CASE STUDIES
CASE STUDIES
CASE #1
Ana Autoestima: making waves in Brazil
SELF-LOVE
RELATIONSHIP JOY
Supporting women in Brazilian favelas to challenge restrictive gender norms that deny them their right to sexual pleasure
Autoestima means “self-esteem”. Ana Autoestima is the name of a virtual friend on WhatsApp who provides accurate information about sexual and reproductive health and rights to women in Rio de Janeiro. She delivers advice on sexual health and well-being to all people who identify as women, in a way that is safe, shame-free and sex- and pleasure-positive.
While Ana Autoestima is a “virtual” friend, the advice she gives is provided by a group of (real) women. They provide tailor-made sexuality education content and answers questions related to sexuality, sexual health and rights, pleasure, family planning, and more.
PROGRAMME COMPONENTS
In addition to sharing information through short videos, Ana Autoestima is building a referral network of allies that offer sexual and reproductive health and rights products and services.
The approach of Ana Autoestima is to move away from the narratives of disease and unwanted pregnancy prevention and to recognize that pleasure is a key motivator of consensual sex. Some of the topics covered include:
- Sexual and non-sexual pleasure, erogenous zones, and desire versus arousal.
- What bodies with vulvas and bodies with penises can be like.
- Masturbation as a means of self-discovery and self-pleasure.
- Orgasms – the changes bodies can go through during sexual activity to (maybe) reach different types of orgasms, and reframing orgasms from being the only goal of sex.
- The ins and outs of how sex works, and expanding the concept of sexual intercourse from penis-in-vagina sex to include non- and other penetrative encounters, activity between people of the same sex assigned at birth, etc.
- How contraceptives can be sexy!
- Pleasure in partnered sex, the importance of knowing what feels pleasurable so one can communicate about it, how to get to know one’s partner’s/partners’ body/bodies, and (sexy) consent.
PROGRAMME OUTCOMES
Many of the women who’ve engaged with Ana Autoestima have talked about feeling more confident and able to talk to others about sexual well-being and pleasure, including partners, children, friends, peers and colleagues. Women also described how experiencing sexual pleasure, especially through masturbation, led to them feeling more confident and able to value and love themselves and their bodies.
Others described benefits to their partner relationships and confidence at work. These stories show that sexual joy is both a personally significant and deeply affirming outcome for the women, as well as a catalyst for wider changes in their lives.
The programme team also found that the focus on pleasure makes it easier to find participants who want to join. They said that participants recognize it’s “not just another SRHR programme”.
TESTIMONIALS ABOUT SEXUAL JOY
The women in the project created fictional names for themselves, so they felt freer to tell their stories. In the following story, 33-year-old “Bela” describes some of the wider changes that learning about and experiencing sexual joy has had in her life and the lives of others:
I feel more capable of having more sexual freedom. Having more pleasure. Today, I don’t hide that anymore. If I feel like doing something, I go and do it. In different places. With toys, without toys. I’m interested in exploring that… In just going for it. I don’t hide anymore. I’ve hidden my pleasure too much. I think it shouldn’t be hidden because it’s so delicious. It’s so good. Both in sex and in personal life. It’s so pleasurable to sit at a bar table alone and have a beer and order a snack. It’s so pleasurable to learn to know your body, to touch yourself. It’s a bit embarrassing at first, but then, man, it’s still wonderful. It’s good because you learn to know yourself. The group broke down that taboo that we, women, have. […]
I have a 13-year-old son.[…] I sat down with my son and put the [Ana Autoestima educational] videos on for him to watch. As a mother, I’m ashamed to talk. But this helped me to have a dialogue with him. I put the videos on for him to watch. Son, here, about sexuality, you’ll have to show your pleasure. You know, he’s 13 years old and this helped me a lot. Here, I get goosebumps just talking about it. It’s something I didn’t have with my mother. And this helped me to have it with my son.
