Microsoft Word - 10. McCave et al_16672_Human Sexuality copyedit final ______________ Emily McCave, Ph.D., MSW, is an Assistant Professor in the Department of Social Work at Quinnipiac University in Hamden, CT. Benjamin Shepard, Ph.D., LMSW, is an Associate Professor in the Human Services Department at CUNY/NYC College of Technology in Brooklyn, NY. Virginia Ramseyer Winter, MSW, is a doctoral candidate at the University of Kansas in Lawrence, KS. Copyright © 2014 Advances in Social Work Vol. 15 No. 2 (Fall 2014), 409-427 Human Sexuality as a Critical Subfield in Social Work Emily McCave Benjamin Shepard Virginia Ramseyer Winter Abstract: Human sexuality is of vital importance to social work practitioners, educators, and scholars. Yet historically, the profession’s leadership around it has waxed and waned, impacting practice. This article discusses the importance of human sexuality as a critical subfield within social work. It suggests that the mechanisms, namely textbooks, journals, and national conferences, for stimulating human sexuality social work scholarship are limited. The authors assert that the taboo of human sexuality limits the advancement of a cohesive professional discourse and contributes to the continued oppression of marginalized populations. Recommendations for providing better support for those who study, teach, and practice in the arena of human sexuality are offered. Keywords: Human sexuality, social work scholarship, social work education Throughout the 20th and 21st centuries, a group of passionate leaders within our profession asserted that social workers should recognize human sexuality as an integral, rather than a peripheral or even “deviant,” aspect of human functioning. One such leader, social worker and sexuality educator, Diane Brashear, suggested, “to ignore our sexuality is to deny our humanity” (1976, p. 18). Yet unfortunately, ignoring and pathologizing sexuality has happened all too often within social work education, scholarship, and practice (Myers & Milner, 2007). Social workers Gochros and Shultz (1972) attributed this phenomenon, particularly the lack of competency and willingness of social workers to discuss sexuality issues with clients, to the fact that social workers are “people first, and then professionals” (p. 246). This problem is not unique to just the area of human sexuality; social workers recognize that a lack of understanding in any major aspect of one’s culture or identity can interfere with effective practice, establishing culturally competent practice as an ethical standard within the profession (National Association of Social Workers [NASW], 2008). Negotiating differences in practice requires self-awareness of personal and cultural values and also a commitment to dismantling oppression through empowerment and advocacy. Issues related to human sexuality fall squarely within the arena of cultural competency given the diverse lived experiences, attitudes, and behaviors of clients, many of whom experience marginalization because of their sexuality. Indeed, NASW (2008) specifically states in the Ethical Standard 1.05, “Cultural Competence and Social Diversity,” that social workers are ethically bound to “…understand the nature of social diversity and oppression with respect to …sex, sexual orientation, gender identity or expression ...marital status…” (para. 30). ADVANCES IN SOCIAL WORK, Fall 2014, 15(2) 410 Further, NASW (2008) asserts in the preamble of the Code of Ethics that the mission of the social work profession is to enhance the well-being of individuals and the larger society. Particular attention is paid to vulnerable and marginalized populations and to considering the impact of the environmental context on individual, family, organization and community behavior on well-being. The World Association for Sexual Health (WASH, 2013) states that “full development of sexuality is essential for individual, interpersonal, and societal well-being” (para. 1). Social work supports the importance of human sexuality as a critical topic for social workers while calling attention to the influence of the economic, social, political, and familial contexts on achieving optimal sexual well-being. Further, NASW (2008) suggests special focus should be on the marginalization of individuals and groups by understanding the societal mechanisms that regulate aspects of human sexuality. Given this, social workers have a responsibility to gain knowledge and skills for generalist and advanced practice and to support expanding existing knowledge through teaching and scholarship on human sexuality issues. The first step to building competency in a particular domain is defining its scope. The ever-evolving concept of human sexuality makes it challenging to capture within a single definition. Too often the word “sexuality” is considered synonymous with sexual orientation (Trotter, Crawley, Duggan, Foster, & Levie, 2009). Yet human sexuality is an expansive term. For example, the World Health Organization (2006) suggests human sexuality is: … a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors. (para. 6) While this definition highlights that human sexuality is central to daily life and is experienced and expressed in complex ways, it does not explicitly address the relationship between sexuality, oppression, and privilege – a connection that is paramount to social workers. Sexual privilege, the ability to experience your sexual attitudes, identities, or behaviors, as “normal” or “healthy,” is maintained at the expense of “others” who will be taught that their sexuality and sexual decisions are “abnormal” or “unhealthy” (Crimp, 1988; Crimp, Pelligrini, Pendleton, & Warner, 1997). The importance of reframing such negative