<figure><img src="image_1.png" /></figure>

HAL
open science

# The Birth of a Social Problem: Sexual Assistance Advocacy in France (1975–2011)

Pierre Brasseur

<figure><img src="image_2.png" /></figure>

## To cite this version:

Pierre Brasseur. The Birth of a Social Problem: Sexual Assistance Advocacy in France (1975–2011). Sexuality Research and Social Policy, 2025, 10.1007/s13178-025-01187-4. halshs-05272668

HAL Id: halshs-05272668

https://shs.hal.science/halshs-05272668v1

Submitted on 22 Sep 2025

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

<figure><img src="image_3.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
# The Birth of a Social Problem: Sexual Assistance Advocacy in France (1975–2011)

Pierre Brasseur<fnref n="1" />

Received: 30 August 2022 / Accepted: 18 August 2025

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025

## Abstract

**Introduction** Since the early 2000s, France has witnessed growing debates around the necessity of legislating support mechanisms for individuals with disabilities to engage in sexual relationships. This study examines how sexual assistance emerged as a legitimate public policy issue through strategic advocacy efforts.

**Methods** This research employed documentary analysis of 778 texts (1975–2011) and 23 semi-structured interviews with key stakeholders collected between 2015–2017. Data were analyzed using thematic analysis following Braun and Clarke's framework, examining how different actors constructed and contested meanings around sexual assistance.

**Results** The analysis reveals three key phases: medicalization of disability sexuality (1975–1995), emergence of rights-based discourse (1995–2005), and strategic institutionalization (2005–2011). Marcel Nuss and other activists successfully reframed sexual assistance from a medical issue to a fundamental rights concern through strategic coalition building, international comparisons, and media mobilization.

**Conclusions** The French case demonstrates how marginalized groups can successfully challenge cultural taboos and construct new policy categories through sustained advocacy efforts. Sexual assistance advocacy succeeded in legitimating previously unthinkable concepts while highlighting persistent tensions between professional expertise and disabled people's autonomy.

**Policy Implications** The partial success of sexual assistance advocacy reveals the need for sustained policy efforts that address both cultural acceptance and institutional barriers. The French experience offers valuable lessons for advocacy groups working on controversial issues, emphasizing the importance of strategic framing, international examples, and long-term coalition building.

**Keywords** Disability · Sexuality · Social movements · Advocacy · France · Sexual assistance

## Introduction

The emergence of sexual assistance as a public issue in France represents a significant transformation in how society conceptualizes the intersection of disability and sexuality. What Marcel Nuss, a prominent disability rights activist, termed"assistance sexuelle" in the early 2000s challenged fundamental assumptions about disabled people's sexual autonomy and rights. This concept, referring to paid sexual services specifically designed for people with disabilities, sparked unprecedented debates about the boundaries between healthcare, social services, and sex work.

The French case offers a unique perspective on how marginalized groups strategically construct social problems and advocate for policy change. Unlike other European countries where sexual assistance emerged through gradual policy evolution, France experienced a rapid transformation from complete silence on disability and sexuality to national parliamentary debates within a single decade. This rapid shift raises important sociological questions about the mechanisms through which advocacy groups legitimate controversial issues and transform social taboos into legitimate policy concerns.

This article analyzes the socio-historical construction of sexual assistance as a public issue in France between 1975 and 2011. It examines how disability advocacy organizations, led by charismatic activists like Marcel Nuss, successfully framed sexual assistance as a fundamental human right rather than a form of prostitution. The research contributes

<figure><img src="image_4.png" /></figure>

<footnote>Pierre Brasseur
pierre.brasseur@ulb.be</footnote>

<footnote n="1">¹ Department of Sociology, Université Libre de Bruxelles (ULB), Avenue F.D. Roosevelt 50, 1050 Brussels, Belgium</footnote>
to social movement theory by demonstrating how strategic framing, coalition building, and media mobilization can overcome institutional resistance to controversial issues.

# Literature Review

## Disability, Sexuality, and Medicalization

The intersection of disability and sexuality has been profoundly shaped by what Foucault (1978) identified as the "medicalization of sexuality"—the transformation of sexual behaviors into objects of medical knowledge and intervention. For disabled people, this double medicalization—of both disability and sexuality—creates what Shakespeare (2006) describes as "compulsory able-bodiedness," a normative framework that positions disabled sexuality as inherently problematic.

Oliver's (1990, 2009) seminal work on the social model of disability provides crucial theoretical grounding for understanding how medical approaches to disabled sexuality function as mechanisms of social oppression. The social model's distinction between impairment (biological reality) and disability (social construction) reveals how professional discourse about "sexual dysfunction" obscures the social barriers that actually constrain disabled people's sexual expression (Barnes, 1991; Finkelstein, 1980).

