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Drawing on a range of theoretical perspectives and engaging with new empirical evidence from around the world, this collection examines how privilege, agency and affect are linked, and where possibilities for social change might lie.

Recognition that social, economic, political, and environmental factors directly affect HIV risk and vulnerability has stimulated interest in structural approaches to HIV prevention. Progress in the use of structural approaches has been limited for several reasons: absence of a clear definition; lack of operational guidance; and limited data on the effectiveness of structural approaches to the reduction of HIV incidence. In this paper we build on evidence and experience to address these gaps. We begin by defining structural factors and approaches. We describe the available evidence on their effectiveness and discuss methodological challenges to the assessment of these often complex efforts to reduce HIV risk and vulnerability. We identify core principles for implementing this kind of work. We also provide recommendations for ensuring the integration of structural approaches as part of combined prevention strategies.

\"7 Not all discrimination against people based on their sexuality necessarily results from this dread, and self-loathing is a term that is too easily deployed at anyone who might infringe communal norms (eg, not declaring one's sexuality publicly is often termed self-loathing, but might result from other factors). [...]an important distinction exists between homophobia, with its emphasis on individual pathology, and heteronormativity, which emphasises systematic discrimination or, as Tom Boellstorffputs it, \"operates at the level of generalized belief and social sanction, rather than on an emotive plane\".8 Writing about Indonesia, Boellstorffargued that during the past decade, a particular form of political homophobia developed, consisting of a new violence directed against gay men (less often lesbians) who were seen as threatening a particularly masculinist nationalism.8 His analysis helps explain what is often seen as rising homophobia in many parts of the developing world, and links concerns about changing sexual and gender norms to larger sociopolitical factors.

The concept of sexual and reproductive health and rights has evolved in the 21st century from previous narrower conceptualisations. In 2018, the Guttmacher–Lancet Commission proposed a broader and integrated defining framework, together with a package of essential health service elements. Despite this, progress on the sexual and reproductive health agenda has been inconsistent, with progress in some areas and considerable gaps in others. Even in areas that have seen breakthroughs in biomedicine and technology, progress has been partial owing to inadequacies in funding, policy, and implementation. Additionally, initial executive orders of the Trump administration in early 2025 presented a major challenge to sexual and reproductive health and rights in the USA, and orders on US foreign aid threaten devastating impacts on sexual and reproductive health and rights in recipient low-income and middle-income countries. As discussions of sexual and reproductive health and rights are often seen to be sensitive or controversial, even when had at a senior government level, any consideration of time trends in sexual and reproductive health outcomes need to consider the complex interplay between trends in social and cultural factors, politics and legal frameworks, and technology and biomedicine. The perceived sensitivity of sexual and reproductive health means that providing adequate education on sex, sexuality, and relationships is crucial, and this education is often resisted by religion or traditionalist sentiments. Furthermore, technological change means that many young people receive this education online, which has both positive and negative effects. A thorough understanding of the driving factors behind global epidemiological trends in sexual and reproductive health—such as fluidity in gender and sexual identity, biomedical innovations in contraception and the treatment and prevention of HIV and other sexually transmitted infections, gender-based violence, access to safe abortion, fertility needs, and comprehensive sexuality education—is crucial in assessing progress on the sexual and reproductive health and rights agenda. To this end, this Series paper provides an overview of trends in sexual and reproductive health and rights outcomes since 2018.

