SUPPLEMENT ARTICLE

A Life Course Approach to Patterns and Trends in Modern

Latin American Sexual Behavior
Michel Bozon, PhD,* Cecilia Gayet, MHD, MSS, and Jaime Barrientos, PhD

Abstract: This article explores trends in sexual behavior in Latin

America, envisaged from a life-course perspective, taking into
account social differences. It is focused on three main issues: the
timing of early sexual and reproductive events, sexual activity during
adulthood, and measurement of homosexuality-bisexuality. It draws
on general population data from nonspecific surveys, as surveys
dealing specifically with sexual behavior are scarce in Latin
American countries. A traditional feature in these societies is the
huge amount of social inequality, which translates directly into social
differences in sexual experience, especially among women. Despite
the decline in fertility, an early start of unions and of reproductive
experience remains typical of groups with lower education. Another
aspect is the diversity of national patterns and gender systems, very
far from the image of cultural homogeneity generally associated with
this region. Data show a low prevalence of homosexuality/bisexuality,
which can be a result of underreporting. The paper eventually stresses
the necessity of carrying out more sexual behavior surveys of the
general population in the region.
Key Words: homosexuality, Latin America, reproductive health,
sex behavior
(J Acquir Immune Defic Syndr 2009;51:S4S12)

nvestigation of sexual behavior has been on the increase for

a few decades as a result of not only the outbreak of AIDS
but also of the difficulties met by sexual and reproductive
health policies. Both in the amount of knowledge and in the
trends, there is huge regional variation, mostly due to
differences in cultural, social, and economic determinants of
sexual behavior.1,2 Designing interventions in the field of
sexual health implies a good knowledge of region-specific
trends. While many investigations address Africa, Europe, and
high-income countries, the knowledge is very scarce on Asia.
Latin America lies in between, being a part of the world with
a growing amount of investigation on sexual behavior, mostly
qualitative but increasingly quantitative.
In a recent overview of the demographics of Latin
America and the Caribbean since 1950,3 the authors stressed
common trends in the region: abrupt decline of fertility in
majority of countries, little change in nuptiality and celibacy
levels, and unprecedented progress in educational levels,

From the *Ined, Paris, France; Flacso, Mexico City, Mexico; and School of
Psychology, Universidad Catolica del Norte, Antofagasta, Chile.
Copyright 2009 by Lippincott Williams & Wilkins

S4

| www.jaids.com

together with worsening social inequality and high poverty

levels. High levels of violence against women (widely
explored in Demographic Health Survey surveys), homophobia,4 and unsafe abortion5,6 are also part of the cultural context,
molded both by machista culture and by an influential Roman
Catholic Church. These common factors do not prevent a high
diversity of sexual patterns in the region, and a parallel diversity
of contexts of sexual risk, resulting in a wide range in
prevalence of HIV.
This article aims to explore the trends of sexual behavior
in Latin America, envisaged from a life course perspective,
without leaving aside social differences. Is there a loosening of
the traditionally tight link between sexual life and marital life
and of the link between sexuality and reproduction? The article
is focused on 3 main issues: trends in the timing of early sexual
and reproductive events, sexual activity during adulthood, and
measurement of homosexual/bisexual behaviors. A gender
perspective is always present although the data do not always
allow for this type of analysis.

DATA AND METHODS

We tried to use as many recent national population
surveys as possible, namely the DHS surveys of the 2000
decade (Bolivia 2003, Colombia 2005, Haiti 2005, Honduras
2005, Nicaragua 2001, Peru 2000, and Dominican Republic
2002), being aware of their advantages (standardization
offering good conditions for comparative analyses) and of
their shortcomings (missing countries, especially those of the
Southern Cone; few surveys including men). An additional
survey on reproductive health in Mexico was included7
(Encuesta Nacional de Salud Reproductiva, 2003). Among
the indicators provided by the DHS surveys, we selected the
data on the first events of sexual life and on adult sexual life as
a whole, including use of modern contraception, the calendar
of fertility, and of sterilization, separation, and experience of
forced sexual intercourse from the partner and from others.
Comparing 2 age-groups (cohorts aged 4549 and
2529), and 3 educational levels (up to incomplete primary,
complete primary and incomplete secondary, complete
secondary and superior) enables us to take into account both
trends and social inequality. Educational national systems
being different in some cases with a short primary of 5 years
(eg: Colombia), in others of 8 years (eg: Bolivia or Dominican
Republic), with a long secondary (eg: Haiti), or a shorter one
(eg: Peru) the distribution and meaning of levels are not
comparable from one country to another. Nevertheless it
makes sense to distinguish educational levels within each
country. On homosexuality/bisexuality, because few data on

J Acquir Immune Defic Syndr
Volume 51, Supplement 1, May 1, 2009

Copyright 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

J Acquir Immune Defic Syndr
Volume 51, Supplement 1, May 1, 2009

Latin American Sexual Behavior

TABLE 1. First Sexual and Reproductive Events of Women, by Age Groups and Educational Level, in Selected Latin
American Countries

Women

Bolivia
2003 DHS

Colombia
2005 DHS

Haiti
2005 DHS

Honduras
2005 DHS

Nicaragua
2001 DHS

Peru
2000 DHS

Dominican
Republic
2002 DHS

Mexico
2003 ENSAR

Age group 2529 size

Median age at first sexual intercourse 2529
Educational level 1
Educational level 2
Educational level 3
Median age at first union 2529
Educational level 1
Educational level 2
Educational level 3
Median age at first child 2529
Educational level 1
Educational level 2
Educational level 3
First child before age 15 (%)
First child before age 20 (%)
Age group 4549 size
Median age at first sexual intercourse 4549
Educational level 1
Educational level 2
Educational level 3
Median age at first union 4549
Educational level 1
Educational level 2
Educational level 3
Median age at first child 4549
Educational level 1
Educational level 2
Educational level 3
First child before age 15 (%)
First child before age 20 (%)