Recent scholarship in critical disability studies has advanced more sophisticated analyses of how sexuality and disability intersect with other forms of social difference. McRuer's (2006) theory of "compulsory able-bodiedness" demonstrates how heteronormativity and able-bodiedness mutually reinforce each other, creating alternative temporalities that resist normative assumptions about sexual development and expression. This intersectional approach reveals how disabled people, particularly women and LGBTQ+ individuals, face multiple forms of sexual marginalization (Garland-Thomson, 2017; Mingus, 2011).

## Social Movement Theory and Issue Construction

The transformation of sexual assistance from a private concern to a public issue exemplifies what Kingdon (2014) describes as the "policy stream" model, where problems, policies, and politics must align to create windows of opportunity for policy change. This analysis draws on three primary theoretical frameworks to understand advocacy processes.

## Frame Analysis

Snow and Benford's (1988, 2000) frame alignment theory provides essential insights into how movements construct

persuasive narratives about social problems. Successful framing requires "diagnostic framing" (identifying problems), "prognostic framing" (proposing solutions), and "motivational framing" (providing rationales for action). Gamson and Meyer (1996) argue that effective frames must resonate with broader cultural values while challenging specific institutional practices.

## Historical Institutionalism

This approach emphasizes how existing policy frameworks shape movement strategies and outcomes (Mahoney & Thelen, 2010; Pierson, 2000). Clemens (1997) demonstrates how movements must work within existing institutional logs-ics while simultaneously challenging them, creating what Campbell (2004) terms "ideational change" through strategic policy entrepreneurship.

## Critical Disability Studies

This framework provides essential understanding of how disability oppression operates through professional control and medicalization (Oliver, 1990; Thomas, 2007). The social model's emphasis on social barriers rather than individual deficits offers crucial insights into how sexual assistance advocates challenged medical approaches to disabled sexuality.

## International Perspectives on Sexual Assistance

International research reveals significant variation in sexual assistance policies, reflecting different cultural attitudes toward disability, sexuality, and sex work. The Netherlands pioneered systematic programs in the 1980s, integrating them into mainstream disability support services through what Kulick and Rydström (2015) describe as a "pragmatic humanistic" approach prioritizing disabled people's sexual autonomy.

Döring et al. (2017) identify three distinct European models: the "therapeutic model" (emphasizing professional medical oversight), the "service model" (treating sexual assistance as personal care), and the "rights model" (emphasizing sexual citizenship). German and Swiss approaches emphasize professional training and ethical guidelines, reflecting what Grenz (2005) identifies as the "professionalization" of sexual services.

These international examples would prove crucial for French advocates, providing both legitimacy and practical blueprints for policy development while demonstrating the feasibility of alternative approaches to disabled sexuality.

<figure><img src="image_5.png" /></figure>
**French Disability Policy Context**

French disability policy has been profoundly shaped by what Gauchet (1992) identifies as the"republican model" of citizenship, which emphasizes universal rights while often ignoring particular needs and differences. This republican universalism has historically resisted identity-based claims-making, creating challenges for disability advocacy movements (Baudot, 2018; Ville & Ravaud, 2014).

The 1975 Orientation Act represented what Stiker (2000) describes as a shift from "charitable" to "rights-based" approaches to disability, establishing legal frameworks for inclusion while maintaining medical models of impairment. French disability advocacy has been dominated by what Barral et al. (2000) term"gestionnaire" organizations—large charities that provide services while representing disabled people's interests to government.

Sexual assistance advocates had to navigate complex moral terrains influenced by republican secularism, Catholic moral influence, and feminist advocacy. The prostitution debates of the 2000s revealed deep divisions within French feminism about sex work, with implications for sexual assistance advocacy (Jakšić, 2016; Mathieu, 2015).

**Methodology**

This research employs a qualitative approach combining historical sociology with interpretive policy analysis to examine the social construction of sexual assistance as a public issue in France. The methodology draws on frame analysis (Benford & Snow, 2000), historical institutionalism (Pierson, 2000), and critical disability studies (Goodley, 2017) to understand how sexual assistance advocates constructed persuasive narratives while navigating institutional constraints.

**Documentary Analysis**

The documentary analysis examined 778 texts spanning 1975–2011, including legislative texts, policy reports, advocacy materials, media coverage, and academic publications. Sources were selected through purposive sampling to ensure representation of different viewpoints and text types, following Prior's (2003) guidelines for documentary analysis.

