Sexual behavior and practices among men and women, Brazil 1998 and 2005
Regina Maria BarbosaI, II; Mitti Ayako Hara KoyamaIII; Grupo de Estudos em População, Sexualidade e Aids*
INúcleo de Estudos de População. Universidade Estadual de Campinas. Campinas, SP, Brasil
IICentro de Referência em DST/Aids. São Paulo, SP, Brasil
IIIFundação Sistema Estadual de Análise de Dados. São Paulo, SP, Brasil
OBJECTIVE: To compare basic findings from two studies on sexual behavior and practices among women and men and their associations with sociodemographic characteristics of this population.
METHODS: Data analyzed were obtained by a questionnaire applied to a probabilistic sample comprised of 3,423 people in 1998, and 5,040 people in 2005, all aged between 16 and 65 years, and living in urban areas of Brazil. Comparative analyses were performed by sex and year of research, and according to sociodemographic variables, using Pearson's chi-square test.
RESULTS: The number of sexual partners in the year that preceded the interview decreased from 29.5% to 23.1% among men. Variability in sexual behavior and practices according to age, level of education, marital status, religion and place of residence, in addition to specific characteristics based on sex, was observed. There was also an increase in the proportion of women who began their sexual life in the 16-to-19-year age group and had completed up to elementary school, or lived in Southern Brazil. Moreover, it was observed an increase of sexual activity reported by women in the last year, and a decrease among men over 55 years of age, Protestant/Pentecostal, or separated/widowed. The proportion of men with more than one sexual partner in the last year decreased among those aged between 25 and 44 years or who have completed up to high-school. There was an increase in oral sex practice reported by women who are over 35 years of age or live in Northern/Northeastern Brazil.
CONCLUSIONS: Comparative analysis from 1998 to 2005 suggested a tendency towards differences between women and men decreasing. This probably results from a pattern of change characterized by an increase in the frequency of female behavior investigated and a decrease in the frequency of male behavior.
Descriptors: Sexual Behavior. Gender and Health. Health Knowledge, Attitudes, Practice. Population Studies in Public Health. Brazil. Cross-sectional Studies.
From the late 1990's on, with the emergence of AIDS, population surveys on sexual behavior and practices began to be conducted. These surveys sought to better understand the relationship between the practice of sexuality and HIV sexual transmission - responsible for a large number of cases in countries suffering from this epidemic.12-14,16,a,b,c
Even though there is not a direct relationship, or one that can be proved, between changes in sexual behavior and the incidence of HIV infection and other sexually transmitted infections (STI), according to Fishbein & Pequegnat,9,15 these surveys constitute an important source of information to assess the impacts of intervention practices and HIV prevention policies in relation to sexual behavior.
In this sense, the perspective of cross-sectional time-series data is particularly useful as it enables comparisons throughout time and, thus, identifies eventual changes in behavior, practices and attitudes towards sexuality. One example is the research conducted by the Centro Brasileiro de Análise e Planejamento - Cebrap (Brazilian Center for Analysis and Planning) in 1998d and 2005,e at the request of the Coordenação Nacional de DST e Aids/Ministério da Saúde (Ministry of Health's National STD/AIDS Coordination).
Information about HIV/AIDS available in Brazil reveals an epidemic with relevant regional differences, and also distinct ways as to how populations are affected,8 emphasizing the importance of considering the dimensions of gender, social class, ethnic group and generation. Analyses considering men and women separately are fundamental to identify and understand differences in sexual behavior patterns,10-12 as well as to adopt prevention and healthcare measures.
This article aimed to compare findings from two studies on sexual behavior and practices by women and men, and also their associations with the population's sociodemographic characteristics.
An exploratory analysis of several indicators was the approach chosen to provide a broader view of the sexual behavior of the population of men and women, thus pointing to possible changes in patterns from 1998 to 2005.
The analyses refer to findings of the survey "Comportamento Sexual e Percepções da População Brasileira sobre HIV/Aids"c (Sexual behavior and perceptions of the Brazilian population regarding HIV/AIDS), carried out in 2005, compared with a similar survey carried out in 1998.d
Data were obtained from a probabilistic sample, in multiple stages, from the Brazilian population aged between 16 and 65 years, living in Brazil's greater urban areas.4 In 1998, 1,835 women and 1,489 men were interviewed, totaling 3,324 individuals; while in 2005, 2,742 women and 2,298 men were interviewed, totaling 5,040 individuals. The research methodology and the sample design are described by Berquó & Barbosa3 and Bussab,4 respectively.