labels when working with marginalized populations is a key component of strengths-based social work practice (Saleebey, 1997). To better prepare social workers to understand and negotiate the myriad of human sexuality issues, it is critical that human sexuality becomes a more visible and cohesive subfield. Competency development needs to occur within professional practice, which can be facilitated through advances in social work education and scholarship. One possible avenue for pursuing such advances is through the cultivation of an environment that fosters the creation and dissemination of human sexuality scholarship. To this end, McCave, Shepard, Winter/HUMAN SEXUALITY IN SOCIAL WORK 411 we examine the history and context of human sexuality and social work scholarship, as well as our experiences as sexuality scholars in social work. Second, we propose potential pathways for change within the arenas of social work scholarship. Lastly, we discuss the importance and timeliness of engaging in such change efforts. We begin with a review of the current state of social work knowledge around this topic. Human Sexuality: Scope, Surveillance, and Social Control While the scope of human sexuality literature is incredibly broad, much has been written about the symbolic nature of human sexuality (Gecas & Libby, 1976; Jackson & Scott, 2010; Longmore, 1998). For example, Hawkes and Scott (2005) argue: Human sexuality is distinct from non-human sexuality in that it is neither immutable nor static but is highly responsive to social forces. Human sexuality is imbued with symbolic meaning and social significance…given that humans are social beings, human sexuality is inevitably influenced by a person’s social location...forms of social stratification, relating to class, status, gender, ethnicity, age and so on, will influence modes of individual self-expression. (p. 7) This focus on the symbolic meaning of human sexuality highlights the connection between human sexuality, social power, and social control. Here, those in power (e.g., government officials, administrators, religious organizations, mass media, etc.) reinforce a hierarchy of social stratification and privilege, routinely advocating for and implementing social policy that regulates aspects of sexuality, including reproductive autonomy and sexuality education (Bywater & Jones, 2007). For example, the U.S. Supreme Court recently ruled that family-owned Christian businesses do not need to provide health insurance coverage to women for certain types of contraceptives, such as intrauterine devices (IUD) or emergency birth control pills (Plan B), because it violates their religious belief that these contraceptives equate to abortion (Liptak, 2014). This is contrary to the federal mandate that employers must provide health insurance that covers all FDA approved contraceptives with no cost-sharing (through deductible or co-pay) to their employees under the Patient Protection and Affordable Care Act of 2010 (National Women’s Law Center, 2014). The impact of this judicial ruling is likely to disproportionately affect lower-income women who have fewer resources to access contraceptives not covered by insurance. Repeatedly, human sexuality has been regulated through discourses involving social control, panic, power, and surveillance (Chambon, Irving, & Epstein, 1999; Shepard, 2007a). For example, social welfare policies have been aimed at the moral regulation of the personal and sexual lives of those on public assistance (Abramovitz, 1996, 2000; Flavin, 2009; Gans, 1995; Piven & Cloward, 1993). In an era of a dwindling welfare state, the actions of the poor, those who subsist on survival services, are increasingly scrutinized and subject to surveillance (Spade, 2011). For feminist philosopher Nancy Fraser (1989), a distinct series of social discourses produced the stereotype of the “welfare mother.” These discourses functioned to create a “gendered” form of “welfare provisions” used to undermine supports for social welfare programs. Within this feminized system, women are labeled as deviant so that the services they receive serve as ADVANCES IN SOCIAL WORK, Fall 2014, 15(2) 412 a mechanism of normalization (Fraser, 1989). Repeatedly, opponents of social services have responded to the new social mobility among women by calling for welfare policies based on social control, mandatory production, and demonization of female sexual self- determination (Abramovitz, 1996, 2000; Flavin, 2009). A racialized, dehumanizing view of women on welfare, combined with anxiety about shifts in the constellation of the nuclear family, fuel these anxieties (Abramovitz, 1996, 2000; Sidell, 1998). Beyond the welfare arena, issues such as variant sexual behaviors, sexual assault, adolescent sexuality, and sexual orientation have been framed as “problems” to be solved by helping professionals (Myers & Milner, 2007). Social workers have often responded with the best intentions, while unknowingly perpetuating the cycle of sexual oppression by delivering services that are based on erroneous assumptions and personal judgments, or avoiding such topics all together (Myers & Milner, 2007). Given the profession’s emphasis on cultural competency, there is ample opportunity to move away from this pattern and to reframe the subfield of human sexuality as one where social workers can gain new knowledge, disseminate scholarship, and engage in anti-oppressive practice that fosters empowerment and challenges the status quo of what is considered “normal” human sexuality. While social workers have the capacity to be leaders in this effort, thus far momentum has been limited. Social work’s response to human sexuality mirrors the larger cultural norms and values on