**Interview Methodology**

Semi-structured interviews were conducted with 23 key informants between 2015–2017, including disability rights activists, healthcare professionals, policy makers, academics, and journalists. Participants were selected through purposive and snowball sampling to achieve theoretical

saturation while ensuring representation across stakeholder groups.

**Note on Anonymity**

While all participants were guaranteed anonymity, Marcel Nuss specifically consented to being identified given his public role as the primary advocate for sexual assistance in France. His public advocacy work is extensively documented in media and academic sources, making anonymization impractical and potentially misleading to readers.

**Analytical Approach**

Data analysis followed Braun and Clarke's (2006, 2019) reflexive thematic analysis approach, adapted to incorporate insights from frame analysis and critical discourse analysis. The analysis identified three primary themes corresponding to historical phases of advocacy development.

**Results**

**The Medicalization of Disability and Sexuality (1975–1995)**

The 1975 Orientation Act marked a crucial turning point in French disability policy, establishing disability as an administrative category while simultaneously reinforcing medical models of impairment. This legislation, while groundbreaking in recognizing disabled people's rights to education and employment, remained silent on questions of sexuality and intimate relationships, reflecting broader patterns of medicalization that positioned disabled sexuality as requiring professional intervention.

The Dutch approach during this period provided an early contrast to French medicalization. The Netherlands began developing sexual assistance programs in the 1980s within mainstream disability services, emphasizing user control rather than professional gatekeeping. This model would later prove influential for French advocates seeking alternatives to medical approaches.

Early French discussions of disability and sexuality emerged within professional circles, particularly among sexologists and rehabilitation professionals who adopted what Goffman (1963) termed a"stigma management" approach. The 1980 International Colloquium on Disability and Sexuality in Paris represented the first major French forum for addressing these issues, but discussions remained firmly within medical frameworks focused on sexual rehabilitation rather than sexual rights.

Professional discourse during this period consistently portrayed disabled people as either asexual or as sexual
deviants requiring control (Finger, Finger 1990; Morris, 1991). This "asexual assumption" served multiple functions for institutional care providers, allowing them to avoid confronting uncomfortable questions about sexual rights while maintaining control over residents' intimate lives.

However, tensions emerged within this medical framework as HIV/AIDS highlighted the sexual lives of institutionalized disabled people. The AIDS crisis disrupted comfortable assumptions about disabled asexuality, forcing recognition that people with intellectual disabilities were sexually active despite institutional policies prohibiting sexual expression. A 1997 National AIDS Council report revealed significant HIV transmission rates in disability institutions, providing irrefutable evidence of sexual activity among populations previously assumed to be asexual.

## The Emergence of Rights-Based Discourse (1995–2005)

The mid-1990s witnessed a fundamental transformation in how disability and sexuality were conceptualized in French policy discourse. This shift from medical to rights-based framings reflected broader changes in disability advocacy globally, influenced by emerging international human rights frameworks and successful advocacy models from other European countries.

## The HIV/AIDS Crisis as Catalyst

The HIV/AIDS crisis served as what Birkland (1997) terms a "focusing event"—an external shock that suddenly elevates previously marginalized issues. Research revealing widespread sexual activity in disability institutions despite official policies fundamentally challenged medical assumptions about disabled asexuality.

The 1997 National AIDS Council report marked the first official recognition that institutionalized disabled people were sexually active beings requiring HIV prevention services rather than sexual control. This epidemiological evidence created a "policy window" (Kingdon, 2014) enabling advocates to challenge medicalized approaches to disabled sexuality.

## Rights-Based Frame Development

Marcel Nuss emerged as a key "frame entrepreneur" during this period, developing sophisticated rights-based arguments that distinguished sexual autonomy from sexual liberalism. His advocacy carefully navigated French republican values by emphasizing individual autonomy rather than group-specific rights, drawing on feminist scholarship about bodily integrity while distinguishing sexual assistance from commercial sex work.

International examples proved crucial for legitimating rights-based approaches. The Dutch model of municipal funding and professional regulation appealed to French preferences for public sector involvement, while user-directed approaches aligned with emerging trends toward personalized disability services. German emphasis on professional training provided additional legitimacy through structured regulatory frameworks.

## Professional Resistance and Strategic Response

The shift toward rights-based discourse encountered significant resistance from established professional networks who viewed it as threatening their expertise and authority. Professional resistance took several forms, including methodological critiques of advocacy research and ethical concerns about sexual exploitation.