Selection of the variables analyzed was based on two criteria so as to constitute indicators related to STI/HIV transmission, and to allow comparisons between 1998 and 2005. Thus, the variables refer to: the sexually active population throughout life and in the 12 months preceding the interview; individuals who had sex with a same-sex partner throughout life; number of sexual partners in the 12 months preceding the interview; sexual practices adopted with the last partner (steady and/or casual).
Sexual relations were defined as the practice of oral sex or sex with either anal or vaginal penetration. Therefore, at all moments when the questionnaire mentioned sexual relations, this was clarified as follows: "Have you ever had sexual relations, that is, have you had sex in any of the following ways: sex with vaginal or anal penetration or oral sex?"
The sexually active population throughout life shows the number of individuals who have already had sexual relations at least once in their lifetime. The sexually active population in the 12 months preceding the interview included men and women who reported at least one sexual relation in this period, among those who already were sexually active. The differentiation between these two indicators, proposed by Cleland & Ali,5 enables the distinction between "primary abstinence", identified as the beginning of sexual life, and "temporary or secondary abstinence", characterized by the interruption of sexual relations, which could be associated with, among other factors, the selection of sexual partners and/or the frequency of sexual relations.5
The occurrence of sexual relations with same-sex partners was analyzed in relation to the lifetime period exclusively, based on the question: "Have you ever had sexual relations with people from the same sex?". The variables "number of sexual partners" and "sexual practices" were analyzed only in relation to the 12 months preceding the interview.
The variable that referred to the number of sexual partners in the last 12 months was constructed from the question: "In the last 12 months, how many people did you have sexual relations with?".
Among sexual practices described by the interviewees, the occurrence of oral sex and sex with vaginal or anal penetration with the last partner (steady or casual) in the 12 months preceding the interview was selected for analysis.
The sociodemographic variables selected were: age group, categorized into the 16-to-19, 20-to-24, 25-to-34, 35-to-44, 45-to-54, and 55-to-65-year age groups whenever possible; level of education, categorized as elementary school (including illiterate), high-school and college; ethnic group/color, dichotomized into White and non-White (Black, mixed race, Asian and Indigenous); marital status: single, married/cohabitating relationship, separated/divorced/widowed; religion, according to the following categories: Catholic, Protestant/Pentecostal, others and none; geographic region of residence in the country: North/Northeast, Central-West/Southeast, South and state of São Paulo.
Bivariate analyses were conducted using Pearson's chi-square test and were adjusted with the incorporation of information from the sample design, using the SPSS 13.0 statistical software's complex samples module. Analyses were performed by sex and year of survey, where a significance level of 5% was adopted for all statistical tests. A 5% significance level was used as criterion for all analyses.
Given the reduced sample size of certain groups of interest, comparative analyses between 1998 and 2005 were shown exclusively when these were likely to produce reliable estimates for both periods. Whenever sample size enabled, stratified analyses of the demographic variables selected were performed. Comparative analyses by sex according to year were only shown in case of statistically significant differences.
The project of the survey "Comportamento Sexual e Percepções da População Brasileira Sobre HIV/Aids" was approved by the Ethics Committee of Faculdade de Saúde Pública of Universidade de São Paulo.
Results related to the sexually active population throughout life are shown on Table 1. The proportion of women and men who reported having had sexual relations sometime during their lives remained unchanged for the 1998 and 2005 population groups. However, differences according to sex, with a greater proportion of men compared to women, could be observed. These differences were statistically significant in both periods studied.
Analysis by age group revealed a non-homogeneous distribution of women and men, in both periods, with women beginning their sexual life later than men. A slight decrease in the proportion of sexually active men in the 20-to-24-year and 35-to-44-year age groups was observed.
As regards the level of education, a smaller proportion of people from both sexes, who had completed up to high-school and begun their sexual life, was recorded in 2005. However, among women who had completed up to elementary school, a statistically significant increase in this proportion could be observed, exclusively associated with young girls aged between 16 and 19 years.