sexuality, which favor social control rather than the field’s stated emphasis on self-determination (Ehrenreich, 1985; Margolin, 1997; Myers & Milner, 2007). There are multiple reasons for this response. Similar to Tatum’s (1997) astute declaration that none of us are able to avoid breathing in the “smog” of cultural racism (p. 6), social workers likely have an internalized belief system in which certain sexual attitudes and behaviors are perceived as more normative than others. This internalization is influenced by the frequent use of public shaming and stigma to regulate and control individual sexual behavior (Bay-Cheng, 2003; McAlinden, 2005). The consequences of this are manifested in social work practice (e.g., homophobia and discrimination of sexual minorities within residential treatment) (McCave, 2008), research (e.g., negating and ridiculing the worth of sexuality research) (Hammond & Kingston, 2014; Israel, 2002), and teaching (e.g., avoiding the integration of human sexuality content into social work courses) (Dunk, 2007). Yet, it is the profession’s obligation to train future social workers to provide high quality, culturally competent care (NASW, 2008). Rather than focus on the pathology of certain sexual issues (e.g., teenage sexual behaviors) and characteristics of certain populations (e.g., sexual abuse victims) (Dunk, 2007; Morrow & Messinger, 2006), we emphasize a strengths-based approach that favors self-determination more in line with the field’s code of ethics (Saleebey, 1996). The regulation of human sexuality can be seen within the social work academic arena as well. This is evidenced by the career challenges the authors of this paper have faced as result of their choices to study sexuality within the social work academy. According to one of the authors, while pursuing a graduate degree in social work, students and faculty seemed uncomfortable with discussions of sexuality-related material, such as teen pregnancy and HIV prevention, while advancing punitive policy solutions. While McCave, Shepard, Winter/HUMAN SEXUALITY IN SOCIAL WORK 413 women’s sexuality was often blamed for problems extending from teen pregnancy to reproductive autonomy (Abramovitz, 1996, 2000), few students or faculty seemed interested in critically engaging in questions about why this was the case. Another author of this paper was told in no uncertain terms by a faculty mentor in 2007, in one of the initial explorations of dissertation topics, all of which centered on human sexuality in some way, that pursuing a “gay dissertation” (i.e., research focused on gay and lesbian sexual health) would be a barrier to a successful academic career because it would result in being “tracked” into “that kind of research.” While the intention might have been well meaning, the comment was both personally and professionally degrading. Moreover, it ultimately affected the final choice of dissertation topic. Perhaps ironically, the second experience that the same author had on several occasions was in fact related to the dissertation topic, which examined health providers’ HPV vaccination attitudes and behaviors. Throughout the dissertation phase and especially while on the job market in 2009, one message came back consistently from other social work academics – that while the topic was interesting, it was not really a social work subject; rather it was a topic for public health researchers. This author was frustrated with having to justify her intellectual pursuits to strangers. Repeatedly being told her research did not “fit” within her own profession made her question the worth of her research, and her worth as a social work scholar. The pattern of social control continued when the authors went on the job market for social work teaching jobs in the mid-2000s. When interviewing for a position at a large research institution in the northeast, one of the authors of this paper was told that the interview committee had laughed at one of the publications listed on the author’s curriculum vitae the day before the job talk at the school. The article in question was a book review of a book published by MIT Press published in a top tier journal. During this informal pre-interview conversation, the author asked what the faculty thought about questions about sexuality and self-determination as a part of social work education. “We are not there yet,” one of the members of the appointments committee noted during the informal discussion. Unfortunately, experiences such as these can perpetuate feelings of academic and professional marginalization for engaging in topics outside widely accepted categories of mainstream social work research (e.g., child welfare, mental health, gerontology). These experiences are not unique to those who pursue sexuality issues (Canda, 2003). While related fields have built a rich literature critically engaging questions about sexuality and difference (Bernstein, 2007; Crimp, 1988; Foucault, 1978; Freud, 1975; Warner, 1999), the social work knowledge base is limited when it comes to questions about human sexuality and practice (Timm, 2009). Rather than expand our often limited knowledge base around this topic, social work tends to look the other way (Dunk-West & Hafford- Letchfield, 2011; Goldstein, 1990; Martin, et al., n.d.; Morrow & Messinger, 2006). Our experiences suggest that social work sexuality scholars are forced to contend with a lack of understanding contributing to a bias that mirrors patterns seen in the larger culture (Spade, 2011). To be fair, one of the authors’ experiences in the related field of psychoanalysis suggests providers in this area have equally difficult times engaging with ADVANCES IN SOCIAL WORK, Fall 2014, 15(2) 414 questions about human