However, advocates addressed these concerns through sophisticated "frame alignment" processes (Gerhards & Rucht, 1992), adapting arguments to address specific audiences while maintaining core principles. For conservative audiences, advocates emphasized professional oversight and protection from exploitation. For progressive audiences, they emphasized user control and challenging professional paternalism.

## Strategic Institutionalization (2005–2011)

Following increasing public attention, sexual assistance advocates focused on institutionalizing their gains through formal organizations and training programs. The 2007 Strasbourg Conference marked a turning point, bringing together international experts and French stakeholders to develop concrete proposals for sexual assistance implementation.

## Strategic Framing and Coalition Building

Sexual assistance advocates employed multiple framing strategies simultaneously, carefully navigating cultural taboos while building broad coalitions. The key innovation was reframing sexual assistance as "intimate care" rather than sexual commerce, drawing on established frameworks of personal assistance and healthcare support.

Marcel Nuss's strategic approach connected sexual assistance to core republican values of equality and autonomy while avoiding associations with commercialized sexuality. This "intimate care" frame drew on established precedents in French disability policy, positioning sexual assistance as an extension of existing care frameworks rather than a radical innovation.

Coalition building required careful negotiation with conservative disability organizations concerned about sexual assistance damaging disabled people's social acceptance.

<figure><img src="image_6.png" /></figure>
Advocates addressed these concerns through frame align-
ment processes, emphasizing professional oversight for
conservative audiences while maintaining emphasis on user
control for progressive supporters.

Media Strategy and International Learning

Strategic media engagement proved essential for building public support. Advocates developed sophisticated strategies providing compelling narratives while avoiding sensationalism, focusing attention on advocates themselves rather than potential service users.

International examples played crucial roles in legitimat-
ing sexual assistance while providing concrete policy mod-
els. However, this required careful "policy translation" (Stone,
2004) rather than simple transfer, adapting foreign models to
French institutional and cultural contexts while emphasizing
aspects that resonated with French republican values.

Organizational Development and Legal Challenges

The creation of Collectif Handicaps et Sexualités in 2007
provided a permanent advocacy platform, while the subse-
quent formation of Handicaps et Sexualités O.S.E. in 2011
established formal training programs for sexual assistants.
These organizational developments reflected a strategy of
professionalization designed to distinguish sexual assistance
from informal sex work.

However, institutionalization revealed significant limita-
tions. Despite media attention and political support, sexual
assistance remained legally ambiguous within France's
restrictive prostitution laws. The 2011 parliamentary debates
represented both the high point and limitation of advocacy
efforts—while major political parties acknowledged the
legitimacy of disabled people's sexual rights, they stopped
short of creating legal exceptions for sexual assistance.

Discussion

Theoretical Contributions to Social Movement
Theory

This analysis significantly advances social movement the-
ory by demonstrating how advocacy groups can success-
fully challenge deeply entrenched cultural taboos through
sophisticated strategic processes. The sexual assistance
case provides empirical validation for Snow and Benford's
(1988, 2000) frame alignment theory while extending under-
standing of how marginalized groups navigate institutional
constraints.

Frame Analysis Contributions

The research reveals the crucial importance of"frame
bridging"(Snow et al., 1986) in connecting previously
unthinkable concepts to established cultural values. Sexual
assistance advocates succeeded by linking their demands
to core republican principles of equality and autonomy
rather than challenging these values directly. This strategic
approach enabled cultural transformation without triggering
backlash mechanisms that often derail controversial advo-
cacy efforts.

The study also demonstrates how successful framing
requires simultaneous attention to diagnostic, prognos-
tic, and motivational elements (Snow & Benford, 1988).
Advocates carefully balanced individual and structural
explanations for sexual exclusion, proposed concrete policy
solutions, and provided compelling moral rationales that
resonated with diverse audiences. This multi-dimensional
approach proved essential for building broad coalitions while
maintaining coherent advocacy messages.

Historical Institutionalism Insights

The analysis reveals how existing policy frameworks
both constrained and enabled advocacy strategies, sup-
porting Pierson's (2000) arguments about path depend-
ency while demonstrating possibilities for"ideational
change"(Campbell, 2004). French republican universalism
created particular challenges for identity-based claims-mak-
ing, requiring advocates to emphasize individual autonomy
rather than group-specific rights.

However, the same institutional frameworks that con-
strained advocacy also provided opportunities. The estab-
lished precedent of personal assistance services created
legitimate frameworks for extending support to intimate
care, while HIV/AIDS policy developments opened win-
dows for challenging medical approaches to disabled sexu-
ality. This demonstrates how institutional entrepreneurs can
work within existing logics while gradually transforming
their meaning.