As for religion, the proportion of men who had begun their sexual life is lower among Protestants/Pentecostals than among Catholics or those from other religions. Among women the distribution was found to be independent from religion.
Analysis according to geographic region of residence enabled to verify an increase in the number of sexually active women in Southern Brazil from 1998 to 2005, associated with teenagers aged 16 to 24 years and women from 25 to 34 years.
Results related to the sexually active population in the last year are shown on Table 2. The proportion of sexually active women and men who reported having had sexual relations in the year preceding the interview remained unchanged in the 1998 and 2005 population groups. This proportion was much greater among men than women, and these differences were statistically significant in both years.
Distribution by age group of sexually active individuals in the year preceding the interview was not homogeneous among women in both periods; among men, it was not homogeneous in 2005 exclusively (p<0.0001).
In 2005, the smallest proportions of sexually active men in the year preceding the interview were concentrated in the 16-to-19 and 55-to-65-year age groups. From 1998 to 2005 there was an apparent decrease in the proportion of sexually active men in the last year, beginning at 45 years of age. Yet, this difference was not statistically significant.
Among women, the distribution remained homogeneous in the first four age groups, in both periods analyzed, decreasing from age 45 onward (p<0.0001). Concomitantly, it could be observed an increase in the proportion of sexually active women in the last year, in the 55-to-65-year age group, a difference that was not statistically significant.
As regards level of education, the pattern observed in 1998 was confirmed in 2005: a smaller proportion of women who had completed up to elementary school had an active sexual life in the year preceding the interview (1998, p=0.0609; 2005, p<0.0001). This characteristic was found to be exclusively associated with women aged over 45 years. On the other hand, men's active sexual life in the year preceding the interview did not reveal any significant association with the level of education.
In terms of ethnic group/color, a homogeneous distribution in both periods was observed, among men and women, with a reduction in the proportion of White men with active sexual life in the year preceding the interview (p=0.0229).
As regards religion, a homogeneous distribution among men could be verified in both periods; and among women, in 1998. From one period to another, it was possible to notice a reduction (p=0.0377) in the proportion of Protestant/Pentecostal men with active sexual life in the year preceding the interview.
In terms of marital status, there was a decrease in the percentage of sexually active men in the year prior to the interview among those who were separated and widowed, between both periods (p=0.0051), whereas, among separated and widowed women, this percentage increased (p=0.0006). When this analysis was also adjusted by age, it was observed that the increase among separated and widowed women occurred in the age groups from age 25 onward; among men in the same situation, the decrease occurred from age 35 onward.
From 1998 to 2005, there was a reduction in the percentage of sexually active men living in the state of São Paulo in the year preceding the interview (p=0.0002). When this analysis was also adjusted by age, it could be observed that this reduction was exclusively associated with men aged over 45 years.
In 2005, 3.2% of men reported having had sexual relations with other men at some point in their lives - the same proportion observed in 1998 (p=0.7677). In 1998, 3.0% of women reported having had sexual relations with other women at some point in their lives. Comparative analyses between 1998 and 2005 were performed only for the male population, due to the reduced size of the female sample that reported same-sex relationships in 2005. In addition, it was not possible to analyze the relation between sociodemographic variables and same-sex relationships.
As regards the number of partners in the year preceding the interview, differences in sexual behavior among men and women were more evident. The proportion of men who mentioned more than one sexual partner was approximately five times greater than that of women in both periods. This proportion decreased in the male group and remained unchanged among women. Results referring to the number of partners in the last year are shown on Table 3.
It was not possible to perform comparative analysis according to sociodemographic variables for the female population between 1998 and 2005, given the reduced size of this part of the female sample (5.2%). Even though the proportion of men who had more than one partner in the year preceding the interview continued to drop in relation to age, this decrease was concentrated among men aged between 25 and 34 years (p=0.0307) and between 35 and 44 years (p=0.0354). Among teenagers aged between 16 and 19 years, a reduction of about 15% was observed, though not statistically significant.
In the male population as a whole, there was a reduction in the number of partners in the group who had completed from elementary school to high-school. This reduction suggests a positive relation between number of sexual partners in 2005 and the level of education.
In addition to the differences per age group and level of education observed, between 1998 and 2005, a decrease in the proportion of Catholic, White and single men who had more than one partner in the last year was verified.