sexuality and difference, especially around topics related to “deviant” sexual behavior. These experiences are well documented (Timm, 2009). To be competent educators and practitioners, we are compelled to advance the social work knowledge base so as to support client self-determination in negotiating their sexual selves. This can be challenging given the social, legal and ethical issues related to human sexuality. WASH (2013) identifies eleven sexual human rights, which include the right to sexual freedom, sexual autonomy in individual decision-making, and to be free from sexual violence, as well as the right to sexual privacy. It also includes the right to be free from sexual discrimination, the right to experience sexual pleasure and sexual expression. It asserts that individuals have the right to choose with whom they associate sexually and to make their own reproductive choices. Yet, people can only make these choices freely when they have access to current, evidenced-based sexuality education and responsive health care (WASH, 2013). A caveat is stated within this declaration that it is never the sexual right of an individual, organization, or society to engage in acts of sexual coercion, sexual discrimination, sexual violence, or sexual exploitation. These sexual rights and limitations serve as a guide for assisting practitioners who want to promote client sexual self-determination. Integrating these sexual rights into one’s practice acknowledges that, “The expression of sexuality is a window into who each person is and how they relate to each other,” notes Timm (2009, p. 15). However, when social workers avoid the topic of human sexuality, it limits a client’s ability to fully engage in self-determination. Furthermore, “Not talking about it sends a message that it is taboo and ignores valuable clinical information… One of the biggest barriers to productive, therapeutic conversations about sexuality is a lack of training; many … professionals simply are not adequately trained,” (Timm, 2009, p. 15). Yet, there are ways around this limitation. By recognizing sexuality as an integral part of social work education and practice, we can replace patterns of paternalism with strengths-based models of care more consistent with our code of ethics and evidence-based practice (Saleebey, 1997). A critical component of building this knowledge base involves cultivating and disseminating scholarship and linking it with practice. Yet, when it comes to human sexuality, cultural competence has waxed and waned. Human Sexuality and Social Work Scholarship While social welfare scholars have long recognized that sexuality has a rightful place in the social work curriculum, the scholarship has rarely matched the need for this material (Abramowitz, 1971; Dunk-West & Hafford-Letchfield, 2011; Martin, et al., n.d.; Morrow & Messinger, 2006). The ebb and flow of sexuality-focused scholarship reflects the field’s historic ambivalence about such scholarship. While scholarship can take many forms, three primary types of social work scholarship – books, journals, and conferences – are examined. Scholarship on human sexuality and social work in the form of books and journals was limited for much of the 20th century. Social work pioneers Sophonisba Preston Breckinridge and Edith Abbott published a book in 1912 entitled, The Delinquent Child McCave, Shepard, Winter/HUMAN SEXUALITY IN SOCIAL WORK 415 and the Home: A Study of the Delinquent Wards of the Juvenile Court of Chicago. In it, the authors suggest that girls were more vulnerable to sexual encounters with adults when in families and communities that had severely limited resources and this, in turn, led to juvenile delinquency among these girls. In the early years of the profession, human sexuality knowledge was disseminated via the Proceedings of the National Conference of Social Work (formerly called the National Conference on Charities and Correction) (National Conference of Social Work, 1921). The topics presented were indicative of society’s unease with human sexuality; the index referenced the topics of childhood ideation about sex; the “steamy side” of sex; problems related to sex; moral education as the solution to sex; and the interpretation of sex by adolescents (p. 525). Two decades passed before a social work book on human sexuality was published, entitled, A Case Work Approach to Sex Delinquents (Wessel, 1947), again supporting a pathology framework. It was not until 1972, that editors Harvey Gochros and LeRoy Schultz published the first progressive, comprehensive book on human sexuality and social work, Human Sexuality and Social Work. The purpose of the book was to “…cut through the relative silence surrounding explicit sexual problems as they relate to social work practice” (Gochros & Schultz, p. 15). In the preface, the editors outlined nine professional values and beliefs that served as the foundation for the writings that were included. To paraphrase, these values and beliefs included: 1) the legitimacy of sexuality as an area of importance for social workers; 2) the recognition of sexuality as a complex aspect of humanity influenced by a variety of factors both internal and external to the individual; 3) the belief that sexual behavior is learned; 4) the right of every individual to be sexually fulfilled (within the context of society’s laws); 5) the assertion that sexual variation is normal; 6) the belief that social workers should be at the forefront of new theory and technological development as it relates to dealing with sexual problems; 7) the belief that social workers should be at the table in promoting progressive social policy related to sexuality; 8) the assertion that promoting sex education policy