This Commentary addresses key decisions made and policies approved primarily during the first six months of the second Trump administration in the U.S.A. that affect global health, with an emphasis on their implications for the work of World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United States Agency for International Development (USAID), and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), among others. We highlight the roots of these decisions and priorities in Project 2025 (a policy guidance plan endorsed by more than 100 right-wing U.S. organizations), and their articulation through a series of Executive Orders implemented in accord with the U.S. Department of Government Efficiency (DOGE). The Commentary also addresses the ways in which what might be best be described as a politics of cruelty has informed the U.S. administration's actions, assesses the impact that this is likely to have on the future global health, and suggests some of the reasons why global health proved to be such an easy target for the incoming U.S. administration.

RESUMOEste Comentário aborda decisões-chave tomadas e políticas aprovadas durante os primeiros seis meses da segunda administração Trump nos EUA que afetam a saúde global, com ênfase nas suas implicações para o trabalho da Organização Mundial da Saúde (OMS), o Programa Conjunto das Nações Unidas sobre HIV/AIDS (UNAIDS), a Agência dos Estados Unidos para o Desenvolvimento Internacional (USAID), e o Plano de Emergência do Presidente dos EUA para Alívio da AIDS (PEPFAR), entre outros. Destacamos as raízes dessas decisões e prioridades no Projeto 2025 (um plano de orientação política endossado por mais de 100 organizações de direita dos EUA) e sua articulação por meio de uma série de Ordens Executivas (OEs) implementadas de acordo com o Departamento de Eficiência Governamental dos EUA (DOGE). O Comentário também aborda as formas pelas quais, o que poderia ser descrito como uma política de crueldade, informou as ações da administração dos EUA, avalia o impacto que tal política provavelmente terá na saúde global e sugere algumas das razões pelas quais a saúde global se mostrou um alvo tão fácil para a atual administração americana.

The language of 'strengths' and 'strengths-based approaches' has rapidly grown in health research, yet rarely have these approaches been evaluated for their conceptual adequacy. This paper presents an analysis of recent literature to examine how young people's 'strengths' have been represented. We found that most papers use the language of resilience and protective factors to focus mostly on individual traits or attributes. This literature offers limited, if any, understanding of how 'strengths' are produced, being concerned instead with describing and classifying individual traits. A smaller group of studies has used concepts of capital to frame strengths in relation to the durability and quality of relationships. Our analysis suggests that this relational understanding of 'strengths' opens up more productive conceptual space for policies and programmes to intervene not with individuals but with social relations: the practices, identities and collective knowledges that produce and sustain young people's positive trajectories.

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.

This strengths-based study investigated Aboriginal adults' views on young people's sexual health, attitudes and relationships. Between 2019 and 2020, sixteen interviews were conducted with adults aged 25 and older from two Aboriginal communities in Western Sydney, Australia. In this paper, we discuss adults' perspectives on intergenerational communication about sex in their communities. Participants highlighted intergenerational learning via talking as a highly valued community practice and a crucial social-cultural resource for supporting young people's sexual wellbeing. However, they also identified stigma, shame and perceived generational differences as barriers to adults talking openly with younger people about sex. To foster more open intergenerational discussion, participants recommended adopting holistic, positive and non-judgemental approaches when engaging with young people. They also emphasised the need for community-wide initiatives - such as programmes and services - that encourage collective learning, yarning and care to promote positive sexual health outcomes.

Purpose Significant improvements have been made in Aboriginal and Torres Strait Islander peoples’ (First Nations) maternal and perinatal outcomes over the past decade, such as decreasing rates of smoking and preterm birth and increasing birthweights. In Australia, higher rates of adolescent pregnancy are reported among First Nations compared with non-First Nations people. Having a baby during adolescence (youth pregnancy) increases the risk of poorer maternal and perinatal outcomes, including social outcomes such as poverty and educational attainment. This study examined First Nations peoples’ perspectives about youth pregnancy and parenthood in Western Sydney, Australia. Methods Sixty-eight First Nations people aged ≥16 years living in Western Sydney, Australia were interviewed in 2019–20. Interview data were analysed using thematic analysis. Main findings Approximately half of the participants were aged ≥18 years. Most participants lived with family and around half were high school students. Four themes relating to youth pregnancy and parenthood were identified: 1) youth pregnancy was normalised (e.g. ‘There’s always some young person in [the] community pregnant, if not several… it’s celebrated as well. It’s not so much of a negative thing’); 2) a desire to avoid youth pregnancy (e.g. ‘I think young people try and avoid pregnancy because they don’t wanna be a teen mum’); 3) gendered experiences of youth pregnancy and parenthood (e.g. ‘I don’t think a teenage boy would have like time like for a baby’); and 4) perspectives of caring responsibilities within families (e.g. ‘I feel like within Aboriginal communities, it’s always seen as the oldest kid has to kind of help out the parent’). Principal conclusions Although youth parenthood was acceptable in communities, most participants wanted young people to avoid pregnancy and parenthood. There was a clear community approach to raising children, especially from the oldest children helping out with child raising.