Women also expressed their feelings after getting advice from Ana:
“Today I have the ability to show my partner things he never experienced. Understand? He ends up liking it. Wow, that’s cool!… I’m grateful that he knows his pleasure and recognizes mine.” (“Bela”)
“When we cuddle, even if we don’t have sex, just touching and kissing on the mouth is pleasure. Because people think that’s the only way, vagina with penis, vagina with penis. And sometimes you do it without quality and don’t feel pleasure.” (“Lu”)
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CASE #2
Program H: inspiring homens and hombres
to transform gender norms
Enabling boys and young men to recognize and change the restrictive gender norms that affect their lives, including in relation to their sexual lives and experiences. Promundo is a Brazilian organization working across Latin America to engage men and boys as allies in gender equity through research and community-based activities. It expanded its work to the USA in 2011 with the launch of Equimundo: Center for Masculinities and Social Justice.
Promundo’s work is widespread, transformative and eminently positive in its approach to the well-being of men and boys. One of its most successful programmes is Program H [https://promundo.org.br/programa-h/], which launched in 2002 and has been implemented by partner organizations in at least 32 countries. It is recognized by international organizations including the World Bank, WHO and other United Nations agencies.
Program H is aimed at young men; educators, health professionals and community organizations; and schools and youth training spaces and men’s social health spaces. It is named after homens and hombres, the words for men in Portuguese and Spanish.
GENDER EQUITY WORK THAT EMBRACES PLEASURE AND DESIRE
Program H encourages young men and adults to reflect on how gender norms affect their lives, relationships and communities, and sexual well-being and pleasure are integral throughout these efforts. For example, one section of the Program H manual states:
To teach young men about their bodies and to question myths helps boys understand their own desires and sexual pleasure, which can make the physical and emotional changes of adolescence less frightening.”
– Program H: Working with young men manual, p28
Each component of the manual involves a series of activities, lasting from 45 minutes to 2 hours, for use with groups of young men. Most partners who implement the programme choose between 10 and 16 activities to deliver over 10 weeks.
For instance, ‘The Erotic Body’ is an activity aimed at sparking discussion of “desire, excitation and orgasm and to clarify that men and women have equal sexual drives, needs and desires.” (p52).
Promundo recognizes that seeing young men and boys as allies, not obstacles, to gender equality demands a focus beyond health and risk, to encompass sexual well-being and pleasure as fundamental aspects of life.
THE THREE COMPONENTS OF PROGRAM H: RESEARCH, PROGRAMME AND PROMOTION
Research
The curriculum was developed by conducting household surveys and qualitative studies with young men to identify the factors that promote equitable attitudes. It demonstrated that gender-equitable attitudes were more prevalent among men who had peer-group support, had benefitted from gender equality and had meaningful male role models. The methodology was then adapted by organizations around the world to fit their context.
Programme
This involves group workshops that give boys and young men the opportunity to reflect on masculinity and gender norms. The program manual includes 70 adaptable activities, from role-playing to conversation-starters and hands-on exercises using art supplies, male and female condoms, dildos, balloons, music and other materials. Discussions of key topics are supported with exercises, such as ‘mapping’ the male and female ‘erotic bodies’, focused breathing and guided imagery.
Promotion
Youth-led campaigns and activism support the workshops. These include promotion of messages about equality and other relevant issues, and a non-verbal audio-visual cartoon called “My life as João” (“Once upon a boy”in English), which is a potent conversation starter.
EVALUATING THE IMPACT OF PROGRAM H
Equimundo reviewed 14 Program H impact evaluations carried out in 12 countries: Bosnia and Herzegovina, Brazil, Chile, Croatia, Ethiopia, India, Kosovo, Namibia, Rwanda, Serbia, the United States, and Vietnam. The review found that Program H contributed to more gender-equitable attitudes among participating young men in nine of the 14 studies. Some studies reported a reduction in the perpetration or acceptance of partner violence and violence against women more generally.
Program H was also found to have contributed to:
- increased condom use
- reduced STI symptoms
- increased HIV testing and use of sexual and reproductive health services
- improved attitudes toward contraceptives
- greater communication with partners about HIV and contraceptives
- improved sexual and reproductive health knowledge.
MORE INFORMATION
Promundo: https://promundo.org.br/
Equimundo: https://www.equimundo.org/programs/program-h/
Program H manual: https://promundo.org.br/manual-h-trabalhando-com-homens-jovens/
“I am more satisfied with [my] relationship now than in the past … because now there’s more respect, more affection, more understanding, more exchange, a lot of emotional intelligence, a lot of companionship. So, there’s no way not to be satisfied, there’s more joy.”