Critical Disability Studies Applications

The research validates key insights from critical disability
studies about the oppressive nature of medical approaches
to disabled sexuality while revealing how rights-based
framings can challenge professional dominance. The trans-
formation from medical to rights-based discourse exempli-
fies what Oliver (1990, 2009) identified as the potential for
disabled people's organizations to challenge expert control
through political mobilization.

The analysis also reveals the intersectional nature of dis-
ability oppression, particularly how gender, sexuality, and
disability interact to create unique forms of marginalization. The forced sterilization debates highlighted these intersections while providing strategic opportunities for sexual assistance advocates to position their demands within broader campaigns for bodily autonomy.

## Contemporary Legal and Policy Developments

Recent developments since 2011 have highlighted the ongoing relevance of sexual assistance debates while revealing persistent institutional barriers to policy change. The 2016 French prostitution law, which criminalized clients while decriminalizing providers, created new ambiguities around sexual assistance that remain unresolved.

### Current Legal Framework

Under current French law, sexual assistance occupies an ambiguous position that creates significant risks for all parties involved. The 2016 law's broad definition of sexual services potentially encompasses sexual assistance, while exceptions for therapeutic touching remain poorly defined. This legal uncertainty has several practical consequences:

#### For Service Users

Disabled people seeking sexual assistance face potential criminalization under anti-prostitution laws, creating barriers to accessing services while reinforcing stigma around disabled sexuality. Recent court cases have demonstrated that authorities may pursue charges against sexual assistance users, creating chilling effects on service access. The unclear legal status also discourages open discussion with healthcare providers and social workers, limiting integration with mainstream disability services.

#### For Service Providers

Sexual assistants operate in legal limbo, lacking clear professional protections or regulatory frameworks. This ambiguity prevents the development of quality standards, training programs, and professional oversight that advocates originally envisioned. Recent prosecutions have highlighted these vulnerabilities while deterring potential providers from entering the field.

### For Advocacy Organizations

Legal uncertainty constrains advocacy efforts, limiting public discussion and preventing the development of formal service networks. Organizations like CHS must carefully navigate legal boundaries while supporting members' needs,

often providing information and support rather than direct services.

Recent studies by Miami and Nuss (2018) and Courtois (2019) reveal that these legal ambiguities have significantly limited the development of sexual assistance services compared to initial advocacy goals. While cultural acceptance has continued to grow, practical access remains severely constrained by regulatory uncertainty.

## International Comparative Analysis and Policy Learning

### European Policy Divergence

Recent comparative research reveals increasing divergence in European approaches to sexual assistance, with important implications for French policy development. Döring and Poeschl's (2019) updated analysis identifies several distinct trajectories:

The Netherlands has further integrated sexual assistance into mainstream disability services while maintaining municipal funding and professional oversight. Recent reforms have emphasized user control and service personalization, aligning with broader trends toward person-centered disability support. Kulick and Rydström's (2015) ethnographic research demonstrates how this integration has normalized sexual assistance while maintaining quality standards.

Germany has developed increasingly sophisticated regulatory frameworks emphasizing professional training and ethical guidelines. Sommer and Rieger's (2019) recent study reveals how these frameworks both enhance service quality and create new forms of bureaucratic control that may limit access for some users. The German emphasis on professional credentialing has influenced other European countries while raising questions about over-medicalization.

Switzerland has moved toward user-directed funding models that enable disabled people to purchase sexual assistance within personal assistance budgets. This approach maximizes user control while minimizing professional gatekeeping, though recent evaluations suggest challenges in ensuring service quality and provider training (Basson & Grüebler, 2020).

### Lessons for French Policy Development

These international experiences offer several insights for potential French policy reforms:

#### Integration vs. Separation

Successful models integrate sexual assistance into mainstream disability services rather than creating separate

<figure><img src="image_7.png" /></figure>
systems. This approach reduces stigma while ensuring coordination with other support services. French policy development could build on existing PCH (Personal Compensation Allowance) frameworks to enable sexual assistance funding within personalized support packages.

## Regulatory Balance

Effective regulation requires balancing quality assurance with user autonomy. Over-regulation may create barriers to access, while under-regulation may compromise service quality and provider protection. The German emphasis on professional training could inform French approaches while avoiding excessive bureaucratization.

## Municipal vs. National Approaches

Successful implementation often occurs at municipal level, enabling local adaptation while maintaining national standards. French policy development could leverage existing decentralized disability service structures while ensuring consistent quality frameworks.