Affiliation with any religion was found to be associated with a greater proportion of single-partner relationships in the last year, both in 1998 and in 2005.
In terms of distribution by geographic region of residence, it could be observed a significant reduction in the number of men who had more than one sexual partner in the year preceding the interview in the Central-West/ Southeast regions (32.2%, in 1998, 17.5%, in 2005; p=0.0038). In the North/Northeast regions, proportions were similar in both periods, approximately double the proportions found in the other regions in 2005 (p<0.0001).
As regards sexual practices, in 2005, almost 100% of sexually active people in the year preceding the interview reported the practice of vaginal sex with the last steady or casual partner. Only 1% of men and 0.3% of women did not mention it - proportions comparable to those observed in 1998. Given the following set of choices - vaginal, anal and oral sex - 60.8% of men reported vaginal sex as an exclusive practice in 1998, and 53.6% in 2005 (p=0.0530); among women, these figures were 62.7% and 57.3%, respectively (p=0.2720).
Due to the almost absolute predominance of vaginal sex, stratified analyses will be shown for oral sex (Table 4) and anal sex (Table 5) exclusively.
No significant differences in the practice of oral sex for the 1998 and 2005 samples were observed. Less than half of men and women reported having practiced oral sex with the last sexual partner (Table 4).
In the periods analyzed, the distribution of people who practiced oral sex was found to be heterogeneous for both sexes, age group, level of education, religion, marital status or number of partners in the year preceding the interview. This practice decreased from the age of 35 onward (in 1998 and 2005), even though a significant increase in the 35-to-44-year age group of women (p<0.0001) and 45-to-65-year age group of men (p=0.0143) was observed.
Reported oral sex increased from 1998 to 2005, according to the level of education, among both women and men. Moreover, an increase in this practice among women who had completed up to elementary school was observed (p=0.0443).
Smaller proportions of reported oral sex were recorded among men and women affiliated with Catholicism or Protestantism/Pentecostalism, in comparison with the remaining categories. Differences were close to 20%.
In both periods, the practice of oral sex was found to be more widespread among single women and men, or those with more than one sexual partner in the last year. Statistically significant increase in this practice among married men/those in a cohabitating relationship (p=0.0150) and with a single female partner (p=0.0037) was found to be significant. In both periods, reported oral sex remained more frequent in the White men and women group. When considering distribution by geographic region of residence, a change of pattern was verified between 1998 to 2005, with distributions that were not homogeneous There was an increase in reporting among men living in the North/Northeast regions (p=0.0275) and in the state of São Paulo (p<0.0001). On the other hand, there was a decrease (p=0.0283) among those who lived in the South region. An increase in reported oral sex among women who lived in the North/Northeast regions was recorded in 2005 (p=0.0093).
The practice of anal sex remained unchanged in both periods analyzed. Reporting was less frequent when compared to oral sex, and men mentioned its occurrence more often (Table 5). Comparative analyses between 1998 and 2005, according to sociodemographic variables, were not performed for the female population due to the reduced sample size. This practice was greater among young males aged between 16 and 19 years and it decreased with age; while among women, it was more frequent among those aged between 20 and 44 years.
As observed in relation to oral sex, the distribution of people who practice anal sex differed according to sex, level of education, religion, marital status or number of partners. Men and women who have completed up to elementary school, are affiliated with Catholicism or Protestantism/Pentecostalism, are married/in a cohabitating relationship, and had only one partner in the last year tend to report anal sex less frequently.
In the periods analyzed, reported practice of anal sex remained homogeneous among both White and non-White women and men. As regards distribution by geographic region of residence, homogeneity for both sexes was verified in 2005, with an increase in this practice by men in the state of São Paulo from 1998 to 2005 (p<0.0479). Given the reduced sample size in 1998, this increase must be viewed with caution.
There is a debate in the literature concerning validity and reliability of data produced by surveys on sexual behavior and practices due to the subjective nature of this type of information, which may be influenced by memory bias, adequacy of response and other bias.10,11,15 As this refers to behavior related to people's private, intimate life, reporting of this information is particularly susceptible to social pressures and may thus lead to responses that are considered socially desired.10
In addition, temporal trends of sexual behavior data should take into consideration a possible impact on responses caused by cultural changes that have occurred throughout time. A sexual practice, when experienced at different moments, could be reported with more or less frequency, due to more or less liberal cultural contexts in relation to the practice at the time in question.