–Equimundo participant in consultation for the Good Vibration framework
CASE #3
The Pleasuremeter: a new approach to sexual history-taking and counselling
Helping health professionals to explore contradictory messages about sex, gender, sexuality and pleasure and to challenge gender norms
The Pleasuremeter is a tool for health professionals working in sexual and reproductive health and rights. It guides the process of sexual history-taking during counselling, education and service delivery, and enables practitioners to move sexual health discussions beyond the typical focus on sexual risk-taking and towards concepts such as sexual well-being and pleasure.
The Pleasuremeter is a component of the Global Advisory Board for Sexual Health and Well-being (GAB) toolkit, Sexual pleasure: the forgotten link in sexual and reproductive health and rights,[ co-authored by Doortje Braeken and Antón Castellanos-Usigli
HOW THE PLEASUREMETER WORKS
The Pleasuremeter uses two motivational interviewing techniques: 1) asking open-ended questions and 2) using scales to assess readiness for change. The Pleasuremeter is not a quantitative scale, but rather a script that shifts sexual history-taking from a sole focus on risk and health towards concepts of sexual pleasure and well-being.
It guides health professionals in exploring how an individual experiences sexual pleasure and six enabling factors for sexual well-being: self-determination, consent, safety, privacy, confidence and communication/negotiation. These six factors are doorways in to discussing ideal sexual experiences.
The GAB toolkit provides detailed information for using the Pleasuremeter. For example, it provides guidance on introducing the tool to clients:
“Now I’m going to show you a table that has different factors associated to our sexual health and well-being. I want you to think about your sexual encounters in the last 12 months and score each factor from 1 to 10 that corresponds to your actual experiences in that area. After you’ve rated the factors, we will have a little chat about each of them. Please let me know if you feel uncomfortable about answering something in particular or if you don’t understand something.” P66
[Global Advisory Board for Sexual Health and Wellbeing Sexual pleasure: the forgotten link in sexual and reproductive health and rights – training toolkit [Internet]. 2018 [cited 2019 Feb 2]:[118 p.].]
It also provides an easy scoring schema for clients to use to assess their experiences
OUTCOMES AND INDICATORS
Among the organizations using the Pleasuremeter is RTI International, an independent scientific research institute. They are looking to use the Pleasuremeter with SRHR providers and clients, specifically young LGBTQI+ people of colour in the USA. RTI is assessing how these interactions occur, and any stigma that’s present or risk-based language that deters clients from fully engaging or not getting the full range of care they need (i.e. not getting on or staying on post-exposure prophylaxis [PrEP]).
RTI is ultimately hoping to see changes in PrEP outcomes. They are still at the preliminary stage of research, collecting quantitative and qualitative data on feasibility and acceptability of use of the Pleasuremeter. They have also developed sex-positive questions on surveys related to client sexual behaviour that they will use along with more traditional measures.
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CASE #4
Get Up Speak Out: an asset-based approach to sexuality education
Pleasure-focused sexuality education that supports empowerment, challenges gender norms and encourages young people to ask questions that protect their health
Get Up Speak Out (GUSO) was a five-year programme (2016–2020) that aimed to empower all young people – especially girls and young women – to realize their SRHR in an environment that is positive toward young people’s sexuality.
It was implemented by seven SRHR country alliances (in Ethiopia, Ghana, Indonesia, Kenya, Malawi, Pakistan, and Uganda) together with a consortium consisting of Rutgers, Dance4Life (a Rutgers programme), Aidsfonds, CHOICE for Youth and Sexuality, IPPF and Simavi.
One of the main components of GUSO was to encourage pleasure-inclusive comprehensive sexuality education (CSE). Most sexuality education programmes do not acknowledge everyone’s pleasure. Although sexual pleasure remains a highly significant, if not primary, motivating factor for sexual behaviour, it is still often associated with shame, and the pursuit of sexual pleasure is usually positioned as a cause of, or contributor to, disease.
GUSO took an asset-based approach to CSE. It started from the premise that sex-positive CSE – encouraging discussion about desire, sexual pleasure and confidence in negotiating consensual and pleasurable sex – supports empowerment and helps young people ask questions that protect their health.
PLEASURE AUDIT OF GUSO IN KENYA AND GHANA
A pleasure audit was conducted of the CSE components of GUSO in Kenya and Ghana. The aim was to understand what was meant by an “environment that is positive towards young people’s sexuality”; what role pleasure played in this; how or if it was discussed; what were the contextual factors affecting the discussion; and how the sex-positive approach could have been strengthened.