## Implications for Disability Rights and Social Policy

The sexual assistance case reveals broader tensions in contemporary disability policy between rights-based rhetoric and paternalistic implementation. While France has embraced international disability rights frameworks, practical implementation remains constrained by institutional cultures emphasizing professional expertise over disabled people's autonomy.

## Rights vs. Protection Paradigms

Recent scholarship by Revillard (2019) and Baudot (2020) reveals persistent tensions between rights-based and protective approaches in French disability policy. Sexual assistance advocacy exemplifies these tensions while demonstrating possibilities for challenging paternalistic assumptions through sustained advocacy efforts.

The UN Convention on the Rights of Persons with Disabilities provides frameworks for addressing these tensions through emphasis on autonomy, non-discrimination, and social inclusion. However, implementation requires addressing institutional cultures that continue to prioritize professional control over disabled people's self-determination.

## Intersectionality and Multiple Disadvantage

Recent research highlights how disability intersects with other forms of social difference to create unique patterns of marginalization. Sexual assistance advocacy revealed these

intersections while providing opportunities for coalition building across different social movements.

Future policy development should address these intersectional dimensions while ensuring that sexual assistance services remain accessible to multiply marginalized groups, including disabled women, LGBTQ+ disabled people, and those from ethnic minorities.

## Methodological Reflections and Future Research Directions

### Participatory Research Approaches

This study's reliance on documentary analysis and elite interviews reflects broader patterns in disability research that may marginalize disabled people's perspectives. Future research should employ participatory methodologies that center disabled people's experiences while addressing power dynamics in research relationships.

Recent developments in critical disability studies emphasize the importance of "nothing about us, without us" approaches that position disabled people as research partners rather than subjects. Future sexual assistance research should adopt these participatory frameworks while addressing practical challenges around sensitive topics and vulnerable populations.

### Longitudinal Analysis

The study's focus on the 1975–2011 period limits understanding of longer-term advocacy outcomes and policy evolution. Recent longitudinal research by Watson and Shakespeare (2020) demonstrates the value of extended timeframes for understanding social movement impacts and policy change processes.

Future research should examine how sexual assistance advocacy has evolved since 2011, particularly in response to changing legal frameworks and cultural attitudes. This longitudinal approach could reveal whether initial advocacy successes translate into sustained policy change or require ongoing mobilization efforts.

## Cross-National Comparative Studies

While this study references international examples, systematic comparative analysis could reveal broader patterns in sexual assistance advocacy and policy development. Recent comparative research by Mladenov (2020) demonstrates how cross-national analysis can illuminate both universal patterns and context-specific factors in disability policy development.
## Digital Advocacy and Social Media

The emergence of digital advocacy platforms since 2011 has transformed social movement strategies and outcomes. Recent research by Ellis and Kent (2021) reveals how disabled people use social media for advocacy while navigating accessibility barriers and online harassment. Future sexual assistance research should examine how digital platforms shape contemporary advocacy efforts.

## Policy Implications and Recommendations

The emergence of sexual assistance as a public issue in France carries significant implications extending beyond the specific French context. This analysis reveals several key policy considerations for policymakers, service providers, and advocacy organizations.

## Regulatory Framework Development

The French experience demonstrates the necessity of clear regulatory frameworks that protect both service users and providers while ensuring quality standards. Recent international developments suggest several approaches for addressing current legal ambiguities:

### Professional Regulation Model

Following German and Swiss examples, France could develop professional training and certification frameworks for sexual assistants. This approach would provide legal clarity while ensuring service quality, though implementation should avoid excessive bureaucratization that might limit access.

## Personal Assistance Integration

Sexual assistance could be integrated into existing personal assistance frameworks through PCH expansion. This approach would reduce stigma while ensuring coordination with other disability services, though it would require addressing current legal barriers under prostitution law.

## Municipal Pilot Programs

Local pilot programs could test different approaches while building evidence for national policy development. This

strategy would enable experimentation while respecting local cultural contexts and political preferences.

## Rights-Based Service Development

The partial success of sexual assistance advocacy in gaining cultural legitimacy while failing to achieve legal recognition highlights limitations of rights-based discourse without corresponding institutional change. Policymakers should address gaps between rhetorical acceptance of disability rights and practical implementation of supportive policies.

Future policy development should prioritize user control and self-determination while ensuring appropriate safeguards against exploitation. This requires moving beyond protective paradigms that position disabled people as inherently vulnerable toward approaches that recognize their autonomy and agency.

## Limitations and Directions for Future Research

### Sample and Scope Limitations

This analysis focuses primarily on advocacy organizations and policy elites, with limited attention to broader public opinion or the perspectives of disabled people not directly involved in advocacy efforts. Future research should examine how sexual assistance debates were received within broader disabled communities and what factors shaped different responses.

