Every Body, But Not Every System: Where Sexual Health Infrastructure Is Failing
Published in Microbiology, General & Internal Medicine, and Public Health
World Sexual Health Day 2026 carries a theme that sounds inclusive: "Every Body." Five dimensions follow from it: the personal, the relational, the institutional, the cultural, and the political. The first two depend on the last three. And it is the last three that are now under direct threat.
When I was at WHO headquarters, I coordinated the development of the WHO Consolidated Operational Handbook on Sexually Transmitted Infections, released in February 2026. The handbook brings together, for the first time, all WHO normative and operational guidance on STI prevention, diagnosis, treatment, surveillance, and service delivery published between 2016 and 2025. It exists because the global STI response has never matched the scale of the problem. More than one million new curable STIs are acquired every day. Syphilis infections rose to an estimated eight million globally in 2022, with about 700,000 cases of congenital syphilis. These numbers are not new. The failure to act on them is not new either.
The systems we built are not enough
The WHO Global Health Sector Strategy on STIs sets a target: reduce gonorrhoea and syphilis infections by 90% by 2030 (SDG 3). Most countries are not on track. Many have no national STI strategy at all. Those that do often lack the budget, the workforce, or the political will to put it into operation.
Start with diagnostics. Most low- and middle-income countries still use syndromic management. Clinicians treat symptoms without a confirmed pathogen. Point-of-care tests for syphilis exist but reach only a fraction of the population that needs them. For Mycoplasma genitalium, a pathogen with macrolide resistance above 60% in parts of Europe, most clinics cannot test at all. The operational handbook introduces the STI prevention and care cascade as a framework to map where people fall out of the system. In most settings, they fall out early.
Then look at services. STI care, HIV treatment, and sexual and reproductive health remain separate in most countries. Patients move between departments that do not share records, referrals, or accountability. The handbook provides package-based guidance to integrate these services within primary health care. But integration needs a national decision, national financing, and national ownership. External donors cannot build it. Countries must.
Stigma and silence are structural failures, not cultural inevitabilities
STIs remain taboo in nearly every setting, including the most advanced. Patients delay care because of shame. Clinicians avoid sexual history-taking because they lack training or comfort. Public health campaigns on STIs are rare compared to those on diabetes, cancer, or even HIV. Advocacy is weak because few political leaders will attach their name to a sexually transmitted infection.
This silence has a cost. Without public pressure, STI programmes stay underfunded. Without advocacy, national STI responses stay low on the political agenda. Without open conversation, the populations most affected (sex workers, men who have sex with men, adolescents, people in conflict settings) remain invisible to the systems that are supposed to serve them.
"Every Body" cannot be a theme for one day in September if the rest of the year these bodies do not appear in national health budgets, training curricula, or parliamentary debates.
When policy environments shift, health systems pay the price
Sexual health infrastructure is shaped by policy decisions that often happen far from clinics. When foreign assistance decreases, HIV and STI service sites close. A Lancet analysis of 133 countries found that two decades of global health programming prevented 91.8 million deaths. The same analysis projects 14 million additional deaths by 2030 if current funding reductions continue. In Pakistan, 331 children were infected with HIV at a single hospital through reused needles. These are failures of financing, governance, and oversight.
Vaccine programmes face similar pressures. When immunization policy follows political debate rather than scientific evidence, coverage drops. The history of vaccine programme disruptions across multiple countries shows how quickly public trust, once lost, takes a generation to rebuild.
The populations that carry the cost are always the same: women, children, sex workers, men who have sex with men, people in conflict zones, people in poverty. Sexual health does not exist in isolation from these broader policy shifts. Every disruption in global health financing or evidence-based decision-making reaches STI services, often first.
What "Every Body" demands
If the WSHD 2026 theme is more than a slogan, it must translate into structural demands. Countries must own their national STI responses with domestic financing, not depend on external donors whose priorities shift. Surveillance systems must detect resistance before it becomes untreatable. Diagnostic capacity must reach beyond referral hospitals. Vaccine programmes must follow scientific evidence. Service models must integrate STI, HIV, and reproductive health care so that patients do not fall between them. Training pipelines must produce providers who can meet patients without judgment.
The SDG 3 targets on STIs are five years away. Most countries will not meet them. The question is whether we will name the reasons (underfunding, stigma, weak advocacy, fragile national ownership) or continue to write declarations that no system is built to deliver.
On September 4, World Sexual Health Day asks us to close that gap. The operational handbook exists. The evidence exists. What remains is the institutional will to act on them.
Ismaël Maatouk, MD, MPH, PhD, is a Professor of Dermatology and STIs at the University of Balamand (Lebanon), and a global sexual health physician. He is an Editorial Board member of BMC Global and Public Health.
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