are not ill. 5 This change in how disability is viewed changes the ways in which interactions between the health professions and disabled people are seen. An optimal emancipatory approach gives maximum choice and control to disabled people in all matters in their lives, including health. This is especially pertinent in the field of sexuality and disability. 6 Health professionals have been seen as complicit in denying disabled people their rights to sexual expression and sexual choices, and in perpetuating myths about disabled people. On the one hand, disabled people have been viewed as asexual or as eternal children, and on the other they have been viewed as sexually rampant and unable to control sexual impulses. 7 However, the new emphasis on sexual rights as part of human rights for disabled people may create dilemmas for clinicians caring for patients who are disabled, especially in South Africa in the context of high rates of sexual violence and of HIV/AIDS. The magnitude of the HIV/AIDS epidemic forces clinicians to think critically about the sexuality of disabled people and how the epidemic affects them. 8 Ethicist Jacob Appel holds contemporary views of the right to sexuality and to sexual liberty for disabled people: 9 'Sexual rights are a fundamental element of human rights. They encompass the right to experience pleasurable sexuality, which is essential in and of itself and, at the same time, is a fundamental vehicle of communication and love between people. Sexual rights include the liberty and autonomy in the responsible exercise of sexuality. ' Researchers and healthcare practitioners corroborate these views. Murphy and Elias, 10 who are experienced paediatricians based in the USA, suggest that …