Histories of Sexual Health in Britain, 1918-1980

在二十世纪，英国在性健康政策和服务方面经历了几次根本性的转变。这些发展带来了巨大的好处，并有助于打破阻碍获得保健的耻辱和不平等现象。然而，根本问题依然存在。使这些问题更加复杂的是，迫在眉睫的抗生素耐药性危机和地方当局资金削减威胁着性健康服务。面对这样的挑战，历史可以给我们很多启示。了解临床实践、社会条件、文化态度和政策干预的历史影响，使我们能够认识到长期趋势和模式。它使我们能够更好地应对性健康结果、服务提供和服务用户体验方面持续存在的新挑战。我正在领导一个跨学科项目，用这些知识武装我们，追踪英国从第一次世界大战结束到艾滋病流行开始的性健康状况。如今，性健康被定义为拥有愉悦和安全的性生活的能力，并被认为是整体健康和幸福的重要组成部分。从历史上看，它的定义要窄得多。在临床实践中，它意味着与梅毒和淋病作斗争，这是卫生当局关注的主要“性病”（VDs）。在公众的想象中，它意味着保持道德和优生学上的“适合”，以确保种族和国家未来的健康。渐渐地，性健康迅速膨胀，成为一个独立的临床领域，并涵盖了其他各种新发现的vd，如衣原体，以及孕产妇福利和计划生育的各种规定。这个项目的关键是英国国家资助的VD服务。它成立于1918年，1948年后被纳入英国国民医疗服务体系，是英国向社会化医疗转变的重要组成部分。数以百万计的病人通过其遍布全国的诊所网络就诊。然而，除了少数学者外，所有人都忽视了整个计划。在他们工作的基础上，我们采用新的方法和未被充分利用的档案来推进未被充分研究的时期，地点和主题。我们从越来越多的跨国性健康史中获得灵感，探索英国参与由国际联盟和后来的世界卫生组织设立的倡议，以了解区域政治和文化如何影响对全球挑战的反应。由于该项目优先考虑服务用户体验，因此我们将重点关注1948年至1980年间访问过诊所或在诊所工作的人的口述历史。该项目解决了性健康历史上的主要空白，并为当前的问题提供了重要背景。但在探索历史上的性健康时，它也突出了英国历史上的一系列主题。例如，VD服务旨在帮助克服在获得医疗保健方面的性别、阶级和种族不平等。当然，这项政府倡议在纠正各种社会不公正现象和地方性卫生挑战方面取得了很大进展。但在实践中，在诊所和更广泛的社会中，偏见和耻辱持续了几十年，甚至一直持续到现在。妇女和工人阶级继续被视为传染病的“带菌者”，需要管理和监视。LGBTQ+社区在医疗保健领域历史上面临的结构性暴力今天继续破坏他们的福祉和健康结果。同样，制度性种族主义继续对非裔美国人的性健康经历产生破坏性影响。凭借其强有力的研究、政策和参与规划，该项目将丰富人文和卫生研究，建立公众对性健康的理解，为政策提供信息，加强临床培训，并在卫生工作者中创造更多的反思做法。在这样做的过程中，它将在改善性健康结果和服务用户体验方面产生长期效益。

During the twentieth century, Britain experienced several radical transformations of its sexual-health policies and services. These developments brought huge benefits and helped to break down the stigma and inequalities that impeded access to care. Yet fundamental problems remain. Compounding these problems, sexual-health services are threatened by a looming crisis of antibiotic resistance and funding cuts to Local Authorities. History has much to teach us as we face such challenges. Understanding the historical impact of clinical practices, social conditions, cultural attitudes and policy interventions enables us to recognise long-term trends and patterns. And it makes us better equipped to tackle persistent and emerging challenges in sexual-health outcomes, service delivery and service-user experiences.I am heading an interdisciplinary project that arms us with this knowledge, tracing sexual health in Britain from the end of the First World War to the beginning of the AIDS epidemic. Today, sexual health is defined as the ability to lead a pleasurable and safe sex life and is recognised as a vital component of overall health and wellbeing. Historically, its definition was much narrower. In clinical practice, it meant combating syphilis and gonorrhoea, the principle 'venereal' diseases (VDs) preoccupying health authorities. In the public imagination, it meant remaining morally and eugenically 'fit' to ensure the future health of the race and nation. Gradually, sexual health ballooned, becoming its own clinical field and encompassing a variety of other, newly identified VDs like chlamydia as well as diverse provisions for maternal welfare and family planning.Key to this project is Britain's state-funded VD Service. Established in 1918 and integrated into the NHS after 1948, it was a vital part of Britain's shift towards socialised medicine. Millions of patients passed through its nationwide network of clinics. Yet the entire scheme has been overlooked by all but a handful of scholars. Building on their work, we employ new methods and underused archives to push into understudied time periods, places and themes. We take inspiration from a growing collection of transnational sexual-heath histories, exploring Britain's involvement in initiatives set up by the League of Nations and, later, the WHO to understand how regional politics and culture has influenced responses to global challenges. And because the project prioritises service-user experiences, an important focus is on oral histories that we will conduct with people who accessed or staffed clinics between 1948 and 1980.The project addresses major gaps in the history of sexual health and provides vital context for current problems. But in exploring historical sexual health, it also foregrounds a range of themes in British history. For example, the VD Service was intended to help overcome gender, class and racial inequalities in access to healthcare. Certainly, this government initiative went a long way towards correcting a variety of social injustices and endemic health challenges. But in practice, within the clinics and wider society, prejudices and stigma persisted for decades and continue even into the present. Women and the working classes continued to be viewed as 'vectors' of contagion, in need of management and surveillance. The structural violence faced historically by LGBTQ+ communities within healthcare continues today to undermine their wellbeing and health outcomes. Similarly, institutional racism continues to have a damaging impact on BAME sexual-health experiences.With its robust research, policy and engagement programme, the project will enrich humanities and health research, build public understandings of sexual health, inform policy, augment clinical training and create more reflexive practices among health workers. In so doing, it will have long-term benefits in improved sexual-health outcomes and service-user experiences.