Narratives of resilience are proliferating in health policy and research where they are used to address problems threatening individuals and communities. Resilience approaches are often considered alternatives to other models of intervention because they signal a shift away from deficit assumptions to more empowering ways of promoting health. To date, however, there has been a lack of scrutiny of the nature, assumptions and effects of resilience discourse within the health field. This paper critically analyses the logics that underpin the use of such discourse, and the implications of their allure. Findings show that resilience discourse is largely understood and operationalised in neoliberal, individualistic and reductionist terms. Such logics create normative standards for what counts as 'proper resilience' and, by doing so, engender experiences of guilt and shame when individuals are not 'resilient enough'. Seen differently, through the logics of social relationality, for example, resilience can engender new forms of subjectivity and practice for individuals and communities as 'expert' and 'knowing'. Relational resilience is especially evident in First Nations scholarship, where it is conceptualised in terms of collective values, practices and identities rather than the attributes of individuals, offering opportunities to advance thinking about resilience and its use in health contexts.

Queer Generationsoffers a groundbreaking study of sexual citizenship, based on the coming of age narratives of two social generations of LGBTQ people in Australia. The open access book’s assembly and analysis of narrative accounts demonstrates the differences contained in people’s experiences of LGBTQ youth sexual citizenship. It is the first book to provide a robust empirical account of the diverse ways in which sexual citizenship is experienced and understood by different social generations of LGBTQ people growing up. By so doing,Queer Generationsoffers a unique analysis of ongoing contestations over the place of sexual and gender diversity in relation to citizenship. The ebook editions of this book are available open access under a CC BY-NC-ND 4.0 licence on bloomsburycollections.com. Open access was funded by the Bloomsbury Open Collections Library Collective.

This article explores LGBTQ + young adults’ schooling and university experiences at the intersection of ethnicity and sexuality in Australia. Using the lenses of sexual citizenship and belonging, a sociomaterial polytextual analysis of the ‘middle’ was conducted with data from qualitative in-depth narrative and photo-elicitation interviews among Lebanese, Indian and Anglo LGBTQ + young adults. The analysis found that while participants had encountered bullying and prejudicial attitudes based on sexuality, gender and ethnicity, many of them had positive experiences at school and viewed university as facilitators of opportunity and discovery. The findings suggest that educational institutions are neither inherently safe nor unsafe; rather, they are important spaces whereby the sociomaterial entanglements of identity, sexual citizenship and belonging are negotiated. Crucially, they demonstrate that minority sexuality, ethnicity and gender themselves are not immutable barriers to participation, and call for strategic investment into spaces that support both student safety and critical discussion.

In Australia, Aboriginal young people who are lesbian, gay, bisexual, trans, queer or otherwise sexuality and gender diverse (LGBTQ+) are recognised within several overlapping priority populations in state and federal sexually transmissible infection and HIV strategies. However, limited research has documented their unique sexual health experiences, needs and preferences. In this qualitative study, semi-structured interviews were conducted with 10 LGBTQ+ Aboriginal young people aged 16-24 years in New South Wales. Interviews incorporated questions about service access, positive and negative experiences and self-determined healthcare priorities. We conducted a strengths-based thematic analysis to understand the issues of greatest importance in sexual healthcare for participants. Using the framework of 'imaginaries', we explored how participants imagined sexual healthcare that would meet their individual and cultural needs. The dominant imaginary centred on respect, representation and the as-yet-unrealised possibility of sexual healthcare designed by and for people who shared the intersection of Aboriginal and LGBTQ+ experience. We identified individual-level, service-level and societal-level factors influencing this imaginary, including relationships, accessibility and experiences of racism. Analysing the imaginaries constructed by LGBTQ+ Aboriginal young people of empowering, culturally safe sexual healthcare that is 'for them' provides insight into potential service design to improve sexual health outcomes for this population.