However, as emphasized by Bastos et al,2 "population-based surveys are usually not prone to systematic errors that may compromise comparisons and contrasts, once non-systematic errors are minimized and their sampling strategy is handled in a proper way, as well as the reliability and validity of the instruments used".
Taking all this into consideration, it could be observed that there were no significant changes in sexual behavior patterns among women and men from 1998 to 2005 for the population as a whole. The only exception was the number of sexual partners in the year preceding the interview, which decreased among men.
Different sexual behavior patterns according to gender remained similar, namely, women begin their sexual life later; a smaller proportion of women continued to be sexually active in the last year and an even smaller proportion mentioned more than one sexual partner in the last year. Even though results reported by Szwarcwald et alf do not offer estimates of the population with more than one partner in the last year, patterns found in the present study are comparable to those found by these authors in 2004.
Also, changes in male and female patterns of sexual practices with the last partner were not identified. Differences by gender were exclusively observed in relation to anal sex, less frequent among women.
Even though there are no available data for the same age group in Brazil, a population survey conducted by Heilborn et al11 in 2002 among young males and females aged between 18 and 24 years, living in the cities of Salvador (Northeastern Brazil), Rio de Janeiro (Southeastern Brazil) and Porto Alegre (Southern Brazil), recorded a predominance of vaginal sex. Oral sex was found to be a more widespread and less asymmetric practice among men and women. Anal sex was less frequent in the sexual repertoire of teenagers and showed significant differences by gender.
On the other hand, differences by gender, identified in the reporting of anal sex, were not found in studies performed in countries such as the United States, England and Australia.7,13,14 According to Heilborn et al,11 the higher frequency of anal sex among males in Brazil possibly reflects the fact that men place a high value on reporting this practice, more than it evidences its occurrence. However, frequencies observed in the present study, among both women and men, were found to be at higher levels than those reported by studies performed in England13 and the United States,14 where indicators comparable to the ones from this study were used. This fact may indicate that anal sex is more frequent in Brazil. Similar patterns were also observed in Chile in 2000.g
In terms of patterns related to same-sex relationships throughout life, no differences among men and women were found: about 3% of the population interviewed (1998) reported having had sexual relations with same-sex partners throughout life, a proportion that remained the same among men in 2005.1 Similar pattern was found in France in 2006.ª Comparative analysis between the French findings in 2006 and data available for 1992 in this same country reveals stability of estimate throughout time among men and an increase in this proportion among women. In Brazil, however, it was not possible to establish reliable estimates for the female population in 2005, due to the small number of same-sex relationships reported. More than an objective reduction of the event, this finding suggests that, among women, reporting homosexual relationships still involves fear of prejudice and disapproval and, in this sense, it is more likely to be omitted in the research contexts. This was previously pointed out in an ethnographic study by Barbosa & Facchini.h
If the analysis did not reveal substantial changes for the group of men and women, from 1998 to 2005, the stratified analyses showed a more diversified and complex picture. This picture is characterized by variability of behavior and sexual practices, according to age, level of education, marital status, religion, and geographic region of residence, factors that interact with each other in a particular way according to gender.
A more in-depth discussion about these inter-relationships requires multivariate analyses so that the effect of all the variables of sexual behavior and practices can be controlled. In spite of this, findings from the present study seem to point to a decrease in the differences between women and men, corroborating Bozonf e Johnson et al's13 analysis of recent changes in France and England, respectively.
This reduction in differences was found to be associated, in the Brazilian case, with a pattern of change characterized by: an increase in the proportion of women who began their sexual life between 16 and 19 years of age, had completed up to elementary school, or lived in the South region; an increase in reported sexual activity among women in the year preceding the interview; a reduction in similar reporting by men aged over 55 years, Protestant/Pentecostal, or separated/widowed; a decrease in the proportion of men with more than one sexual partner in the last year, among those aged between 25 and 44 years or who had completed up to high-school; and an increase in the reported practice of oral sex by women aged over 35 years or who lived in the North/Northeast regions.