2673
18.6
17.6
18.0
20.6
20.7
19.0
19.2
24.3
20.9
19.4
19.8
24.8
2.3
43.1
1477
18.8
18.3
18.7
21.2
20.9
20.3
19.9
23.6
21.8
21.4
20.3
24.5
2.7
33.1

5652
17.9
15.9
17.0
18.8
21.8
18.4
19.6
24.6
21.5
18.5
19.5
24.9
1.9
37.4
4379
18.8
17.2
18.6
21.5
21.1
19.5
20.7
24.1
21.7
20.2
21.2
25.0
1.5
32.6

1761
18.0
16.9
18.6
20.1
20.1
18.4
22.1
25.7
22.2
19.7
24.6

2.2
33.4
939
18.6
18.4
20.7
20.5
21.1
20.7
23.6
25.3
22.6
22.3
26.1
26.2
1.8
26.6

3294
18.2
16.9
18.2
21.4
18.8
17.3
18.7
22.5
20.0
18.5
20.0
23.9
2.7
49.7
1585
18.2
17.2
19.0
22.4
18.7
17.7
19.4
22.7
20.1
19.0
20.4
23.7
3.2
48.6

1943
17.8
16.2
17.9
20.9
18.0
16.2
17.9
21.5
19.5
18.0
19.5
23.2
5.2
53.7
1066
18.1
16.9
19.1
22.1
18.4
17.1
19.4
22.2
20.0
18.8
20.5
24.2
5.5
48.4

4245
19.3
17.1
17.6
21.5
21.8
18.3
19.0
25.0
22.2
19.1
19.7
25.4
1.2
31.4
2529
19.0
17.5
18.4
22.0
21.2
19.4
20.3
24.6
21.8
20.2
20.8
25.2
1.7
34.9

3624
18.2
16.3
17.8
20.9
18.9
16.6
18.5
22.6
20.5
18.3
19.9
23.9
3.6
45.3
2201
18.2
17.0
19.3
22.7
18.7
17.3
19.8
23.5
21.0
19.4
22.2
25.7
4.4
41.5

3140
19.4
17.2
18.4
20.7
21.2
18.0
19.9
23.2
21.9
18.7
20.0
23.7
0.8
33.1
1774
19.3
18.1
18.9
21.6
20.8
18.9
20.2
22.8
21.3
20.0
20.3
23.6
1.9
39.0

the general population are available,8 surveys on specific

populations were used, this section remaining by necessity
more exploratory.

Trends in Early Sexual and

Reproductive Events
In Latin and Latin American societies, the aim of
teenage sexual socialization is clearly gender specific. While
men are traditionally urged to prove their manhood as early as
possible, social control is exerted on young females to delay
their sexual initiation.9 This postponement used to last until
union formation so as to avoid premarital loss of virginity,
which remains a strong value, even when transgressed.10 First
intercourse, union formation, and birth of the first child are
then strongly connected. A change in this traditional cultural
pattern for women does not presuppose only a new timing of
events but a decoupling of early events.
Among the countries of this sample, the trends in female
age at sexual initiation in the past 2 decades are very similar
(Table 1). Only in Colombia did the age of women at sexual
debut drop significantly (20.9 year). In all remaining
q 2009 Lippincott Williams & Wilkins

countries, stability prevailed: the age remained unchanged

or went through a small downward or upward trend (less than
0.5 year in 2 decades). As a result, the median age at initiation
is very much concentrated between 18 (17.8 in Nicaragua) and
19 (19.4 in Mexico). In all countries, timing of female sexual
initiation was and remains strongly differentiated by educational level, the lower education groups starting between 3 and
4 years earlier than the upper education groups, who are late
starters. The overall stability of age at female debut is due to
the persistence of this gender-specific class structure and due
to the rise in educational levels, which prevents sexual debut
from going down very much.
As a matter of fact, social differences in the timing of
female initiation are closely connected to social differences in
timing of first union. During the 2 decades under study, the
link between initiation and first union has remained rather tight
in Central America and in the Dominican Republic but has
loosened in Andean countries and Colombia (and in other
countries not in this sample), where a growing dissociation
between sexual initiation and union has appeared for women.
No change is observed in Haiti and in Mexico, where the
www.jaids.com |

Copyright 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

S5

J Acquir Immune Defic Syndr
Volume 51, Supplement 1, May 1, 2009

Bozon et al

existence of a premarital period was already established 2

decades ago. In all countries, the higher education groups
experience a markedly longer period of premarital sexual
activity in the younger cohorts, whereas groups with lower
education go on having very short premarital periods and early
first unions (for another example on Brazil.)11
One Latin American paradox, already noted by several
authors, is that despite the rapid drop in overall fertility, which
should reach as low as replacement level before the end of the
decade,3 there is no trend toward delayed childbearing as
a whole, a phenomenon known as the problem of teenage
pregnancy.12 This persisting early entry into fertility is
apparent from the trends in age at first child, which remain
stable from one cohort to the other or go down slightly, and
from the proportions of women who had their first child before
20 (between 31.4 in the younger cohort in Peru and 53.7 in
Nicaragua). The proportions with a first child before 15, however, remain very low (between 1% and 3%, except for
Nicaragua at 5.2%). In Andean countries, Colombia and
Mexico, first union and first child are very connected, whereas,
despite early unions, Central American and Caribbean women
tend to postpone the birth of their first child. On the other hand,
the gap between the higher education groups and the lower
education groups in the timing of first child has tended to
increase over the cohorts and it now exceeds 5 years in all
countries. From the start, then, there are large social differentials
in the sexual and reproductive trajectories. While early sexuality
and reproductive career remain symbolically associated among
women in the lower class groups, a postponement behavior,
together with a period of childless sexual life, has emerged as
a new norm among the more educated groups.
In the 3 countries for which we have information on men
(Table 2), male age at sexual initiation goes on being much
lower than the age of women (by 2 years on average), and this
gender gap did not diminish over the past 2 decades. Another
aspect of the timing of male initiation is that it does not vary by
educational level or by any other sociodemographic or cultural

factor, which is an indication of the continuing universality of

the injunctions of masculinity in these societies (for another
example on Brazil13). This early male initiation implies a
rather long premarital period for males, which still favors
experiences with sex workers and older women when younger
women are not available.14,15 Men as a whole are strongly
prompted to have early sexual initiation without preoccupation
for union formation.