This paper describes the strategies used by Aboriginal young people to build positive relationships and sexual wellbeing. It does so to counter the risk-focussed narratives present in much existing research and to showcase the resourcefulness of Aboriginal young people. We used peer-interview methods to collect qualitative data from 52 Aboriginal young people living in western Sydney, Australia. Participants reported a strong desire to stay safe and healthy in their sexual relationships and to achieve this they relied heavily on oral communication and yarning strategies. Participants viewed communication as a way to gain or give advice (about bodies, infections, pregnancy, relationships); to assess the acceptability and safety of potential partners; to negotiate consent with partners; to build positive relationships; and to get themselves out of unhealthy relationships. Participants also discussed 'self-talk' as a strategy for building sexual wellbeing, referring to narratives of self-respect and pride in culture as important in establishing Aboriginal young people's positive views of self and as deserving of respectful and safe sexual relationships. These findings suggest that future programmes and interventions based on yarning could be well-regarded, given it is a cultural form of pedagogy and a strategy Aboriginal young people already use to build positive relationships and identities.

Drawing from a life history study we examine memories and experience of schooling in Papua New Guinea among 45 trans women and sexuality diverse men. While participants reported regulating their expression of gender and sexuality to 'fit in' and avoid physical and verbal abuse at school, others felt able and supported to express their gender and sexuality diversity more freely beyond stereotypical norms. Schools provided a varietyof experience for trans and sexuality diverse youth, unsupportive in many ways but supportive in others. The study highlights the importance of examining the impact of colonial discourses driving homophobia and transphobia in diverse settings, and understanding the socio-cultural climates of schools to identify solutions to the discrimination and violence experienced by trans women and sexuality diverse students. Further research into the current experiences of trans, gender and sexuality diverse young people in school would provide a valuable comparative perspective to our retrospective study.

This book explores the relationship between COVID-19 and AIDS.It considers both how the earlier HIV pandemic informed our engagement with COVID-19, as well as the ways in which COVID-19 has changed how we remember and experience AIDS.Individual sections focus on sexual and intimate relationships, inequalities and injustice, the progressive biomedicalisation of the response (in the absence of a vaccine or effective treatment or cure), and professional, practitioner and community perspectives on the pandemics.The authors come from a wide variety of backgrounds -including public health, nursing, law and legal studies, political studies, and the humanities and social sciences.

This paper examines the findings from a series of studies commissioned in 1992 by the WHOs Global Program on AIDS that were carried out in Costa Rica Indonesia Mexico and Senegal. Within the context of gender relations the studies aimed to examine the capacity of the female condom to empower women in sexual negotiations with men. In spite of their overall subordination to men the women in the study were noted to be able to use a range of culturally- specific strategies to influence social and sexual relationships with men. Within this context the female condom generated a positive response from women. Women in both sex-work and non-sex-work reported enhanced pleasure security and a feeling of control over the sexual act. The paper notes that the positive reception of the female condom may have partially been due to the women’s active participation in the intervention element of the study and to the education and support they received. In conclusion it is noted that the studies highlight the importance of adopting a culturally appropriate multidimensional perspective that views women’s empowerment as a continuum rather than a final product.

Since their adoption in 2015, the Sustainable Development Goals including Goal 5 have been criticized for their failure to recognize diversity of experience and expression with respect to gender, sex, and sexuality. Whether or not this exclusion was the intention of those who framed the goals and their associated targets is a matter of debate, but the reality is that gender-diverse people, together with their sex and sexuality diverse counterparts, remain largely absent from the SDGs (including Goal 5). In moving forwards, this chapter advocates for the need to recognize and address the needs of all people as the bearers of rights, if the goals of the SDGs are to be met. We identify four barriers contributing to the exclusion of gender and sexuality diverse people from programs and policies: neglect of concern (both institutionally in other ways) for human rights as they apply to all individuals; problems of politics as they relate to gender, sex, and sexuality; the continued power of patriarchy over individual and community life; and the neo-liberal framing of gender and sexuality diverse people. We propose a paradigmatic shift to ensure that equity, inclusion, and respect can be enjoyed by all people—regardless of gender and sexuality—in the twenty-first century.