Interpretation of changes that occurred in the behavior and practices throughout time requires caution and needs to take into consideration the possible impact of methodological issues previously pointed out. Nonetheless, successive observations - with repeatedly negative values among men and positive among women - raise the hypothesis that a process of change in sexual behavior and practices is taking place in Brazil. This change may be better understood through specific, in-depth analyses, and confirmed by repetition of research so as to obtain more points in time.
Until now, studies on tendency and changes in sexual behavior and practices in Brazil have been based on diverse research samples and tools. One exception was the Pesquisa Nacional de Demografia e Saúde - PNDS (National Survey on Demography and Health) performed in 1986 and then repeated in 1996,i which, however, did not prioritize such themes. For these reasons, temporal trend analyses of patterns of sexual behavior and practices in Brazil may not have been found in the literature consulted, following the example of studies performed in sub-Saharan African countries,5,6 England13 and France.ª
The difficulty to compare findings from the present study with similar Brazilian studies, in terms of the geographic reach and population coverage, is also associated with the analytical approach used to collect data on sexual behavior and practices. Other population studies on sexual behavior and practices were performed on a national level (2003j and 2004f). However, analyses conducted from these studies, when considering sex to be merely a category among other sociodemographic variables, did not emphasize their internal differences. This, in its turn, caused comparison with several results from the present study to be impracticable. Such fact probably reflects the unreasonable incorporation of gender into epidemiological studies and analyses in general, a perspective of analysis that has been internationally adopted by studies7,13,14,i of this nature and which is vital for studies on sexuality.
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2. Bastos FI, Bertoni N, Hacker MA, Grupo de Estudos em População, Sexualidade e Aids. Consumo de álcool e drogas: principais achados de pesquisa de âmbito nacional, Brasil 2005. Rev Saude Publica. 2008;2(Supl 1):109-17.
3. Berquó E, Barbosa RM, Grupo de Estudos em População, Sexualidade e Aids. [Introdução]. Rev Saude Publica. 2008;42(Supl 1):7-11.
4. Bussab W de O, Grupo de Estudos em População, Sexualidade e Aids. Plano amostral da Pesquisa Nacional sobre Comportamento Sexual e Percepções sobre HIV/Aids, 2005. Rev Saude Publica. 2008;42(Supl 1):12-20.
5. Cleland J, Ali MM. Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data. Lancet. 2006;368(9549):1788-93.
6. Cleland J, Ali MM, Shah I. Trends in Protective Behaviour among Single vs. Married Young Women in Sub-Saharan Africa: The Big Picture. Reprod Health Matters. 2006;14(28):17-22.
7. Visser RO, Smith AM, Rissel CE, Richters J, Grulich AE. Sex in Australia: heterosexual experience and recent heterosexual encounters among a representative sample of adults. Aust N Z J Public Health. 2003;27(2):146-54.
8. Dourado I, Veras MASM, Barreira D, Brito AM. Tendências da epidemia de Aids no Brasil após a terapia anti-retroviral. Rev Saude Publica. 2006;40(Supl):9-17.
9. Fishbein M, Pequegnat W. Evaluating AIDS prevention interventions using behavioral and biological outcome measures. Sex Transm Dis. 2000;27(2):101-10.
10. Gagnon JH. Uma interpretação do desejo: ensaios sobre o estudo da sexualidade. Rio de Janeiro: Garamond; 2006.
11. Heilborn ML, Aquino EML, Bozon M, Knauth DR, organizadores. O Aprendizado da sexualidade: reprodução e trajetórias sociais de jovens brasileiros. Rio de Janeiro: Garamond; 2006.
12. Hubert M, Bajos N, Sandfort T. Sexual behavior and HIV/AIDS in Europe: comparisons of national surveys. London: UCL Press; 1998.
13. Johnson AM, Mercer CH, Erens B, Copas AJ, McManus S, Wellings K, et al. Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet. 2001;358(9296):1835-42.
14. Laumann EO, Gagnon JH, Michael RT, Michaels S. The social organization of sexuality: sexual practices in the United States. Chicago: The University of Chicago Press; 1994.
15. Pequegnat W, Fishbein M, Celentano D, Ehrhardt A, Garnett G, Holtgrave D, et al. NIMH/APPC workgroup on behavioral and biological outcomes in HIV/STD prevention studies: a position statement. Sex Transm Dis. 2000;27(3):127-32.