Context of Sexual Activity During Adulthood

Although the Latin American region seems to follow a
rather universal pattern of living in union and having
children,16 an analysis of separations, of the length of reproductive period, of use of modern contraception (especially
permanent methods), and of forced sexual intercourse brings
to light complex trajectories and the existence of several
national or social models regarding the decoupling of sex life
and reproductive life and the style of gender relations.
While the intensity of union (marriage or consensual
union) is universal among all countries of the sample (more
than 90% of women and 97% of men have had a steady union
in their life), the prevalence of separation reveals heterogeneity
between countries and social groups.17 In one group of countries, including Haiti, the Dominican Republic, and Nicaragua,
the proportions of ever-separated individualswhether separated at the time of the survey or with more than 1 unionare
high (Table 3). In other countries, the levels are low (Peru,
Bolivia, Mexico). Groups with lower education have the
highest levels of separation. Some DHS surveys that were
administered to men bring some information on respondents
with simultaneous partners: 3% of Bolivian men in union vs
20% of Dominican men have had an extra partner in the
preceding year, and the proportion grows with educational
level. These proportions are negligible among women.
The length of the reproductive period varies according to
country and social class. In this paper, where fertility is not the
topic of interest, reproductive length, which is obviously

TABLE 2. First Sexual and Reproductive Events of Men by Age Groups and Educational Level in Bolivia, Haiti, and
Dominican Republic
Men 25-to 29-Year Old

Size of the age groups

Median age at first sexual intercourse
Educational level 1
Educational level 2
Educational level 3
Median age at first union
Educational level 1
Educational level 2
Educational level 3
Median age at first child
Educational level 1
Educational level 2
Educational level 3

S6

| www.jaids.com

Men 45- to 49-Year Old

Bolivia
2003 DHS

Haiti
2005 DHS

Republica
Dominicana
2002 DHS

16.7
16.5
16.4
17.1
22.9
21.0
21.0
25.6
22.0
21.4
21.4
23.6

15.7
16.3
15.6
15.3
26.3
24.5
26.1

16.2
16.2
16.3
15.8
22.3
21.8
20.6
24.8
25.4
24.2
23.9

Bolivia
2003 DHS

Haiti
2005 DHS

Republica
Dominicana
2002 DHS

17.5
17.9
17.1
17.2
23.1
22.5
22.0
25.1
23.7
23.1
23.1
25.6

16.9
16.9
17.2

25.6
25.1
26.9

16.9
17.1
16.5
17.1
23.5
21.8
25.0
26.1
25.1
24.3
28.7
27.7

q 2009 Lippincott Williams & Wilkins

Copyright 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

J Acquir Immune Defic Syndr
Volume 51, Supplement 1, May 1, 2009

Latin American Sexual Behavior

TABLE 3. Adult Sexual and Reproductive Events of Women, by Age Groups and Educational Level, in Selected Latin
American Countries

Women

Bolivia
Colombia
Haiti
Honduras Nicaragua
Peru
2003 DHS 2005 DHS 2005 DHS 2005 DHS 2001 DHS 2000 DHS

Age group 2529 size

2673
Ever separated (%)
5.8
Educational level 1
6.5
Educational level 2
9.0
Educational level 3
3.6
Sterilized before age 25 (%)
0.6
Educational level 1
1.0
Educational level 2
0.9
Educational level 3
0.0
Ever used modern contraceptive methods (%)
55.1
Educational level 1
46.2
Educational level 2
62.1
Educational level 3
62.5
Type of partner at last intercourse in the last 12 months (%)
Husband/cohabiting partner
71.9
Fiance
8.1
Other
2.1
No intercourse in the preceding year
17.9
Use of condom at last intercourse (%)
6.9
Educational level 1
2.6
Educational level 2
6.2
Educational level 3
12.2
Ever had forced intercourse from
husband/cohabiting partner (%)
12.4
Ever had forced intercourse from other than
husband/cohabiting partner (%)
4.3
Age group 45-49 Size
1477
Ever separated (%)
16.1
Educational level 1
16.0
Educational level 2
22.3
Educational level 3
12.9
Median age at last child 4549
37.2
Educational level 1
38.7
Educational level 2
34.3
Educational level 3
34.4
Sterilized before age 30
1.5
Educational level 1
1.2
Educational level 2
2.9
Educational level 3
1.8
Ever used modern contraceptive methods (%)
40.9
Educational level 1
29.0
Educational level 2
59.7
Educational level 3
70.4
Type of partner at last intercourse in the last 12 months (%)
Husband/cohabiting partner
70.4
Fiance
0.8
Other
1.0
No intercourse in the preceding year
27.8
Ever had forced intercourse from
husband/cohabiting partner (%)
16.2
Ever had forced intercourse from other than
husband/cohabiting partner (%)
3.0