Background Australian surveillance data document higher rates of sexually transmissible infections (STIs) among young Aboriginal people (15 – 29 years) in remote settings than non-Aboriginal young people. Epidemiological data indicate a substantial number of young Aboriginal people do not test for STIs. Rigorous qualitative research can enhance understanding of these findings. This paper documents socio-ecological factors influencing young Aboriginal people’s engagement with clinic-based STI testing in two remote settings in the Northern Territory, Australia. Methods In-depth interviews with 35 young Aboriginal men and women aged 16–21 years; thematic analysis examining their perceptions and personal experiences of access to clinic-based STI testing. Results Findings reveal individual, social and health service level influences on willingness to undertake clinic-based STI testing. Individual level barriers included limited knowledge about asymptomatic STIs, attitudinal barriers against testing for symptomatic STIs, and lack of skills to communicate about STIs with health service staff. Social influences both promoted and inhibited STI testing. In setting 1, local social networks enabled intergenerational learning about sexual health and facilitated accompanied visits to health clinics for young women. In setting 2, however, social connectedness inhibited access to STI testing services. Being seen at clinics was perceived to lead to stigmatisation among peers and fear of reputational damage due to STI-related rumours. Modalities of health service provision both enhanced and inhibited STI testing. In setting 1, outreach strategies by male health workers provided young Aboriginal men with opportunities to learn about sexual health, initiate trusting relationships with clinic staff, and gain access to clinics. In setting 2, barriers were created by the location and visibility of the clinic, appointment procedures, waiting rooms and waiting times. Where inhibitive factors at the individual, social and health service levels exist, young Aboriginal people reported more limited access to STI testing. Conclusions This is the first socio-ecological analysis of factors influencing young Aboriginal people’s willingness to undertake testing for STIs within clinics in Australia. Strategies to improve uptake of STI testing must tackle the overlapping social and health service factors that discourage young people from seeking sexual health support. Much can be learned from young people’s lived sexual health experiences and family- and community-based health promotion practices.

As the world enjoys the promise of biomedical advances against HIV, numerous challenges remain. Some of these are connected to politics, others are connected to resource constraints. Other barriers are linked to the need to ensure that the concepts used to think about HIV remain current. Terms such as “MSM” (men who have sex with men) and “community” require critical interrogation at a moment when their political origins seem forgotten. Likewise, struggles between groups most affected by HIV and scientists and policymakers (an enduring feature of the epidemic) remain a key aspect of the response. The dangers of co-option and distraction remain real. In this context, it is vital to promote community ownership, political commitment, solidarity, and respect for differences, not as competing values, but as part of the ultimate solution to HIV.

This article examines the ways in which cosmopolitanism is imagined and planned for by 91 young women attending four private (elite) schools in one area of England. Despite many study participants coming from families where parents travelled internationally for business, few had a strong desire to reproduce such orientations in their own futures. Moreover, the elite schools attended placed relatively little emphasis on cosmopolitanism and transnationally mobile futures. For the few English young women doing the International Baccalaureate and/or actively considering higher education abroad, the decision to do so was driven by individual rather than family or social ambitions. Through our analysis we consider further whether cosmopolitanism is a form of (cultural) capital or a quality more embedded within the girls’ habitus. The relatively ambivalent attitude to cosmopolitanism found in the study schools ties in to an ethnocentrism which sees an ‘English education’ as among the most prestigious in the world.

This article contributes to theorizations of agency through a focus on how understandings of power within young women's sexual and intimate relationships connect with their descriptions of feeling, reacting and sensuous bodies, to suggest why and how agentic practice takes place. Drawing on the narratives of 54 young women aged 16-18 years in one secondary school in England, findings concur with other literature which suggests that sensations experienced on or within the body can instigate (agentic) practice. Significantly, however, both physical and verbal practices are drawn on during agentic moments. Young women who discursively position themselves as 'powerful' integrate their bodies within such an understanding, using this integration to shore up the possibilities for agentic practice. Moving away from an understanding of practice as 'accommodating' and/or 'resisting' norms and inequalities, this article identifies four strategies described by the young women (assertive, refusing, proactive and interrogative) for facilitating more sustained agency.

Recognition that social, economic, political, and environmental factors directly affect HIV risk and vulnerability has stimulated interest in structural approaches to HIV prevention. Progress in the use of structural approaches has been limited for several reasons: absence of a clear definition; lack of operational guidance; and limited data on the effectiveness of structural approaches to the reduction of HIV incidence. In this paper we build on evidence and experience to address these gaps. We begin by defining structural factors and approaches. We describe the available evidence on their effectiveness and discuss methodological challenges to the assessment of these often complex efforts to reduce HIV risk and vulnerability. We identify core principles for implementing this kind of work. We also provide recommendations for ensuring the integration of structural approaches as part of combined prevention strategies. [PUBLICATION ABSTRACT]