Located in the northwest corner of South America, Colombia is bordered by the Caribbean Sea on the north, Panama on the northwest, the Pacific Ocean on the west, Ecuador and Peru on the south, and Brazil and Venezuela on the east. Its 440,762 square miles (1,138,910 square kilometers) places it in size between the states of Texas and Alaska. Three mountain ranges, the Andes, the Western, and the Central and Eastern Cordilleras, run through the country from north to south. The eastern range is mostly high tablelands and is densely populated. The Magdalena River rises in the Andes and flows north to the Caribbean Sea through a rich alluvial plain. The sparsely settled eastern plains are drained by the Oronoco and Amazon Rivers. Four percent of the land is arable and capable of producing crops, 29 percent is pasture and meadowlands, 49 percent is forest and woodland, and 2 percent is devoted to permanent crops.
In the 1999 estimated 39.3 million Colombians, the age distribution was 33 percent under age 15 years, 62.4 percent between ages 15 and 64, and 4.6 percent age 65 or older. Ethnically, 58 percent of Colombians are mestizo Spanish and Amerindian mix, 20 percent white, 14 percent mulatto Caucasian and black mix, 4 percent black, and 4 percent other. Seventy-three percent live in the cities. Ninety-five percent of Colombians are Roman Catholic. Spanish is the official language. Life expectancy at birth in 1997 was 66.2 for males and 74.1 for females. The 1999 birthrate was 24.5 per 1,000 persons, the infant mortality rate 24.3 per 1,000 life births, and the death rate 6 per 1,000 persons, for an annual natural increase of 1.89 percent. The Total Fertility Rate (TFR) in 1997 was 2.7 births per fertile woman, placing Colombia 134 out of 227 nations. In 1992, Colombia had one physician per 1,078 persons. Education is free and compulsory for five years between the ages of 6 and 12. Eighty-seven percent of Colombians are literate. The 1997 estimated per capita Gross Domestic Product was $6,200.
Prior to the arrival of Europeans, the area that is now Colombia was home to various sedentary and semisedentary cultures, including the kingdoms of Funza and Tunja and the semisedentary Chibcha, who might have numbered about a million. Some of the area was part of the Inca Empire. By the 1530s, Spain had conquered the area and in 1538 established the colony of New Granada, with its capital in Bogatá, within the jurisdiction of the Viceroyalty of Peru. In 1740, a new Viceroyalty was established that included modern-day Colombia, Ecuador, Panama, and Venezuela. In 1819, forces under Simon Bolívar defeated the Spanish at the Battle of Boyacá, and the area gained its independence in 1821.
Colombia then became part of the Federation of New Granada. Venezuela and Ecuador broke away from this federation in 1829. By the 1850s, Colombia and Panama had adopted a federal system, but the system quickly deteriorated with the semi-sovereign states locked in a constant struggle with the central government for autonomy. In 1903, when the Colombian government rejected an offer by the United States for construction of a canal in Panama, the United States supported a revolt by Panama, which then declared its independence from Colombia.
Since the 1850s, Colombian politics have been characterized by a struggle between two groups that early on coalesced into the Liberal and Conservative parties. The on-going Liberal-Conservative struggle has led to at least six civil wars, usually ending in interparty compromise. For most of the last century, the Roman Catholic Church played a major role in Colombias social life and political struggles. The 1987-1988 Concordat gave the Church official protection, while the state assumed authority over public education. The Churchs central position in Colombian society was not substantially affected by the Concordat of 1942.
The worldwide depression of the 1930s seriously disrupted both the economy and the politics of Colombia. The overall economic collapse, coupled with the Conservative Partys brutal repression of the labor movement, led to a Liberal victory in 1930, followed by a new civil war between peasants loyal to the two parties. By 1934, Liberal president Alfonso López had inaugurated his Revolution on the March program of socioeconomic reform.
During the 1946 elections, Conservatives won the presidency with a minority of the overall vote, defeating a split Liberal Party. Armed conflict instigated by leaders of the two parties erupted to start La Violencia, from 1948 to 1957, during which more than 200,000 people died. In the summer of 1957, the two parties reached an agreement on constitutional reform that was designed to last 16 years and allow for regular alternation of the presidency between the two parties. This agreement lasted 11 years, until 1968, when constitutional revisions allowed official recognition of other political parties.
The 1960s and 1970s were marked by the emergence of terrorist and paramilitary groups on both the right and left, some with ties to the drug trade. This violence greatly reduced the power-sharing monopoly of the two parties. Since 1989, political violence has claimed over 35,000 lives. In March 1990, one of the most notorious left-wing groups, M-19, laid down its arms, entered the political mainstream, and won 19 of the 70 seats in a constitutional convention called to rewrite the Constitution. Other leftwing groups soon followed suit.