The study's geographical focus on France limits generalizability to other national contexts with different cultural, legal, and institutional frameworks. Comparative research examining sexual assistance advocacy in other countries could reveal universal patterns while identifying context-specific factors that shape advocacy outcomes.

### Temporal Boundaries

The study examines the 1975–2011 period and cannot assess longer-term outcomes of sexual assistance advocacy efforts. Recent developments since 2011, including changing legal frameworks and cultural attitudes, require systematic analysis to understand advocacy legacies and ongoing challenges.

### Intersectional Analysis

While the study acknowledges intersectional dimensions of disability oppression, deeper analysis of how gender, sexuality, race, and class interact with disability in sexual assistance debates could provide more nuanced understanding of advocacy challenges and opportunities.

Future research should examine how multiply marginalized disabled people experience sexual assistance debates
and whether advocacy efforts adequately address their specific needs and perspectives. This intersectional approach could reveal both gaps in current advocacy strategies and opportunities for more inclusive approaches.

## Impact Assessment

The study cannot definitively assess whether sexual assistance advocacy achieved its intended outcomes in terms of improved sexual rights and opportunities for disabled people. Future research should examine the practical impacts of advocacy efforts on disabled people's lives while recognizing the challenges of measuring sensitive outcomes.

## Conclusion

The emergence of sexual assistance as a public issue in France demonstrates how marginalized groups can successfully challenge cultural taboos through strategic advocacy efforts. Within a single decade, disability rights advocates transformed sexual assistance from an unthinkable concept to a legitimate policy debate through sophisticated framing strategies, coalition building, and media mobilization.

This transformation reflects broader changes in disability policy from medical to rights-based approaches while highlighting persistent tensions between professional expertise and disabled people's autonomy. The partial success of advocacy efforts—achieving cultural legitimacy without legal recognition—reveals both the possibilities and limitations of social movement strategies in challenging deeply entrenched assumptions.

The French experience offers valuable lessons for advocacy groups working on controversial issues in other contexts, emphasizing the importance of strategic framing, international examples, and sustained coalition building. However, the case also demonstrates that cultural acceptance may be insufficient without corresponding legal and institutional changes to address practical barriers facing marginalized communities.

**Funding** This research received support from the French Ministry of Higher Education and Research between 2011 and 2017. The research was conducted in compliance with Plan S principles for open access publication.

## Declarations

**Ethics Approval** This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the University Ethics Committee of Lille University.

**Competing interests** The author declares no competing interests.

## References

Barnes, C. (1991). *Disabled people in Britain and discrimination: A case for anti-discrimination legislation*. Hurst & Company.

Basson, M., & Grüebler, D. (2020). User-directed sexual assistance funding in Switzerland: Outcomes and challenges. *Disability & Society*, *35*(8), 1247–1265.

Barral, C., Paterson, F., Stiker, H.-J., & Chauvière, M. (Eds.). (2000). *L'institution du handicap. Le rôle des associations*. Presses universitaires de Rennes.

Baudot, P.-Y. (2018). Layering rights: The case of disability policies in France (2006-2016). *Social Policy and Society*, *17*(1), 117–131.

Baudot, P. Y. (2020). *Politiques du handicap: Une approche sociologique*. Presses Universitaires de France.

Benford, R. D., & Snow, D. A. (2000). Framing processes and social movements: An overview and assessment. *Annual Review of Sociology*, *26*(1), 611–639.

Birkland, T. A. (1997). *After disaster: Agenda setting, public policy, and focusing events*. Georgetown University Press.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. *Qualitative Research in Psychology*, *3*(2), 77–101.

Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. *Qualitative Research in Sport, Exercise and Health*, *11*(4), 589–597.

Campbell, J. L. (2004). *Institutional change and globalization*. Princeton University Press.

Clemens, E. S. (1997). *The people's lobby: Organizational innovation and the rise of interest group politics in the United States*. University of Chicago Press.

Courtois, M. (2019). Sexual assistance in France: Legal ambiguities and practical challenges. *Sexuality and Disability*, *37*(3), 421–438.

Döring, N., Daneback, K., Shaughnessy, K., Grov, C., & Byers, E. S. (2017). Sexual assistance for people with disabilities: A systematic review. *Archives of Sexual Behavior*, *46*(4), 1009–1025.

Döring, N., & Poeschl, S. (2019). Sexual assistance regulation in Europe: Professional frameworks and ethical considerations. *International Journal of Sexual Health*, *31*(2), 167–182.