Dominican
Republic
Mexico
2002 DHS 2003 ENSAR

5652
12.3
24.3
17.8
6.3
6.3
10.7
8.3
4.0
87.5
84.4
91.3
85.8

1761
29.5
40.5
23.9
7.4
0.1
0.1
0.0
0.0
56.2
57.1
55.5
55.1

3294
18.7
23.0
17.9
12.4
5.5
6.4
6.5
1.5
75.3
75.5
78.2
67.7

1943
21.9
28.3
21.2
12.5
7.7
8.7
10.4
2.2
79.6
79.3
84.2
73.7

4245
5.2
11.3
8.1
3.2
1.4
4.4
2.2
0.2
64.3
56.7
70.8
63.3

3624
30.6
43.0
34.9
15.7
14.6
26.0
15.2
3.1
81.4
86.5
83.7
74.9

3140
11.8
15.8
11.5
11.0
7.1
12.3
9.7
4.6
73.7
69.1
75.1
74.2

60.6
20.3
6.9
12.2
15.7
8.2
14.8
18.0

62.5
20.8
0.3
16.5
10.1
2.8
13.7
25.8

71.4
5.2
1.3
22.1
4.0
2.3
4.9
5.0

74.2
3.1
2.9
19.7
4.9
2.7
5.7
7.3

65.8
3.5
7.6
23.1
8.0
2.6
6.1
10.5

69.4
8.9
6.9
14.8
5.8
4.4
6.4
6.7

9.8

10.1*

3.7

6.6
4379
21.2
27.9
20.6
15.3
31.7
31.7
31.2
32.6
14.1
15.6
15.9
9.6
86.4
82.7
87.8
88.1

2.0*
939
44.2
45.4
39.4
17.1
37.8
38.1
36.5
35.0
0.7
0.8
0.2
0.0
40.4
38.4
50.0
77.8

9.0
1585
30.3
31.7
30.9
23.1
34.7
36.3
33.5
33.2
9.2
7.2
12.7
10.4
67.9
61.1
77.4
75.5

1066
41.1
40.4
43.1
41.0
34.3
35.3
32.5
31.4
8.2
6.7
12.0
7.5
73.6
68.3
84.6
75.7

2529
10.9
12.5
11.4
8.4
34.9
37.5
34.3
33.7
2.4
2.3
3.2
1.8
56.1
39.0
60.9
71.1

2201
45.7
50.4
46.1
31.2
30.8
30.3
29.8
32.9
30.2
32.1
35.8
18.6
78.7
79.9
80.5
73.3

61.4
7.0
5.8
25.8

69.4
6.3
0.1
24.2

65.7
2.3
0.8
31.2

60.6
1.6
1.2
36.6

70.6
0.5
2.5
26.3

66.9
2.6
5.0
25.5

12.4

6.7

4.5

5.7

3.2

4.6

2.0

10.4

1.9

7.2

2.6
3.6
1774
17.3
16.3
18.4
17.5
31.9
33.7
31.3
31.3
16.4
13.6
18.7
17.9
76.2
65.2
84.4
83.1

*In the case of Haiti, forced intercourse in the past 12 months.

In the Dominican Republic, no distinction is made between cohabiting partner or other partner.

q 2009 Lippincott Williams & Wilkins

www.jaids.com |

Copyright 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

S7

J Acquir Immune Defic Syndr
Volume 51, Supplement 1, May 1, 2009

Bozon et al

related to fertility level, is taken as a descriptive indicator of

the hold of reproduction on sexual activity. In Bolivia and
Haiti, the gap between the median age at first child and at last
child exceeds 15 years, whereas in Colombia and in the
Dominican Republic it is of 10 years only. In the entire region,
the time devoted to reproduction is longer in unprivileged
groups (from 4 to 9 years of difference between the lower and
higher education groups), although in Colombia and the
Dominican Republic the reproductive lengths are more
homogeneous between educational groups.
The calendar of sterilization brings more evidence on
differentials in the breaking off of the relation between sexuality and reproduction. Among women of the 4549 cohort,
there are large differences between countries: the proportions
of women sterilized before 30 is high in the Dominican
Republic (30%), followed by several countries close to 10%
(Mexico, Colombia, Honduras, and Nicaragua), whereas the
proportions are very low in Andean countries and Haiti. At the
age of 35, half of Dominican women, one third of Mexican
women and one quarter of Colombian women had put an end
to their reproductive life. There is little early sterilization in the

upper educational levels. In the younger 2529 cohort,

between 11% and 25% of women with low educational level
are already sterilized at age 25 in Colombia, the Dominican
Republic, and Mexico.
The availability of modern efficient contraceptives
opened the possibility of separating sexual life from reproduction. As regards the prevalence of modern contraceptives,
countries of Latin America find themselves in very different
situations.18 The proportions in the older cohort who ever used
modern contraception range from around 40% of women in
Haiti and Bolivia to more than 75% in the Dominican Republic
and 85% in Colombia. If one brings together these data and
those on reproductive life, 2 poles come out: a small reproductive period with high use of modern contraceptives in
Colombia and Dominican Republic and an extensive reproductive period with low use of contraceptives in Haiti and
Bolivia. Although women of the younger cohort have had less
time to get acquainted with contraceptives, there is a marked
increase in the use of modern contraception from one cohort to
the other, the gaps between countries remaining unchanged.
The same process is observed with the use of condoms: men of

TABLE 4. Adult Sexual and Reproductive Events of Men by Age Groups and Educational Level, in Bolivia, Haiti, and the
Dominican Republic
Age Group 2529

Men
Size
Median age at last child
Educational level 1
Educational level 2
Educational level 3
Ever separated (%)
Educational level 1
Educational level 2
Educational level 3
Had intercourse with cohabiting partner and other partner
in the twelve months (%)*
Type of partner at last intercourse in the last 12 months (%)
Husband/cohabiting partner
Fiance
Other
No intercourse in the preceding year
Use of condom at last intercourse (%)
Educational level 1
Educational level 2
Educational level 3
Never used condom (%)
Educational level 1
Educational level 2
Educational level 3
Ever had forced intercourse from husband/cohabiting partner (%)
Ever had forced intercourse from other than
husband/cohabiting partner (%)