Colombia has also had to cope with a thriving and growing narcotics trade. Throughout the 1980s, narco-terrorists murdered and kidnapped government officials, journalists, and innocent bystanders with impunity. Despite the assassination of four presidential candidates prior to the 1990 election, the Liberal Party won with a vigorous campaign against the narcotics trade. In 1994, another Liberal president was elected on the promise to invest billions of dollars to improve Colombias infrastructure using money from newly discovered oil fields. Between the summer of 1995 and September 1996, the government arrested the seven top members of the Cali drug cartel.
Observing pieces of Pre-Colombian art and the descriptions of the historians of the Indies (when the colonists arrived), one finds strong evidence that the majority of the aboriginal tribes inhabiting the Colombian territory freely practiced the pleasurable side of sexuality. Among the art pieces of the time, one encounters representations of all possible sexual attitudes: masturbation, heterosexual activity, oral sex, homosexual activity, and bestiality. With the arrival of the Spaniards in the sixteenth century, the sexual interests of the conquistadors towards the Indian women made interracial marriages very popular. The evidence of interracial marriage is evident in the fact that 58 percent of Colombians today are mestizo Spanish/Amerindian and 14 percent mulatto black/Caucasian. At the same time, the Spaniards brought the Catholic religion and the repression of eroticism. The arrival of the African slaves during the seventeenth and eighteenth centuries signified a new miscegenation and the integration of new cultural elements favorable to pleasure rather than procreative sexuality. At the time of independence from Spain and the birth of the republic in the nineteenth century, a nation had been forged that, with respect to sexuality, was somewhere between the exalted libido of the macho population and the erotophobic restrictions of their profoundly religious culture. During the twentieth century, especially in recent decades, the progressive influences of North American culture have been added to Colombian culture. Profound transformations to the family structure and the traditional ideology are being generated by the changes in the Colombian economy at the end of the twentieth century. This has opened a new sexual panorama that is much more complex than in colonial times.
Even though there are important urban, rural, and regional differences, todays sexual attitudes in Colombia are characterized by a double standard, where men are permitted all types of sexual activities while decent women are limited to sexual activities within the confines of marriage for reproduction purposes. There is, however, the beginning of a more permissive attitude towards a womans sexual pleasures if she is in a serious relationship, because the impoverished situation of the majority of Colombians makes it very hard for couples to maintain stable ties.
Colombia continues to be a country where the majority of the population is Catholic, with traditions deeply rooted in the cultural values of Spain. But the few studies that have been done on this issue indicate that the sexual conduct of the people frequently does not conform with the Churchs religious norms. This implies that machismo has played an important role in Colombian society. It has perpetuated discrimination towards women in family life, the work environment, and throughout society as a whole. Machismo places great value on female virginity, emphasizes the importance of the extended family, and supports the underlying concept of sin and guilt as it pertains to sexuality.
The modernization of Colombia, beginning in the 1930s and continuing well into the 1980s, changed many of these societal values. Colombia was transformed from a rural country to an urban country. No longer was religion the focal point of education. In spite of opposition from the Catholic Church, couples were having fewer children and birth control was more widely used. The status of women improved considerably. Employment of women outside the home has led to changes in the family structure. It allowed women to make choices, including how many children they bear, as well as changed their societal status. These societal changes, brought about by the modernization, industrialization, and urbanization of Colombia, continues into the start of the twenty-first century.
Machismo, with its horrible discrimination against woman, is still present in Colombian family life, the work environment, and society. There are few men, even those in the lower socioeconomic bracket, who help with the housework or the raising of the children. With the impoverishment of the country, the number of single mothers who are head of the household increases constantly, but they are still not given the basics: same work, same salary, or even a job. This situation has driven many women and their daughters to prostitution. Politically, women were given equal rights under the law in the 1950s, but they are still the minority in positions of power or in government jobs. Only in the last decade has it been possible for Catholic couples to get a divorce. Abortion is still illegal in Colombia, even though there are estimates that over 300,000 illegal abortions are performed each year. A growing sexual liberation of women has been observed in the past 30 years, but the differences in the sexual conduct of young people of both sexes are still very significant, as seen in Table 1.
In the movement toward gender/sexual equality in Colombia, we find sexologists like Helí Alzate, who was one of the first to vehemently refute the assumed physical, intellectual, and emotional inferiority of women. Also, intellectuals like Maria Lay Londoño and Florence Thomas, pioneers of the feminist movement since the 1970s, have dedicated enormous efforts to the study of couples and the promotion of sexual equality. The ground won by women in respect to their sexuality has not yet had an impact on the machismo attitudes of men. When it does, as it likely will in the near future, one can expect a crisis in the current model of masculinity.