In both Kenya and Ghana, policies restrict what can be taught about sexuality education in schools, and sexuality was usually framed negatively in curricula. GUSO challenged this by including a sex-positive approach in its CSE programme.
Two curricula were reviewed – Youth for Youth (Y4Y) and the Family Health Options Kenya (FHOK) CSE curriculum. The Y4Y Curriculum, adapted by the Centre for the Study of Adolescence in 2011, focused on empowerment of young people. It talked about human sexuality, gender roles, puberty and relationships, and emphasised that young people should be assertive and not influenced by others to make decisions. The discussion on sexuality covered some basic facts and descriptions that were positive.
The FHOK curriculum was generally more positive towards young people’s sexuality. The content covered more than sexuality, including the whole breadth of SRHR, drug use, STIs and HIV. In certain sessions it talked clearly about the positive perspective of sex and sexuality, including a whole session on the human sexual response cycle with facilitator’s notes on sexual expression and enjoyment.
The pleasure audit showed that, despite restrictive sociocultural and legislative contexts, it was possible to adopt a pleasure-inclusive approach. This was demonstrated by the identification of “positive deviants”. These are CSE educators who engaged in behaviors that were outside the norm – in this case, taking a more pleasure-focused approach – which allowed them to solve problems better than others who faced similar challenges.
Young people expressed strong interest in receiving CSE and requested more open, honest and explicit information. When asked what more they wanted to learn about, participants mentioned masturbation, what sex feels like, contraception and condoms, pornography, and relationships. Sometimes it was evident that sexual rights and gender equality had been addressed well, leading to shifts in attitudes and behaviors.
“This education has changed my mind about certain roles at home. Now I help my female siblings to cook. Even when my female siblings were busy doing something, I felt that as a male I hadn’t got a role but now I know better and help with the cooking and washing. I help with domestic chores which I would never have done before CSE.”
– Male learner, Ghana
In addition, the audit found that sexuality educators need more support to gain confidence, frame messages positively and reconcile their own values – including those related to gender equality –with those underpinning effective CSE. While some educators succeeded in providing sex-positive education, they were “swimming against the tide.”
“They share that they have sex for pleasure.”
– CSE teacher, Kenya
Based on these findings, the audit encouraged the development of supportive communities for CSE facilitators. One-off trainings are not enough to unpack personal biases and build comfort with a rights-based, gender-transformative, sex-positive approach. This should be strengthened with regular discussion forums, peer learning, and mentorship from experienced facilitators. Creating opportunities for facilitators to meet, share experiences and validate the importance of addressing pleasure with young people helps normalize conversations that may otherwise feel countercultural.
TOOLS FOR TAKING AND ASSET-BASED APPROACH
CSE is just one of the areas where the asset-based, pleasure-focused approach has been shown to be effective. The pleasure approach can be applied to a wide range of programmes and contexts, using asset-framing tools, such as the following.
Community Asset Mapping:
This involves identifying and charting the existing strengths, assets, and resources within a community, such as human capabilities, social capital and cultural heritage.
Narrative Analysis:
This tool focuses on how people, communities and issues are described. It helps to identify and shift away from deficit-based narratives (e.g. “problem communities”) to asset-based ones that emphasize strengths, aspirations and potential.
Theory of Change:
Used in evaluating asset-based initiatives, this approach explores the underlying mechanisms through which change occurs, helping to understand how interventions are successful in building on individual and collective assets.
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CASE #5
Sex and Sensibilities in the Philippines
Maximizing new media to spread the word that sex and pleasure are for everyone, including women and gender minorities
Sex and Sensibilities is the creation of Ana Santos, a journalist and cutting-edge content provider who has been delivering information about sexual and reproductive health for more than 15 years.
The content she creates takes a positive approach to sex and explicitly discusses sexual pleasure. And she uses language that is gender-inclusive and empowering, encouraging all people – including women and gender minorities – to enjoy sex.
Sex and Sensibilities content spans the spectrum of sex, sexuality and sexual health topics: from “What to do when your condom breaks” to “Is it safe to have sex during pregnancy?” and even sharing the Filipino word for clitoris – a word many people, including Ana until recently, didn’t even know.
