What is Health Promotion Process of enabling people to increase control over, and to improve, their health. Health is a resource for everyday life. Health is a positive concept emphasizing social and personal resources, and physical capacities. Health promotion focuses on achieving equity in health. 2. THEORETICAL FRAMEWORK REGARDING THE IMPLEMENTATION OF CBVCT
13 Sexual Health Promotion to sexual health needs to take physical, psychological, cognitive, socio-cultural, religious, legal, political and economic factors into consideration. Community action is one of the cornerstones of health promotion. What does this mean It means that the communities are actors of their own health and can take steps in leading changes in the health determinants of their members (legislation, organizations, institutional networks, services offered, infrastructures etc. Thus, health promotion focuses on achieving equity (fora definition see table below) in health. Regarding the issue at hand, HIV testing and care, it seems obvious that the health promotion approach is the most adequate to reach our main goalie. ensuring access to health for the most- at-risk populations. As described in the Ottawa charter, health promotion actions aim to reduce differences in current health status and ensure equal opportunities and resources to enable all people to achieve their fullest health potential. This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices” 4 . People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women, men and transsexuals. When speaking about health promotion, we obviously include sexual health. We must emphasize this since sexuality and sexual health are quite often dealt with from a negative or pathological point of view. Because most-at-risk populations include men who have sex with men, transsexuals and sex workers, we believe that it is worth keeping in mind what WHO says about sexuality and sexual health. According to WHO, definitions of sexuality and sexual health emphasize these positive aspects Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of pleasurable and safe 4 Ibid. 5 WHO, Developing sexual health programmes : A framework for action, 2010 “ Equity in health can be deﬁned as the absence of disparities in health (and in its key social determinants) that are systematically associated with social advantage/disadvantage. Health inequities systematically put populations who are already socially disadvantaged (for example, by virtue of being poor, female, or members of a disenfranchised racial, ethnic, or religious group) at a further disadvantage with respect to their health. Equity in health means equal opportunity to be healthy, for all population groups. Equity in health thus implies that resources are distributed and processes are designed in ways most likely to move toward equalising the health outcomes of disadvantaged social groups with the outcomes of their more advantaged counterparts. This refers to the distribution and design not only of health care resources and programs, but of all resources, policies, and programs that play an important part in shaping health, many of which are outside the immediate control of the health sector P Braveman, S Gruskin Defining equity in health, J Epidemiol Community Health, 2003;57, p
14 sexual experiences, free of coercion, discrimination and violence. The objective of CBVCT is not only about providing people with an HIV test but, respecting this positive approach, the main activity will be to help those most at risk to integrate this result into their lives and promote better sexual health. Thus, the work carried out in CBVCT centres will be far from giving a medical response to sexual health as defined below. Typically, a medical response to sexual (ill) health tends to identify sexual and reproductive dysfunctions. This term is problematic as it suggests individual problems, whereas the definition of sexual health suggests that problems of sexual ill-health might be better labeled social dysfunction. Sexual health is directly affected by a range of physical, psychological, cognitive, socio-cultural, religious, legal, political and economic factors, some of which the individual has little or no control over. Standards of sexual health depend on a complex interaction of many of these factors, which must therefore betaken into account in the measurement and promotion of sexual health” 6 Given the importance of this issue, CBVCT centres that offer several services for comprehensive sexual health care will generally be very attractive to clients who need more than HIV VCT. That is why more attention is being paid these days, in several countries, to creating “one-stop-shop services or sexual health centers.