Recent studies (Bodnar et al. 1999; Gonzáles 1999a) show the presence of important religious beliefs related to sexuality. The concept of sin related to pleasure in sex, birth control, and some religious concepts that emphasize feminine resignation are important in the sexual life and relationship of couples in Colombia. According to Paulo Romeo, Apostolic Nuncio in Colombia, the Catholic Church is losing 200 practitioners daily (El Tiempo 1997). According to the calculation presented at the Assembly of Bishops, only 60 of every 100 people baptized will take their first communion. According to Carlos Alzate of the Episcopal Conference of Colombia, only 15 out of a 100 people who consider themselves Catholics on surveys go to Mass (El Tiempo 1997).
To better understand our sexuality, it is necessary to understand the influences of the three biggest ethnic groups in our heritage: the Spanish culture, the African Culture, and the Indian culture (González 2000).
We can affirm with full accuracy that from the Spanish Conquest to the passing of Resolution 03353 by the Ministry of Education in July 1993, sexuality education in Colombia has functioned according to the guidelines set forth by the Catholic Church. Accordingly, sermons originating from the scriptures and dictated from the pulpit were obligingly echoed in all educational institutions.
Our medical students receive their sexological training via lectures in gynecology, urology, and psychology. However, this coursework does not include the erotic aspects of sexuality. It only deals with biological reproduction and the pathologies found in the genital organs. Sexually transmitted diseases are generally discussed with apprehension. At the same time, therapy for sexual dysfunctions remains unknown and the concept of the woman and the family is rooted in the old patriarchal ideology.
The National Program on Sexual Education is best described as a set of principals and guidelines that collectively form the knowledge base, attitudes, behaviors, and values of sexuality. Its purpose is to meet the needs of Colombians in living a healthy, responsible, and gratifying sexual lifestyle, while promoting gender equality. Furthermore, it encourages the people to redefine the traditional roles of men and women, as well as the patriarchal family structure, thus attaining greater equality between marital couples and parents and their children. In addition, the National Program on Sexual Education encourages men and women, without coercion or pressure, to choose the appropriate time at which to bear children. As a result, they need to learn to adequately utilize effective birth control methods. The guidelines proposed by the National Program on Sexual Education should be viewed as a framework for the formation and pedagogical organization of sexual education programs in Colombian schools. Therefore, this proposal is optional and not mandatory.
The following items should be taken into consideration while reviewing these guidelines:
In order to test the effectiveness of the National Sexual Education Programs, two studies were initiated. The first case study, conducted by the Ministry of National Education, investigated 332 schools in 155 school districts in Colombia. Using quantitative methods, it was found that 92 percent of the schools utilized the sex education programs. These schools reported a marked improvement in school morale, as related to sexuality themes.
The second case study, also conducted by the Ministry of National Education, complimented the previous study in that it investigated the pedagogical process of the National Sex Education Programs in academic institutions. Utilizing qualitative methods to examine 16 subjects at different developmental stages in four different regions of Colombia, this study indicates that the sex education programs are at a critical phase of development. They have been introduced to the school system, and opened up avenues of employment and a new view on sexuality, but they have also identified four areas where further effort and development are needed:
Investigations conducted by a variety of groups that strongly support sex education have found that parents are reclaiming their roles as the primary informants of sex education. Mantilla (1993) reported that mens primary sources of information on sexuality were: friends, mother, father, and school. Women reported that their primary sources of information on sexuality were: friends, mother, school, and father. Gutierrez and Franco (1989) found that women reported that their primary sources of information on sexuality were: school, mother, friends, and the general media. Men reported that their primary sources of information were: friends, school, the general media, and father. The Institute of Social Securities (Instituto de Seguros Sociales 1994) found that adolescents posed questions regarding sexuality primarily to their mothers, 47 percent of females and 20 percent of males, whereas only 16 percent questioned their friends and 11 percent questioned their fathers.
Everyday the Colombian mass media discusses sexuality more freely. Several related programs have surfaced. Maria Ladi Londoño-Cali, was one of the first pioneers in this area. Lucia Nader and Marta Lucia Palacio joined in on two major networks, Caracol and RCN (Palacio 1999), and presented a compilation of the most frequently asked questions by her viewers. In print, the pioneering column on sexuality was Window to Sexuality (González 1998, 1999b). This column was originated by José Manuel Gonzáles and is presently written by Fernando Bohorquez, Ph.D. The Herald (Barranquilla) has published an entire page dedicated to human sexuality since 1999, titled Love and Intimacy (González 2000). The pioneering television program was Sexology on Television, hosted by Elkin Mesa (August, 1979). