Issue Brief | Claiming Pleasure in the Context of HIV: Optimizing Care for Women

Pleasure is a right. Empowering women's pleasure is essential for anyone serving women in community or healthcare spaces.

Overview

• The notion of sexual pleasure remains disconnected from HIV prevention, care, research, and policy, despite:
  • The fact that most women living with HIV acquire HIV through sexual transmission¹
  • The fundamental role of sex in health and well-being for many women
  • Mounting evidence of the importance of sex-positivity and sexual well-being to overall health²
• The lack of focus on pleasure is often a symptom of the shame and policing around sex and sexuality for women – particularly women who experience multiple forms of oppression including white supremacy, misogynoir (the overlap of sexism and anti-Blackness experienced by Black women), transmisia (hatred of people of transgender experience), poverty, and vulnerability to HIV
• The attempted dismantling of sexual and reproductive health, rights, and infrastructure by the current US administration worldwide has a particularly deleterious effect on women and others most affected by HIV, heightening the urgency for collaboration to secure bodily autonomy and affirm pleasure in our communities
• To promote discussion and shared learning among pleasure advocates across disciplines, The Well Project convened "The Right to Pleasure: Sexual Health, Women, and HIV," a facilitated virtual conversation, in April 2026
  • This multidisciplinary group of 20 experts (advocates, providers, researchers, and leaders within and beyond the HIV community) sought to challenge biases about pleasure in healthcare and explore solutions centering the expertise of women living with HIV across the gender spectrum and reflecting the needs of all women impacted by HIV

Read more about the convening and view bios of participants

Centering pleasure and affirming sexuality is not just an accessory in healthcare; this approach has been shown to have beneficial effects on women's health and well-being.³ Proactive discussions between women living with HIV or with reasons for HIV prevention and their providers (using appropriate and non-stigmatizing language) builds trust, improves women's engagement in care, reinforces their right to pleasure, and ensures providers are meeting the full range of women's needs.

The importance of sex-positivity and pleasure in healthcare has been demonstrated through research and is evidenced by the World Health Organization (WHO) explicitly recognizing pleasurable and safer sexual experiences as a central aspect of health and well-being.⁴ In spite of this, there remain significant barriers to incorporating pleasure-based approaches into women's healthcare.

"There's a lot of morality that's called into question around sex and pleasure, and then pleasure is always stigmatized as sexual when in essence pleasure is just what feels good to your body." – Cory Roroya, Organizing Director, Healthy and Free TN

Highlighting Gaps

Expressing, addressing, or even describing women's sexuality has long been taboo among many communities. This can negatively impact women, leading to a lack of awareness about:

• One's own body and its capacity for pleasure
• Prevention and acquisition of HIV and other STIs in the context of women's overall wellness
• Reproductive life, including pregnancy and contraception, childbirth and postpartum experience, menstruation and menopause

Healthcare systems reinforce these challenges by neglecting to address women's sexuality in training and education for healthcare providers. Providers' own backgrounds and discomfort around the discussion of sexual health and pleasure may further complicate their willingness to address these topics with the women they care for.⁵ These missed opportunities to holistically reach, serve, and support women can contribute to diminished health outcomes.⁶

"Most providers are trained to really center 'risk' and 'disease' and talk about 'compliance' and 'adherence.' The first thing they have to do is start shifting that mindset. And so, we have to build out education and training." – Marnina Miller, Co-Executive Director, Positive Women's Network-USA

HIV treatment as prevention and Undetectable Equals Untransmittable (U=U, the fact that people living with HIV who take antiretroviral therapy and maintain an undetectable viral load cannot sexually transmit HIV) have, for the most part, inspired favorable changes in approaches to HIV treatment and prevention, as well as the lives of people living with HIV and with reasons for prevention.⁷ However, one unintended consequence of these advances has been an overly narrow focus on viral load as the only metric of well-being for people living with HIV, to the exclusion of important quality-of-life factors like pleasure.

A shared goal among "The Right to Pleasure" participants was to change the landscape so that women across the gender spectrum can celebrate their sexuality, center their needs, and assert their bodily autonomy. This will require sexual health to be reframed in a way that centers dignity, justice, and pleasure without shame. It calls on all stakeholders (communities, providers, and institutions) to challenge generations of negative dynamics around sexuality and actively support women in reclaiming pleasure as an essential part of their well-being.

"Many of us have had to navigate systems that were not designed to hold our full humanity. So we're not just talking about pleasure. We are practicing new ways of being in relationship to ourselves, to each other, and to care." – Jasmine Burnett, Principal, The Office of Jasmine Burnett (formerly Blkfeminst Advisors)

Pleasure is defined in part as "desire; inclination; a source of delight or joy."¹ While the term is frequently used in the context of sexuality within this document, it can also more expansively be used to describe a sense of safety, rest, connection, autonomy, agency, and the ability to feel at home and affirmed in one's body. 

Building Bridges

"[It is important to be] mindful of the gender power dynamics that we have to address daily, and think about how that affects everything we do, including sexual pleasure and intimacy." – Florence Momplaisir, MD, MSHP, Associate Professor, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania

Shifting Power in Healthcare Systems: Addressing Harm to Advance Pleasure

Incorporating pleasure-based approaches into healthcare may require a reckoning with deeply held beliefs, assumptions, and biases. Approaches discussed among participants in "The Right to Pleasure" include:

• Committing to the labor required to repair legacies of harm: To move from a place of shame to one in which a woman's pleasure can be considered and centered, the need to heal harm from generations of shaming and discrediting women's sexuality must be accounted for. Creating spaces of reconciliation in which such harm may be openly addressed can be an important part of trust-building processes.
• Courage and the willingness to be vulnerable: Overcoming barriers around addressing sexual pleasure requires providers to challenge their assumptions about the women they see and, in many cases, themselves. Providers must explore their own "brave spaces," which they can work toward by committing to community agreements around confidentiality and leveraging trauma-informed practices.
• Stepping up – and stepping back: While providers will need to "show up" in these spaces as their authentic selves, they must also recognize when they may not be the right messenger. Similarly, healthcare clinics and other institutional spaces, often sites of harm themselves, may not be ideal environments for repair to begin. It will be important for providers to consider expanding their teams and offerings to incorporate the perspectives and expertise of those most likely to reach the women they serve (e.g., doulas, midwives, elders, and other community-based sources of knowledge and support).

"[It will be important to leverage] providers who talk about pleasure and joy around sex as a model [and to show how that] has established a lot of trust in already marginalized communities." – Marnina Miller, Co-Executive Director, Positive Women's Network-USA

• Training for providers engagement: Unsurprisingly, medical school and continuing medical education do not prioritize women's pleasure in their curriculum. This problematic gap also creates an opportunity to develop new curriculum that centers sexual pleasure, joy, and wellness as part of health. Many HIV and/or women's organizations are well positioned to create and disseminate tools to support providers as they engage in conversations with the women they serve about sex, without shame or assumptions.
• Developing and/or supporting peer-based approaches: Peer support models have played a vital role as trusted messengers in HIV education since the beginning of the epidemic and are uniquely qualified and situated to extend efforts into spaces focused on sexual health and pleasure. Peers' lived experience and expertise can meaningfully impact women living with HIV and with reasons for prevention, as peers are able to meet women where they are in ways providers cannot.

Call to action

The April 2026 convening was informed by survey data from the 20 attendees that explored priorities to ensure women have access to pleasure-centered care and services. Findings from the survey surfaced two important relational themes, including:

• Community members' entwined needs for trust and connection in vulnerable settings, including providers' care
• The importance of providers themselves becoming trustworthy through education, training, and accountability

The convening demonstrated that meaningfully incorporating pleasure into health approaches for women living with HIV and with reasons for prevention will require collaboration and creativity, two areas of tremendous expertise for the HIV community. Actions to explore in diverse settings include:

Health Systems/Healthcare Providers

• Employ existing materials and frameworks promoting inclusion of pleasure into healthcare environments – for example:
  • GOALS Framework for Sexual History Taking in Primary Care⁸
  • National Coalition for Sexual Health's "Sixth P" (Pleasure/Problems/Pride) building upon US Centers for Disease Control and Prevention (CDC)'s previous "Five P's" of sexual history taking (Partners, Practices, Past History of STIs, Protection, and Pregnancy)⁹
• Investigate other potential training models for "trust-building" for all medical office staff (including front desk, support staff, medical providers, etc.); if none exist, develop and promote novel model
  • Training should leverage a trauma-informed service provider model, and be led by compensated expert community members

Researchers

• Create roadmap to support research around women’s pleasure that addresses the challenges and impediments posed by the current policy context
• Identify and pursue research questions that interrogate approaches to incorporating sexual pleasure into healthcare¹⁰
• Undertake literature review or meta-analysis of existing research on incorporation of sexual pleasure into healthcare
• Conduct evaluations of sex-positive and pleasure-based healthcare approaches among other populations to assess and quantify their impact on outcomes; leverage learnings to design research approaches for women living with HIV or reasons for HIV prevention

Community Organizations and Advocacy Groups

• Identify trusted messengers from the community and equip them with tools and resources to work as equal partners alongside providers in exploring pleasure-based approaches
• Review and collate existing materials into a resource center and promote to providers, peer navigators, and women living with HIV and with reasons for prevention (see below for a list)
• Create toolkit of existing offerings, including games exploring consent, fostering comfort and fun in pleasure conversations
  • Develop novel materials to address gaps in content (e.g., "Conversation Cards" for providers around sexual pleasure)
• Create a roadmap of research/researchers centering sexual pleasure in their work to foster connection and inform further content development

Community Members and Community-Based Research Collaboratives

• Conduct surveys to crowd-source ideas for innovative, normalizing, and connection-building approaches to create dialogue around sexual pleasure; identify best practices to implement efforts.
• Create a peer-led online storytelling library featuring the voices of affected women describing their own "case studies," reflecting people's real lives, bodies, and experiences.
• Explore the development of a quality assurance-style certification for providers indicating that they have been vetted as sex-positive
  • Identify organization(s) that would provide "clearance"
  • Leverage learnings from other models, such as Church Clarity
  • Create and promote list of providers
• Identify opportunities to bring providers into conversations around pleasure with the women they serve in community spaces, in addition to clinical ones
  • Work with providers to prepare them to engage in these spaces as listeners and learners (and with humility) rather than the speaker/leader they typically embody 

"Language can cage us or liberate us." – L. Tang Spear, Founder, 4L Solutions

Conclusion

It is impossible to ignore that this discussion is being forged in an environment in which the sexual and reproductive rights and bodily autonomy of women and others across the gender spectrum are under brutal and insidious attack. In this setting, it is more important than ever to identify tools to fill crucial gaps in care, build connection, resist the criminalization of the bodies and choices of oppressed people; and reclaim joy and pleasure as part of advocacy and resistance.

It is well-established that promoting pleasure among women living with HIV and with reasons for prevention leads to better outcomes for health and well-being. It is vital that the institutions and individuals responsible for providing care and services to women build their capacity to engage with this long-avoided topic. The principles of trust, reliable information, and bridge-building must underpin these efforts. Affirming, non-judgmental language, including person-first terminology, will play an instrumental role in this change-making process.

Collaboration will be equally important. Many movements and communities adjacent to HIV offer expertise and best practices that should be leveraged in these efforts. The work ahead is not to reinvent these conversations, but to connect the knowledge and practices that already exist from this convening and across movements, and bring pleasure into the center of HIV advocacy, care, and prevention.