Age Group 4549

Bolivia
2003 DHS

Haiti
2005 DHS

Dominican
Republic
2002 DHS

806

8.9
13.2
6.8
7.1
2.3

597

7.2
10.2
5.7
5.7
4.4

377

22.0
23.1
30.8
12.3
14.1

483
39.1
40.3
38.0
36.6
23.2
19.3
33.0
23.0
2.9

382

32.4
36.5
21.4

10.4

185
35.8
35.7
35.4
37.5
52.0
54.6
71.3
18.3
19.9

68.7
14.8
10.5
6.0
14.4
6.3
12.1
20.9
43.9
71.1
52.0
22.1
0.9

40.0
46.1
4.3
9.6
28.8
10.3
30.8
57.5

54.6
12.4
23.9
9.1
20.4
21.7
15.4
23.2
21.6
26.9
22.4
13.7

80.0
1.9
6.0
12.2
3.4
1.4
1.3
8.3
67.8
85.8
63.6
39.4
1.1

80.4
11.2
2.4
6.0
4.9
3.5
7.3
25.2

82.5
1.6
10.4
5.4
5.7
6.5
4.1
4.8
44.9
57.4
32.3
19.1

3.8

7.9

2.1

4.4

Bolivia
2003 DHS

Haiti
2005 DHS

Dominican
Republic
2002 DHS

*In the case of Haiti, the other partner is a second cohabiting partner.
In the case of Haiti, no distinction is made between forced sex by cohabiting partner and by other partner.

S8

| www.jaids.com

q 2009 Lippincott Williams & Wilkins

Copyright 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

J Acquir Immune Defic Syndr
Volume 51, Supplement 1, May 1, 2009

the younger cohort have a higher prevalence of use. In both

cohorts, use increases with education level.
The status of the partner at last intercourse suggests
scenarios of exposure to sexual risk that differ between men
and women. Most partners at last intercourse are cohabiting
partners. But there are clear-cut differences between men and
women in the proportions: many more men had their last
intercourse with nonsteady partners (Table 4). It is in Peru,
Dominican Republic, and Colombia that the proportions are
higher (7%) in the younger cohort of women who had their last
intercourse with friends, ex-partners, and casual partners.
Among younger men in the countries who provide data,
proportions are much higher (between 24% in Dominican
Republic and 11% in Bolivia). Use of condom at last
intercourse is more often reported by men than by women:
among women of the younger cohort, the proportions of users
range from 4% to 16% (higher in Colombia and Haiti, lower in
Honduras and Nicaragua) and from 14 to 29 for young men
(higher in Haiti, lower in Bolivia).
Gender violence may be described as a set of harmful
behaviors including marital abuse, sexual assault, rape by
partners, and rape by known or unknown persons.19 Sexual
coercion may occur at various moments in a womans life, and
even marital sex, far from being necessarily an act that
provides mutual pleasure, is many times a sort of rough service
achieved by force.20 Sexual abuse may lead to unwanted
pregnancies and to sexually transmitted infections, including
HIV.21 Several authors have noted that in Latin America,
sexual violence reflects the existing gender inequalities,22,23
including a representation of masculinity based on aggression
and a show of force to prove ones virility.24 This concept
of masculinity encompasses also a display of hierarchy of
power between men, either between adults or between
adults and minors. In the context of the prevailing gender
culture, men may have been victimized at various moments in
their life.
Five DHS surveys have included a specific module on
suffered violence, with several questions on sexual violence.
The main findings are that a high proportion of 45- to 49-yearold women in Bolivia and Colombia report having been forced
to have intercourse at least once by their partner (16% and
12%), the numbers for the 2529 group being 12% and 10%.
In Haiti, the question was asked about the past 12 months:
10% of 25- to 29-year-old Haitian women report having being
forced by their partner to have intercourse or sexual practices
they did not want to perform. Forced intercourse over a lifetime
with a person who is not the partner (father, stepfather, brother,
cousin, uncle, ex-partner, teacher, friend, employer, etc) range
from 2% to 10% in the 2 age groups, the report being higher
in Honduras and lower in Bolivia. On the whole, between
15% and 19% of 45- to 49-year-old women report forced
intercourse from any author, as does 13%17% of 25- to
29-year-old women. The groups with upper education report
less sexual violence in both age groups.
Among Bolivian men in the younger cohort, 1% report
sexual coercion from their partner and 4% from other persons
(possibly men). In Haiti, 8% of 25- to 29-year-old men report
forced intercourse in the past 12 months, without information
on the author.
q 2009 Lippincott Williams & Wilkins

Latin American Sexual Behavior

Being a client of sex workers is a common experience

among men, but there are few data on clients of sex workers in
the general population, especially on trends. A recent study
estimated the number of sex workers clients using data from
different sex surveys (DHS) (percentages of 15- to 49-year-old
male respondents reporting sex with a sex worker in the past
12 months) or data from a national sex survey in Chile.25 DHS
prevalence varied from 0.2% in Brazil and 1% in Chile to 4.8%
in Haiti and 8% in Dominican Republic.15 In the Chilean
national sex survey, prevalence was 5.4% among 18- to 69year-old men in the past 5 years.25 The number of men who
have been clients of sex workers at least once in their life are
much higher, which shows how common this experience is
among men: 54.5% of 45- to 49-year-old Honduran men
(Encuesta Nacional de Salud Masculina, 2001) were clients at
least once and 42.7% Chilean men of the 4059 age group.25