and programs is paramount to promoting responsible and fulfilling sexual practices; and 9) the declaration that social work practitioners will be most effective in assisting those with sexual problems when they become formally educated, and when they employ self-awareness and sensitivity. It is not surprising that this first major monograph about human sexuality and social work was written in the early 1970s, given the Women’s and Gay liberation movements and sexual revolution taking place (Allyn, 2000; Heidenry, 1997; Kaufman, 2005). During this time period, dramatic changes in sexual attitudes and behaviors concerning intimacy, homosexuality, interracial relationships, reproductive decision-making, and gender norms (among others) were seen (D’Emilio & Freedman, 1997). Subsequently, social work scholars began asserting the importance of human sexuality as a subfield within social work education and practice. Between 1965 and 1980 social work scholars published 40 journal articles regarding sexuality-related issues focusing on: 1) teaching human sexuality to social work students; 2) addressing gender issues, particularly sexism, within the profession; and 3) preparing social workers to assist clients with sexual issues. ADVANCES IN SOCIAL WORK, Fall 2014, 15(2) 416 The discourse on human sexuality and social work increased dramatically during the 1980s and early 1990s. The Journal of Social Work and Human Sexuality, published by Taylor and Francis, was in circulation from 1982 to 1993 (Taylor & Francis Group, n.d.). It was then discontinued and later became the Journal of Family Social Work. Looking at the contents of each issue of Journal of Social Work and Human Sexuality, several topics were covered each year, with some special issues included as well. Figure 1 highlights that a range of topics were covered in the journal, both focused on specific populations (e.g., adolescents) and issues (e.g., HIV/AIDS). Figure 1. Description of Populations and Issues Covered in Journal of Social Work and Human Sexuality The journal’s rise and decline raises subsequent questions, such as: What precipitated the demise of the journal? Did human sexuality cease to be a broad topic of concern and relevance for social work researchers, teachers, and practitioners? Who stepped in to fill the space this journal left? A review of existing journals found that special topic social work journals certainly include content about human sexuality related to the same Journal of Social Work and Human Sexuality (Circulation: 1982-1993) Population Based Issue Based Adolescents Gay and Lesbians Sex Offenders Racial and Ethnic Minorities Those with Disabilities Women Social Work Students Older Adults Childhood Sexual Abuse Sexual Variance HIV/AIDS & STDs Infertility Health Care Love and Intimacy Sex Therapy Sexual Communication Contraceptives McCave, Shepard, Winter/HUMAN SEXUALITY IN SOCIAL WORK 417 populations and issues covered in the Journal of Social Work and Human Sexuality. Table 1 provides a list of social work journals that include content in these areas of human sexuality. There are also several non-social work specific journals that promote sexuality-focused scholarship (see Table 2). Table 1. Social Work Journals That Include Articles on Sexuality Issues or Populations Sexuality Category Journal Title Issue HIV/AIDS and STDs Journal of HIV/AIDS and Social Services Childhood Sexual Abuse Child and Adolescent Social Work Journal Child and Family Social Work Health Care Social Work in Health Care Health and Social Work Contraceptives Health and Social Work Social Work in Health Care Sex Therapy Psychoanalytic Social Work Clinical Social Work Journal Journal of Analytic Social Work Infertility Health and Social Work Sex Offenders Journal of Social Welfare and Family Law Population Those with Disabilities Journal of Social Work in Disability and Rehabilitation Women Affilia: The Journal of Women and Social Work Social Work Students Journal of Teaching in Social Work Social Work Education (UK) Adolescents Child and Adolescent Social Work Journal Child and Family Social Work Children and Schools Racial and Ethnic Minorities Journal of Ethnic and Cultural Diversity in Social Work Journal of Multicultural Social Work Gay and Lesbians Journal of Gay and Lesbian Social Services Journal of Homosexuality Older Adults Journal of Gerontological Social Work Journal of Social Work in End-of-Life & Palliative Care The Gerontologist ADVANCES IN SOCIAL WORK, Fall 2014, 15(2) 418 Table 2. Sexuality-Focused Journals From Other Related Disciplines Journal Name Years of Circulation American Journal of Sexuality Education 2005-present Annual Review of Sex Research 1996-2007 Archives of Sexual Behavior 1997-present Canadian Journal of Human Sexuality 1998-present Contemporary Sexuality 2000-present Culture, Health & Sexuality 1999-2011 Current Sexual Health Reports 2004-2008 Electronic Journal of Human Sexuality 1998-present Exchange on HIV/AIDS, Sexuality and Gender 2005-present Gender and Sexuality: Journal of Center for Gender Studies, ICU 2005-present International Journal of Sexually Transmitted Diseases and AIDS 2000-2002 International Perspectives on Sexual and Reproductive Health 2009-present Journal of Child Sexual Abuse 2000-2011 Journal of Sex & Marital Therapy 1997-present Journal of Sex Research 1965-present Journal of Sexual Aggression 2003-2011 Journal of the History of Sexuality 1990-present Law & Sexuality 1991-present Perspectives on Sexual and Reproductive Health 2002-present Sex Education 2001-2011 Sex Roles 1997-present Sexologies: European Journal of Sexology 2006-present Sexual Abuse 1988-present Sexual Addiction & Compulsivity 1998-2011 Sexual and Relationship Therapy 2000-2011 