Ellis, K., & Kent, M. (2021). *Disability and digital advocacy: Accessible activism in the age of social media*. Routledge.

Finger, A. (1990). *Past Due: A Story of Disability, Pregnancy and Birth*. Seal Press.

Finkelstein, V. (1980). *Attitudes and disabled people: Issues for discussion*. World Rehabilitation Fund.

Foucault, M. (1978). *The history of sexuality, volume 1: An introduction*. Pantheon Books.

Gamson, W. A., & Meyer, D. S. (1996). Framing political opportunity. In D. McAdam, J. D. McCarthy, & M. N. Zald (Eds.), *Comparative perspectives on social movements: Political opportunities, mobilizing structures, and cultural framings* (pp. 275–290). Cambridge University Press.

Garland-Thomson, R. (2017). *Extraordinary bodies: Figuring physical disability in American culture and literature*. Columbia University Press.

Gauchet, M. (1992). *L'inconscient cérébral*. Seuil.

Gerhards, J., & Rucht, D. (1992). Mesomobilization: Organizing and framing in two protest campaigns in West Germany. *American Journal of Sociology*, *98*(3), 555–596.

Giami, A., & Nuss, M. (2018). Sexual assistance in France: Implementation challenges and policy implications. *Sexuality Research and Social Policy*, *15*(4), 392–405.

Goffman, E. (1963). *Stigma: Notes on the management of spoiled identity*. Prentice-Hall.

Goodley, D. (2017). *Disability studies: An interdisciplinary introduction*. Sage Publications.
Grenz, S. (2005). *Intersections of sex and power in research on pros-
titution: A female researcher interviewing male heterosexual cli-
ents*. *Signs*, *30*(4), 2091–2113.

Jakšić, M. (2016). *La traite des êtres humains en France*. CNRS Éditions.

Kingdon, J. W. (2014). *Agendas, alternatives, and public policies*. Pearson.

Kulick, D., & Rydström, J. (2015). *Loneliness and its opposite: Sex, disability, and the ethics of engagement*. Duke University Press.

Mahoney, J., & Thelen, K. (2010). *Explaining institutional change: Ambiguity, agency, and power*. Cambridge University Press.

Mathieu, L. (2015). *Sociologie de la prostitution*. La Découverte.

McRuer, R. (2006). *Crip theory: Cultural signs of queerness and disability*. NYU Press.

Mingus, M. (2011). Dirty river: A queer femme of color dreaming her way home. *Radical Teacher*, 92, 10–19.

Mladenov, T. (2020). *Disability and postsocialism*. Berghahn Books.

Morris, J. (1991). *Pride against prejudice: Transforming attitudes to disability*. Women's Press.

Oliver, M. (2009). *Understanding disability: From theory to practice*. Palgrave Macmillan.

Oliver, M. (1990). *The politics of disablement*. Macmillan.

Pierson, P. (2000). The path to European integration: A historical institutionalist analysis. *Comparative Political Studies, 33*(2), 123–163.

Prior, L. (2003). *Using documents in social research*. Sage
Publications.

Revillard, A. (2019). *Handicap et travail*. Presses de Sciences Po.

Shakespeare, T. (2006). *Disability rights and wrongs*. Routledge.

Snow, D. A., & Benford, R. D. (1988). Ideology, frame resonance, and participant mobilization. *International Social Movement Research, 1*(1), 197–217.

Snow, D. A., Rochford, E. B., Jr., Worden, S. K., & Benford, R. D. (1986). Frame alignment processes, micromobilization, and movement participation. *American Sociological Review*, *51*(4), 464–481.

Sommer, D., & Rieger, A. (2019). Professional regulation of sexual assistance in Germany: Quality assurance and access challenges. *European Journal of Disability Research*, *13*(2), 89–104.

Stiker, H. J. (2000). *A history of disability*. University of Michigan Press.

Stone, D. (2004). Transfer agents and global networks in the ‘transnationalization’ of policy. *Journal of European Public Policy*, *11*(3), 545–566.

Thomas, C. (2007). *Sociologies of disability and illness: Contested ideas in disability studies and medical sociology*. Palgrave Macmillan.

Ville, I., & Ravaud, J. F. (2014). Disability policies in France: Changes and tensions between the category-based, universalist and personalized approaches. *Scandinavian Journal of Disability Research*, *16*(1), 296–312.

Watson, N., & Shakespeare, T. (2020). *The Routledge handbook of disability studies*. Routledge.

**Publisher's Note** Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

<figure><img src="image_8.png" /></figure>