Measurement of Homosexual/Bisexual
Behavior in Latin American Countries
This last section focuses on describing and characterizing the prevalence of homosexuality/bisexuality in Latin
America, from data collected through questionnaires administered to the general population on a local basis. Research on
Latin American homosexuality is greatly increasing. Many
studies focus on male homosexuality and HIV prevalence
among the male homosexual population.8,26,27 Surveys on
sexual behavior administered to general population, focusing
on male and female homosexual/bisexual prevalence and
attitudes toward it, are rather recent and began after the AIDS
outbreak in the 1990s.25,28 Various findings in other countries
reveal that asking about homosexuality/bisexuality may be
a problem; this could have delayed the study of this issue on
a regional basis, given the sensitivity of the questions,
particularly in environments where homosexuality is strongly
stigmatized or punished. Sexual relations between women
have been less studied, though there is presently more research
reported in Latin America.29
Homosexuality/bisexuality frequency is difficult to
evaluate, and the results are subordinated to the cultural
contexts studied.25 Besides, reported frequency is associated
with the definitions of sex and the words or concepts used to
refer to what, in general terms, is currently known as men who
have sex with men (MSM).30,31 The MSM category is used in
epidemiology for HIV studies,30 omitting the prevalence of
female homosexuality. Homosexuality refers to a series of
constructs and ideas such as sexual desire, sexual behavior,
and sexual identity, none of them binary. Same-sex sexual
behavior exceeds by far homosexual identity. In the whole
world and in Latin America, a high percent of MSM are
married or have regular sexual relations with women as well.32
This bisexual behavior seems to be common in Latin
American societies.33 Regardless of the huge amount of relationships and connections between these concepts, homosexuality is still a source of stigma, prejudice, and discrimination
in the region.30,34
According to a recent metastudy that includes Latin
America, many studies on this issue have been conducted in
the region. They focus on MSM prevalence, with results
fluctuating from 6% to 20%, but little is known about the
www.jaids.com |

Copyright 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

S9

J Acquir Immune Defic Syndr
Volume 51, Supplement 1, May 1, 2009

Bozon et al

TABLE 5. Declaration of Homosexuality and Bisexuality in Latin American Countries (%) by Sex
Same-Sex Sexual
Partners in Lifetime
(Homosexual/
Bisexual)

Sexual Partners
in Past Year (only
Male/Male and
Female)

Ever Had Any Kind of Homosexual Experiences

(Only Homosexual/Both Homosexual/Heterosexual)

Country and Year

of Survey

Survey

Men

Women

Men

Women

Men
Adolescents

Women
Adolescents

Men
Young Adults

Women
Young Adults

GRAVAD (2002)13*
Caceres et al, 199740
Kornblit et al35
Conasida, 1992/199336k
OPS/GTZ (2004)41{
OPS/GTZ (2004)
OPS/GTZ (2004)
OPS/GTZ (2004)
OPS/GTZ (2004)
OPS/GTZ (2004)

Brazil
Peru
Argentina
Mexico
Belice
Costa Rica
San Salvador
Honduras
Nicaragua
Panama

2.8

3, 0
0.4/2.1
1.6
2.1
2
1.3
2.9
2.2

2.8

0.3/0.5

5.2/10.4

2.6/0.3

0.3/13

0.7/3.7

*GRAVAD survey was done in Salvador de Bahia, Rio de Janeiro, and Porto Alegre, on the population from 18 to 24 years, N = 4633.
The survey was done in Lima, the capital city, on a 16- to 30-year-old population, N = 1218.
The Chilean study is part of the fifth National Survey for the Young on 15- to 49-year-old individuals throughout the country, N = 6345.
The Argentine study included 4000 individuals from 15 to 54 years throughout the country in cities with more than 50,000 inhabitants and province capitals. Men total: 1945.
k
This study was done in Mexico City on individuals sexually active in the last 5 years whose age ranged between 15 and 60 years, N = 8068. It included both men and women.
{This survey was done in Belice (Belice), San Jose (Costa Rica), San Salvador (El Salvador), Tegucigalpa (Honduras), Managua, Bluefields and Puerto Cabezas (Nicaragua), and
Panama. The target population was men from 15 to 44 years. Sample size varied between 291 in El Salvador to 600 in Nicaragua.

sampling, and many studies seem to have been made with

convenience samples.8 Other studies exclusively focus on
MSM prevalence among the HIV-infected population. These
studies often publish a mere summary, making it doubtful
whether research is scientific and whether definitions and
questions are comparable, thus resulting in huge differences in
the results for each country and among countries. Besides,
most of these studies do not include women.
Only 2 countries in the region have organized sexual
behavior surveys of the general population, in 1998, on
a national basis: Brazil and Chile. In Brazil, 3.1% of male
respondents and 3% of female respondents (in the 16- to 65year-old population) reported at least 1 same-sex sexual
partner in their lifetime, the corresponding figures for Chile
being 0.5% and 0.1%. In Brazil, more than 90% of those who
report same-sex behavior also report opposite-sex sexual
behavior. DHS surveys done in the region do not ask questions
about homosexual/bisexual behavior, whereas some countries
such as Brazil and Chile have done more studies focused on
the juvenile population.13 A question on the issue was included
in the Honduran National Survey of Male Health of 2001.
Other countries simply do not conduct this kind of survey.
Table 5 shows data collected in several studies done on the
general population in some Latin American capitals, on some
age groups or with smaller sample size. They support the trend
revealed by the surveys on general populations in Brazil and
Chile, even if large cities are generally considered a more
favorable environment for homosexual/bisexual behavior.