Sexual & Reproductive Healthcare Sexualities 2010-present 2008-present Sexuality & Culture 2000-present Sexuality and Disability 1997-present Sexuality Research & Social Policy 2004-present Studies in Gender and Sexuality 2001-2011 While there are certainly a number of sexuality-focused journals, there is no longer a human sexuality journal written by and for social workers. This gap limits social work scholars by leaving them with the option of either publishing in social work journals with a broad scope, focusing their research into one of the few sexuality-focused topic or population journals in social work (e.g., Journal of Gay and Lesbian Social Services), or publishing in non-social work journals, which most likely are interdisciplinary in terms of theoretical and practice orientations. The outcome of this choice may be that social work scholars, teachers, and practitioners struggle to easily find current scholarship on a wide array of sexuality-focused topics within the profession. Additionally, this creates a fragmented discourse for social work scholars, who may be unaware of the latest theoretical, pedagogical, or empirical scholarship disseminated by fellow social work academicians who are researching human sexuality topics that overlap with their own McCave, Shepard, Winter/HUMAN SEXUALITY IN SOCIAL WORK 419 areas of scholarship. A social work human sexuality journal would allow scholars to pursue a more nuanced analysis of the intersectionality of sexuality with issues of race, class, gender, and mechanisms of oppression. At the current time, there are no social work textbooks on human sexuality published for social work educators in the United States. This does not include those texts that are part of the required social work curriculum, which often include some content on human sexuality (e.g., Human Behavior in the Social Environment texts). Currently, there is one British textbook by Bywater and Jones, titled Human Sexuality and Social Work (2007). While this textbook is well written and full of important content, including an anti- oppressive framework, its primary limitation is that it provides historical, policy, and practice information specifically for British social work students. Without accessible and relevant textbooks, social work educators may be discouraged from teaching a human sexuality and social work course. Moreover, given the many social work textbooks representing other subfields (e.g., child welfare, mental health, juvenile delinquency, etc.), it is not unreasonable to question whether this is reflective of a marginalized status of human sexuality within the social work academy. Certainly, there are monographs and texts on practice with special populations or specific issues, such as gay and lesbian families, child sexual abuse, and working with families affected by HIV/AIDS (Hilarski, Wodarski, & Feit, 2008; Morrow & Messinger, 2006; Poindexter, 2010). These writings are profoundly beneficial to students and scholars. Yet, the lack of both a sexuality social work journal and textbook reflects a significant gap in the social work knowledge base (Goldstein, 1990). Human Sexuality and Social Work Scholarship: National Social Work Conferences In addition to books and journals, national social work conferences provide an important opportunity for scholars to disseminate cutting edge scholarship for use by practitioners, social work students, and faculty. Both the Council on Social Work Education (CSWE) and the Society for Social Work and Research (SSWR) utilize conference “tracks” and “clusters and topics” to designate subfields that are of importance to the profession, such as mental health and addictions/substance abuse (CSWE, 2014a; SSWR 2014b). Yet, a notable lack of sexuality-focused research and teaching scholarship is found in a review of the abstracts accepted at two of the major social work conferences hosted by CSWE and SSWR. At the 2012 CSWE Annual Program Meeting (APM), 33 abstracts included the words “sexuality,” “sex,” or “sexual” in either the title or abstract description. This is out of more than 600 sessions offered throughout the conference (CSWE, 2012). These abstracts highlighted a range of sexuality-focused issues, including childhood sexual abuse; sex offenders; sex education; LGBT issues in practice and social work education; prostitution; HIV/AIDS; gender identity; and sexual assault. For the 2013 SSWR conference (SSWR, 2013) the numbers were notably higher than for CSWE – 176 abstracts out of the 500 sessions offered were found when the word “sexual” was used as the search term, followed by 76 abstracts for the term “sex,” and six abstracts for the search term “sexuality.” This latter point is certainly promising as is the fact that a special interest group (SIG) focused on “sexuality ADVANCES IN SOCIAL WORK, Fall 2014, 15(2) 420 development and well-being” was formed in 2013. While there may be a growing recognition and support for research focused on sexuality at SSWR, there currently is not an oral/poster presentation track for human sexuality at either conference. The CSWE conference is focused on utilizing social work education to advance practice and scholarship, while SSWR is geared towards promoting and disseminating cutting edge social work research (CSWE, 2014b; SSWR, 2014a). Yet both are vital opportunities for disseminating social work scholarship, particularly as there is professional recognition that all three areas of social work (practice, education, research) are inextricably connected (CSWE, 2014b). Similar to what has occurred with journal publications, within the national conference arena, human sexuality conference proposal tracks are limited to those which more narrowly focus