MAKING THE MOST OF NEW MEDIA
Ana is at the forefront of new media and technology, using multiple channels to reach as many people as possible. She started with a simple advice column, then added a Facebook page. As people increasingly used Instagram, she adapted her content for the platform, including making videos. She is also planning to start using TikTok, and she has worked with Rappler on a TV show.
She adapts her content to each form of media. For example, on Instagram she uses video, while Facebook posts are text. In her advice column and on Facebook she only writes in English, but she realized this didn’t reach everyone. So her Instagram page is in English and Filipino.
For Instagram and Facebook, Ana decides what to post, often responding to popular discussions. For instance, if national news reports an increase in HIV, she will address it. She receives few direct messages on Instagram, so content is not heavily based on feedback from the audience.
The TV show is produced by a full team.
With more than 5000 followers on Instagram and 9000 on Facebook, a TV show and other offerings, Ana has impressive reach in what is a normally conservative space when it comes to information about sex, pleasure and gender.
EVOLVING ATTITUDES AND HOW TO HAVE IMPACT
Twenty years ago, most of the feedback Ana received was negative. Now, although there is still some opposition, she receives a lot of appreciation, with some people calling her “a saint” who saves lives. For people who want to do similar work, Ana suggests finding like-minded others to build a supportive community, as this work can be lonely. A community can provide emotional and mental support, she says. She also urges people to pursue financial and economic sustainability to maintain their work over time.
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CASE #6
Kimia Pedagogías Críticas: pleasure at the centre of sexuality education in Ecuador
Kimia is a feminist collective based in Quito, Ecuador, that promotes a pleasure-positive approach to sexuality, using creative methodologies and tools to teach comprehensive sexuality education (CSE). The collective initially worked directly with communities, but later shifted its focus to training trainers, allowing them to reach more people indirectly. Currently, they collaborate with a range of partners, at national and international levels, including United Nations agencies, NGOs, health-care providers and organizations working with survivors of sexual and gender-based violence. Kimia adapts their methodology depending on their audience. In trainings for trainers, they focus on strengthening knowledge of pleasure principles and how to apply a pleasure-based approach when delivering CSE. When working directly with communities or young people, they provide CSE that explicitly includes pleasure as a key component.
Beyond education, Kimia also engages in activism. They participate in protests and conducted a review of existing sexuality education materials in Ecuador to assess whether and how these incorporate a pleasure approach.
Remarkably, Kimia’s activists have faced limited resistance to their work. On the contrary, people are consistently enthusiastic, eager to learn more and express a strong need to openly discuss sexual pleasure.
Recommendations for integrating pleasure in sexual health work
Kimia believes that organizations should build a solid foundation of knowledge and confidence about pleasure principles before attempting to integrate them into practice. They emphasize the importance of internal alignment: the entire core team must support and fully understand the approach before sharing it with others. This can begin with small steps such as organizing internal discussions on books or resources that include pleasure-related content. They also value their volunteer model, which they see as a source of unique energy and activism that embodies their activism.
A political and transformative approach to pleasure
Kimia views inequality as a system that deprives people of sexual pleasure. Their work contributes to gender equality by emphasizing pleasure as a political act – an act of liberation and transformation both individually and collectively. According to their ethos, pleasure is a means through which we learn to inhabit our bodies safely and to recognize the beauty of the life that beats within them. It is also a context through which we can appreciate everyone’s right to enjoy and to be loved and happy, and be willing to fight to defend that right for all.
Kimia’s multi-step approach
- Provide a historical context – explain how pleasure has been taken away from specific groups of people and how systems of oppression have contributed to this. This helps participants understand that they are not alone but part of a broader historical pattern.
- Demonstrate a rights-based perspective – show participants that another reality is possible and that sexual pleasure is a right.
- Dream about and share new realities – invite participants to reflect on how the world would look if everyone were freed from constraints. For this, Kimia uses an approach based on feminist fabulations developed by Donna Haraway: an approach for engaging the needs of marginalized communities, using storytelling and philosophical inquiry to question and disrupt traditional hierarchies.
MORE INFORMATION
Speculative Fabulation by Donna Haraway
Haraway, D., 2016. Staying with the Trouble: Making Kin in the Chthulucene. Durham, NC: Duke University Press.