DISCUSSION
It should be noted first that this overview of Latin
American trends in sexual behavior draws mainly on data from

S10

| www.jaids.com

nonspecific surveys (namely DHS surveys, focused on the

reproductive health of women) and on studies based on
convenience samples and on epidemiological issues, when
homosexual/bisexual behavior is concerned. In Latin America,
contrary to Europe, very few surveys of the general population
deal specifically with sexual behavior as a whole.
Among what may be considered as general trends of
sexual behavior in the region, one can mention the persistence
of an early start of unions, still strongly connected to sexual
initiation among women. A persistent gender gap at initiation,
with an earlier debut of men, seems also to be a characteristic
of Latin American sexuality, clearly related to the sexual
double standard of Latin and Mediterranean sexual culture.2
A traditional feature in Latin American societies, which is not
on the decrease, is a huge amount of socioeconomic inequality,
which translates directly into social differences in sexual
and conjugal life histories, especially among women. Early
debut, early fertility, higher rate of separation, early age at
sterilization, and a higher level of sexual violence characterize
the economically unprivileged groups, whereas a late debut,
a longer period of premarital sexuality, late fertility, and lower
rates of sterilization, separation, and sexual violence are found
among the more educated groups. Over the past 2 decades,
social differences in the timing of sexual and reproductive
trajectories have tended to increase. There is persisting
difficulty for women from the unprivileged groups to
dissociate sexual life from reproductive issues, which may
lead them to resort to early sterilization.
Another aspect of sexual culture in the region is the
diversity of national patterns, very far from the image of
cultural homogeneity often associated with Latin America.
There is no single principle of variation. Andean countries
differ widely from Colombia, Colombia from the Caribbean,
q 2009 Lippincott Williams & Wilkins

Copyright 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

J Acquir Immune Defic Syndr
Volume 51, Supplement 1, May 1, 2009

and the Caribbean from Mesoamericawithout even mentioning the countries from the Southern Cone, which were not
part of the sample. There are large differences in the levels of
early sterilization (very high in Dominican Republic), of
separation (very low in Mexico), and of early unions (very
early in Mesoamerica) and in the reported levels of sexual
violence (very high reports in Haiti but also in Bolivia and
Colombia). These trends may reflect different stages of
development or of demographic transition, the varying
influence of family planning and reproductive policies, or
the ethnic composition of the population, which result in
different gender systems. From a gender perspective, many
data and indicators are missing, and it should be noted that this
region has few DHS surveys on men, in comparison with
Africa, for example.
Regarding homosexuality, little is known about the
general population. Apart from the low prevalence and relative
homogeneity of results, regardless of the country evaluated,
available data are coherent with international data in the
following aspects: (a) The general population reports itself as
mainly exclusively heterosexual and (b) bisexuality declaration is greater than homosexuality. However, data on
prevalence must be analyzed with caution because, despite
the big changes regarding Latin American sexuality,37 the
declaration of homosexuality/bisexuality can be strongly
mediated by social desirability, therefore resulting in
underreporting. Data may also be biased by an aim at
quantifying risk behaviors in the context of HIV rather than
homosexual behavior. There are huge differences in the
surveys measurement processes, the way questions are
phrased, and the cultural contexts. This could affect results,
all the more so in countries characterized by a machista culture
in which there is male dominance, a rigid definition of
masculinity, and a very negative evaluation of the violation of
gender roles.38,39 Surveys on homosexual behavior should deal
also with female homosexuality, physical and mental health,
attraction, and homophobia.
Finally, this overview of Latin America reveals gaps in
our knowledge that underscore the urgent necessity of having
real sexual behavior surveys on general populations in the
region. Such surveys should work with more all-encompassing
definitions of sexuality and sexual health, approach sexual
activity in a life course perspective, and take account of
the persisting gender imbalance in sexual interaction and of
the effect of social inequality in living conditions and the
exercise of sexuality. They should also work on discrimination
because sexual health depends on sexual rights.
REFERENCES
1. Wellings K, Collumbien M, Slaymaker E, et al. Sexual behavior in
context: a global perspective. Sexual and reproductive health 2. Lancet.
2006;368:17061728.
2. Bozon M. At what age do men and women have their first sexual
intercourse? World comparisons and recent trends. Popul Soc. 2003;393:
14.
3. Guzman JG, Rodriguez J, Martinez J, et al. The demography of
Latin America and the Caribbean since 1950. Population E. 2006;61:
519576.
4. Ortiz-Hernandez L, Garca MI. Efectos de la violencia y la discriminacion
en la salud mental de bisexuales, lesbianas y homosexuales de la Ciudad
de Mexico. Cad Saude Publica. 2005;21:913925.