on marginalized populations where sexuality is explicitly linked (e.g., practice with LGBT individuals) and topics where federal funding is available (e.g., HIV/AIDS). This is certainly indicative of progress within our profession. However, human sexuality is a broader umbrella under which many interrelated and complex issues come into play, such as sexual orientation, gender identity and expression, sexual behaviors and fantasies, intimacy, sexual negotiation, sexual violence, as well as privilege and oppression of certain populations, including children, women, older adults, those with disabilities, and those with mental illnesses (Bywater & Jones, 2007). While there are benefits to creating narrowly defined tracks, such as “Women” and “HIV/AIDS,” there are unintended consequences. Instead of integrating questions of sexuality into larger debates within the field, the discourse on human sexuality remains fragmented and scholars miss out on the dissemination of research that likely intersects with their own research. Further, it creates a challenge for social work scholars to decide on a proposal track that represents the complexity of their work. Just as social work scholars are likely to look to interdisciplinary journals to publish their work, scholars may also seek out interdisciplinary conferences where their work is well-received and validated. The Society for the Scientific Study of Sexuality (2010) annual conference is an excellent example. This conference is committed to the dissemination and support of scholarship related to human sexuality issues. For social workers, the central limitation of this conference is that most of the individuals who attend and present are not social workers. CSWE and SSWR can capitalize on this distinction and attract social workers to their conferences if they are more inclusive of human sexuality content. It is reasonable to assume that CSWE and SSWR want to be among the top choices when it comes time to choosing between multiple conferences of interest. This is particularly relevant given that social work doctoral students, faculty, and practitioners typically have limited funding available for annual conference travel. Pathways to Advance Human Sexuality Social Work Scholarship The subfield of human sexuality can become more cohesive and visible by stimulating human sexuality social work scholarship through a number of concrete mechanisms. This includes developing a community and infrastructure for supporting those social work scholars and students, who want to build expertise, disseminate knowledge, provide and receive mentorship, and explore their passions. Three arenas of McCave, Shepard, Winter/HUMAN SEXUALITY IN SOCIAL WORK 421 scholarship were presented in this article. Concrete and feasible opportunities for change within each of these arenas exist. First, in regards to social work textbooks, social work scholars who regularly teach human sexuality courses within social work may be uniquely positioned to offer their expertise as either editors or as contributors to such a textbook. Publishers can be contacted to determine if there would be an interest to accept such a manuscript. Second, in considering scholarship disseminated through journals, it is suggested that a new peer- reviewed human sexuality and social work journal be developed and circulated. This could be done through a traditional academic publisher that offers printed journals or an online journal established and maintained through a school of social work or other national social work organization. Third, in regards to social work national conferences, members can submit requests to those in leadership positions within these organizations that a “Human Sexuality” proposal track be offered, either through some reorganization of existing tracks or by adding the track. Including a new established track for scholars and students interested in human sexuality would greatly increase the options for disseminating scholarship as well as social networking while at the conference. Finally, networking opportunities through new Facebook™ groups, such as the Social Work Sexuality Scholars group, point to increased support efforts among those in the field. Combined, these change efforts highlight opportunities to foster cohesiveness within this subfield. Discussion It can easily be argued that sexuality is multifaceted. Dailey (1981) proposed that sexuality includes our attitudes, values, and feelings as practitioners as well as the belief systems of our clients, coworkers, community leaders, and legislators. These belief systems can impact social work practice in countless ways. The intersections between systems, such as families, organizations, communities and society, and sexuality issues, including health and reproduction, sexual identity, intimacy, and sensuality, are vast. Dynamic social forces, including race, class, cultural norms, ideologies, religious beliefs, and family organization, influence the way in which these issues are understood and negotiated. Dailey’s framework highlights the possibilities of our professional impact as change agents if we are proactive in building expertise as practitioners, educators, and scholars. After all, issues of sexuality are connected to and shaped by the social and political milieu in which we operate. The presence of oppression, marginalization, and privilege are at the core of many of the sexuality domains included in Dailey’s framework. The landscape social workers need to be able to traverse is dynamic and complex (Dailey, 1981). However, the involvement by the social work profession in cultivating and producing human sexuality expertise and then disseminating that expertise is currently less than ideal. While