For more information about sexual pleasure (and other resources), please access The Well Project's topic page on Sexual Health and Pleasure. To learn more about our convening, "The Right to Pleasure: Sexual Health, Women, and HIV," including a list of attendees and survey findings, please read "The Well Project Hosts Its First-Ever Convening Exploring Sexual Health, Pleasure, and HIV."

Additional Resources 

About The Well Project

The Well Project is a non-profit organization whose mission is to change the course of the HIV/AIDS pandemic through a unique and comprehensive focus on women and girls across the gender spectrum. The Well Project envisions a world in which women living with or vulnerable to HIV have the information, support, and tools they need to advocate for their health and well-being, and live free from stigma.

This programming is part of SHE/HER/THEY (Sexual Health Education/HIV Empowerment Resources/Treating HIV Equally), which is currently supported through Merck and ViiV Healthcare's Positive Action Grant Program. 

References

¹ Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2018–2022. HIV Surveillance Supplemental Report 2024;29(No. 1). https://stacks.cdc.gov/view/cdc/156513/cdc_156513_DS1.pdf 
² Bond KT, Radix AE. Sexual Health and Well-Being: A Framework to Guide Care. Med Clin North Am. 2024 Mar;108(2):241-255. doi: 10.1016/j.mcna.2023.10.001. Epub 2023 Oct 30. PMID: 38331477; PMCID: PMC12877561. https://pmc.ncbi.nlm.nih.gov/articles/PMC12877561/ 
³ ARhiana Mills, Katie Northcott, Emese Kovacs & Anne Philpott (2023) Opening a portal to pleasure based sexual and reproductive health around the globe; a qualitative analysis and best practice development study, Sexual and Reproductive Health Matters, 31:1, 2275838, DOI: 10.1080/26410397.2023.2275838 To link to this article: https://doi.org/10.1080/26410397.2023.2275838 
^4 
5 Dukes C. Talking about S-E-X in Healthcare Settings: Let's Get Clinical. Dela J Public Health. 2025 Jul 31;11(2):46-49. doi: 10.32481/djph.2025.07.12. PMID: 40786709; PMCID: PMC12333857. https://pmc.ncbi.nlm.nih.gov/articles/PMC12333857/ 
⁶ Thorpe S, Iyiewuare P, Ware S, Malone N, Jester JK, Dogan JN, Hargons CN. "Why Would I Talk To Them About Sex?": Exploring Patient-Provider Communication Among Black Women Experiencing Sexual Pain. Qual Health Res. 2022 Aug;32(10):1527-1543. doi: 10.1177/10497323221110091. Epub 2022 Jun 25. PMID: 35758050; PMCID: PMC11214809. https://pmc.ncbi.nlm.nih.gov/articles/PMC11214809/ 
⁷ Calabrese, S.K., Bor, J., Dukashe, M., Kalwicz, D.A., Mupeli, K., Onoya, D., Stackpool-Moore, L. and Richman, B. (2025), A call to action to advance global research priorities related to Undetectable = Untransmittable. J Int AIDS Soc., 28: e70069. https://doi.org/10.1002/jia2.70069 
⁸ See here: https://www.hivguidelines.org/guideline/goals-framework/
⁹ See here: https://www.nationalcoalitionforsexualhealth.org/tools/for-healthcare-providers/video-series/
¹⁰ Ford JV, Corona-Vargas E, Cruz M, Fortenberry JD, Kismodi E, Philpott A, Rubio-Aurioles E, Coleman E. The World Association for Sexual Health's Declaration on Sexual Pleasure: A Technical Guide. Int J Sex Health. 2022 Jan 25;33(4):612-642. doi: 10.1080/19317611.2021.2023718. PMID: 38595778; PMCID: PMC10903694.
 

¹ https://www.merriam-webster.com/dictionary/pleasure