q 2009 Lippincott Williams & Wilkins

Latin American Sexual Behavior

5. Guillaume A, Lerner S. Abortion in Latin America and the Caribbean.

Mexico, Paris: Ceped, Les Numeriques du Ceped; 2007. Available
at: www.ceped.org/cdrom/avortement_ameriquelatine_2007. Accessed
December 20, 2007.
6. Glasier A, Gulmezoglu M, Schmidt GP, et al. Sexual and reproductive
health: a matter of life and death. Lancet. 2006;368:15951607.
7. Welti Chanes C. Inicio de la vida sexual y reproductiva. Papeles Poblac.
2005:45:143176.
8. Caceres C, Konda K, Pecheny M, et al. Estimating the number of men who
have sex with men in low and middle income countries. Sex Transm Infect.
2006;82(Suppl III):iii3iii9.
9. Bozon M, Hertrich V. Sexualite preconjugale et rapports de genre en
Afrique: une comparaison avec lAmerique latine. In: A. Guillaume et
M. Khlat, ed. Sante de la reproduction au temps du sida en Afrique, Paris,
France: CEPED; 2004:3553.
10. Amuchastegui A.Virginidad e iniciacion sexual en Mexico. Experiencias
y significados. Mexico City, Mexico: Edamex/Population Council; 2000.
11. Bozon M. Levolution des scenarios de la vie reproductive des femmes au
Bresil. Medicalisation, genre et inegalites sociales. Tiers-Monde. 2005;
182:359384.
12. Stern C, Garcia E. Hacia un nuevo enfoque en el campo del embarazo
adolescente. In: Serie Reflexiones. Sexualidad, salud y reproduccion.
Mexico: El Colegio de Mexico; 1999:13.
13. Heilborn ML, Aquino E, Bozon M, Knauth D, and organizadores.
O Aprendizado da sexualidade. Reproducxao e trajetorias sociais de jovens
brasileiros. Rio de Janeiro, Brazil: Garamond; 2006.
14. Carael M. Sexual behaviour. In: Cleland J, Ferry B, eds, Sexual Behaviour
and AIDS in the Developing World. London, United Kingdom: Taylor and
Francis; 1995:75123.
15. Carael M, Slaymaker E, Lyerla R, et al. Clients of sex workers in different regions of the world: hard to count. Sex Transm Infect. 2006;82:2633.
16. Quilodran J. Diverse Transitions to Marital and Reproductive Life. Paths
in eight Latin American countries. Paper presented at the XXVth International Population Conference, IUSSP; 2005; Tours, France. Available
at: http://iussp2005.princeton.edu/download.aspx?submissionId = 50407.
Accessed December 20, 2007.
17. Garca B, Rojas O. Cambios en la formacion y disolucion de uniones en
America Latina. Papeles Poblac. 2002;32:1231.
18. Di Cesare M. America Latina: patrones emergentes en la fecundidad y la
salud sexual y reproductiva y sus vnculos con la reduccion de la pobreza.
Notas Poblacion. 2007;84:1149.
19. Heise L. Gender-based abuse: the global epidemic. Cad Saude Publica.
1994;10:135145.
20. Heise L, Moore K, Toubia N. Sexual Coercion and Reproductive Health:
A Focus on Research. New York, NY: Population Council; 1995.
21. Blanc Ann K. The effect of power in sexual relationships on sexual and
reproductive health: an examination of the evidence. Stud Fam Plann.
2001;32:189213.
22. Lehrer JA, Lherer VL, Lehrer EL, et al. Prevalence of and risk factors for
sexual victimization in college women in Chile. Int Fam Plan Perspect.
2007;33:168175.
23. Ramos Lira L, Koss MP, Felipe Russo N. Mexican American womens
definitions of rape and sexual abuse. Hisp J Behav Sci. 1999;21:236265.
24. Londono Velez A. Violencia sexual. Hacia una sexualidad sana.
Profamilia. 1998;16:59.
25. Arredondo A, Goldstein E, Olivera MP, et al. Estudio Nacional de
comportamiento sexual. Primeros Analisis. Chile 2000. Santiago, Chile:
Conasida and Anrs; 2000.
26. Oliveira de Andrade S, Tamaki E, Vinha J, et al. Vulnerabilidade de
homens que fazem sexo com homens no contexto da AIDS. Cad Saude
Publica. 2007;23:479482.
27. Gayet C, Magis C, Sacknoff D, et al. Practicas sexuales de las
poblaciones vulnerables a la epidemia de VIH/SIDA en Mexico. Mexico
City, Mexico: CENSIDA: Facultad Latinoamericana de Ciencias Sociales,
Sede Mexico; 2007.
28. Ministerio de Saude. Comportamento sexual da populacxao brasileira e
percepc
xoes do HIV/AIDS. Braslia, Brazil: Ministerio da Saude; 2000.
29. Barbosa R, Hara M. Mulheres que fazem sexo com mulheres: algumas
estimativas para o Brasil. Cad Sau de Pu blica. 2006;22:15111514.
30. Caceres C. HIV among gay and other men who have sex with men in Latin
America and the Caribbean: a hidden epidemic? AIDS. 2002;16(Suppl 3):
S23S33.

www.jaids.com |

S11

Copyright 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Bozon et al

J Acquir Immune Defic Syndr
Volume 51, Supplement 1, May 1, 2009

31. Michaels S, Lhomond B. Conceptualization and measurement of homosexuality in sex survey: a critical review. Cad Saude Publica. 2006;22:13651374.
32. UNAIDS. AIDS and Men Who Have Sex With Men. Technical update.
2000. Available at: http://whqlibdoc.who.int/unaids/2000/a62375_eng.
pdf. Accessed January 16, 2008.
33. Aggleton P, ed. Bisexualities and AIDS. Londres, United Kingdom: Taylor
and Francis; 1996.
34. UNAIDS. HIV and Sex Between Men., Policy brief. 2007. Available
at: http://data.unaids.org/pub/BriefingNote/2007/JC1269_Policy_Br_
MSM%20web_sp.pdf. Accessed January 16, 2008.
35. Izazola-Licea JA, Gortmaker S, De Gruttola V, et al. Prevalence of samegender sexual behavior and HIV in probability household survey in
Mexican men. J Sex Res. 2000;37:3743.
36. Izazola JA, Gortmakem S, Tolbert K, et al. Prevalence of same-gender
behavior and HIV/AIDS in a probability households survey in Mexican
men. J Sex Res. 2000;37:3743.

S12

| www.jaids.com

37. Barrientos J, Paez D. Psychosocial variables of sexual satisfaction in

Chile. J Sex Marital Ther. 2006;32:118.
38. Kite ME, Whitley BE. Sex differences in attitudes toward homosexual
persons, behaviors, and civil rights: A meta-analysis." Pers Soc Psychol
Bull. 1996;22:336353.
39. Nierman A, Thompson S, Bryan A, et al. "Gender roles beliefs and
attitudes towards lesbians and gay men in Chile and the U.S. Sex roles.
2007;57:6167.
40. Caceres C, Vanoss Marin B, Hudes E, et al. Young people and the
structure of sexual risks in Lima. AIDS. 1997;11(suppl 1):S67S77.
41. Harkins T, Herrera A. La salud sexual y reproductiva: tambien un asunto
de hombres. Investigacion de base para la promocion de la participacion
de los hombres en los programas de salud sexual y reproductiva en
Centroamerica. Analisis comparativo. 2004; OPS/GTZ. Available at:
http://www.paho.org/Spanish/AD/GE/SSRhombres2005.pdf. Accessed
January 16, 2008.

q 2009 Lippincott Williams & Wilkins

Copyright 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.