the profession promotes models of practice that foster client dignity and respect (Saleebey, 1996), without an adequate knowledge base (Goldstein, 1990), the field tends to rely on paternalistic patterns of care (Epstein, 1975; Margolin, 1997; Morrow & Messinger, 2006). Despite the passage of more than forty decades since Gochros and Schultz wrote their book, Social Work and Human Sexuality, many of the ADVANCES IN SOCIAL WORK, Fall 2014, 15(2) 422 issues and challenges discussed within it are present today. The labeling, pathologizing, and oppression of sexual minorities and other marginalized groups continues to impact society’s most vulnerable populations (Shepard, 2013; Spade, 2011). For example, adolescents are bombarded with conflicting messages about sexuality and what is “right” and “normal.” Gender policing, particularly of compulsory masculinity and heterosexuality, is ever present in our families and our schools (Martino & Pallotta-Chiarolli, 2005). This continues despite the evidence of its tragic consequences, namely the recent wave of teen suicides in response to unrelenting bullying as a result of a teen’s perceived or actual sexual orientation (ABC News, 2010). Today, populations of runaway teens are still forced to live away from home because of sexuality-related issues. On the streets of New York, where there are only 250 shelter beds for LGBT homeless youth, the rate of HIV infection is three times higher among the homeless than the rest of the population (Aviv, 2012). The reality is that in order to survive, these young people turn to squatting and survival sex, putting them at risk. While the stakes are high, the social work knowledge base with regard to sexual minorities is limited (Morrow & Messinger, 2006). In many ways, social workers have failed sexual minorities, who are still judged, neglected, and taken for granted (Aviv, 2012; Shepard, 2007a, 2007b, 2013). Rather than turn away from this complicated area of practice, more social work scholars are needed to tackle both policy and practice issues related to all the issues of sexuality addressed in Dailey’s (1981) framework on holistic human sexuality. The recent policy changes around LGBT equality, HPV vaccination, HIV services, sexuality education, youth services, sexual violence, health care, and reproductive autonomy are forcing the profession to grapple with issues of human sexuality and self- determination in increasingly nuanced ways (Flavin, 2009). Today, social workers are engaging discussions of sexuality in more proactive ways, recognizing sexuality as a vital component for social workers to be able to assess and engage in thoughtful, effective ways (Dunk-West & Hafford-Letchfield, 2011; Timm, 2009). This discourse is needed across the profession. After all, social workers are change agents, capable of challenging mechanisms of oppression that continue to control and stigmatize those we serve. Conclusion Throughout this paper, we presented evidence that suggests that, although human sexuality continues to be a topic of vital importance to social work practice, the subfield of human sexuality within social work is relatively invisible and fragmented. The prevalence of human sexuality social work scholarship and mechanisms for dissemination were discussed. Having insight into the struggles of social work scholars can create much needed momentum to propel those within the social work academy to challenge “regimes of the normal” while creating a new more dynamic social work knowledge base (Chambon, Irving, & Epstein, 1999; Foucault, 1978; Warner, 1999). After all, education is about power, education for change ideally connecting social theory with a practice of social change (Gramsci, 1971). Such a praxis is desperately needed for social work. Fortunately, the foundation for this work exists within current social work education and scholarship. McCave, Shepard, Winter/HUMAN SEXUALITY IN SOCIAL WORK 423 Mechanisms of oppression, such as sexism, heterosexism, ageism, racism, able-bodied- ism, and ethnocentrism, are already at the forefront of our conversations. An important next step is to recognize that within each of these “isms” there is prejudice and marginalization specifically tied to a group’s sexual attitudes, identities, or behaviors. Yet, further work is needed to raise critical consciousness among those within the social work academy to make visible the insidious dynamics of sexual privilege and oppression. If we do not engage students in a dialog that expands the breadth and depth of knowledge on human sexuality, either as an area for discussion within existing courses or within an elective course, how do we prepare future practitioners and scholars to value and wrestle with issues related to human sexuality? How do we motivate social work educators and practitioners to connect with advocates involved in social movements that are committed to dismantling the mechanisms that marginalize and oppress those who are “different” sexually if they are limited in their understanding of the issues (Crimp et al., 1997; D’Emilio & Freedman, 1997; Shepard, 2007b; Spade, 2011; Warner, 1999)? How do we inspire future scholars to “dare to innovate” (Canda, 2003, p. 81) if they feel marginalized for pursuing their academic passions? How do we package or frame each of the separate human sexuality issues (e.g., gay and lesbian families, sexual violence, gender oppression, etc.) as part of a larger whole? Social workers greatly need a broad theoretical framework to examine and understand issues of sexuality, as well as a historical context to understand such issues from a generalist perspective crossing the span of the field. 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