16. Smith AM, Rissel CE, Richters J, Grulich AE, Visser RO. Sex in Australia: the rationale and methods of the Australian Study of Health and Relationships. Aust N Z J Public Health. 2003;27(2):106-17.
17. Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D, et al. Sexual behaviour in context: a global perspective. Lancet. 2006;368(9548):1706-28. Correspondence: Received: 12/10/2007 Article based on the data from the survey "Comportamento sexual e percepções da população brasileira sobre HIV/Aids (Sexual behavior and perceptions of Brazilian population on HIV/AIDS)", sponsored by the Brazilian Ministry of Health through the Centro Brasileiro de Análise e Planejamento (Process n. ED 213427/2004). This article followed the same peer-review process as any other manuscript submitted to this journal, anonymity was guaranteed for both authors and reviewers. Editors and reviewers declare they have no conflict of interests that could affect the judgment process. The authors declare they have no conflict of interests.
Regina Maria Barbosa
Nucleo de Estudos de População-NEPO/
R. Albert Einstein 1300
13081-970 Campinas, SP, Brasil
* (Study Group on Population, Sexuality and AIDS) members: Elza Berquó, Francisco Inácio Pinkusfeld Bastos, Ivan França Junior, Regina Barbosa, Sandra Garcia, Vera Paiva, Wilton Bussab.
a Agence Nationale de Recherches Sur le Sida et les Hépatites Virales. Dossier de presse - Premiers résultats de l'enquête "Contexte de la sexualité en France". Paris; 2007. Available from: http://www.anrs.fr/index.php/anrs/content/download/483/3662/file/DP%2013%20mars%2007%20-
b Arredondo A, Goldstein E, Olivera MP, Bozon M, Giraud M, Messich A, et al. Estudio nacional de comportamiento sexual: primeros analisis, Chile 2000. Santiago: Ministerio de Salud.Comisión Nacional del Sida; 2000
c Naciones Unidas. Programa para El Desarrollo. Actitudes, información e conductas en relación con el VIH SIDA en la población general: informe para el establecimiento de la línea de base para el proyecto Actividades de Apoyo a la Prevención y Control del VIH/SIDA en Argentina. Buenos Aires; 2005.
d Berquó E, coordenador. Comportamento sexual da população brasileira e percepções do HIV/AIDS. Brasília (DF): Ministério da Saúde, Secretaria de Políticas de Saúde, Coordenação Nacional DST e Aids; 2000. (Série avaliação, 4).
e Research conducted by the Centro Brasileiro de Análise e Planejamento [Brazilian Center of Analysis and Planning] (CEBRAP) and the Brazilian Ministry of Health.
f Ministério da Saúde. Coordenação Nacional de DST e AIDS. Pesquisa de conhecimento, atitudes e práticas na população brasileira de 15 a 54 anos, 2004. Brasília;2006.
g Arredondo A, Goldstein E, Olivera MP, Bozon M, Giraud M, Messich A, et al. Estudio Nacional de Comportamiento Sexual: Primeros Analisis, Chile 2000. Santiago: Comisión Nacional del Sida-Ministerio de Salud; 2000.
h Barbosa RM, Facchini R. Mulheres, cuidados à saúde, gênero e diversidade sexual. São Paulo; 2006. (Relatório de pesquisa - Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq - Processo n. 401256/2004-9)/CNPq)
i Unpublished data.
j França Jr I, Paiva V, Lopes F, Venturi G. Aspectos metodológicos e analíticos da pesquisa. Ministério da Saúde/Instituto Brasileiro de Opinião Pública e Estatística, Brasil-2003. São Paulo; 2003. Available from: http://www.aids.gov.br/data/documents/storedDocuments/
Article based on the data from the survey "Comportamento sexual e percepções da população brasileira sobre HIV/Aids (Sexual behavior and perceptions of Brazilian population on HIV/AIDS)", sponsored by the Brazilian Ministry of Health through the Centro Brasileiro de Análise e Planejamento (Process n. ED 213427/2004). This article followed the same peer-review process as any other manuscript submitted to this journal, anonymity was guaranteed for both authors and reviewers. Editors and reviewers declare they have no conflict of interests that could affect the judgment process. The authors declare they have no conflict of interests.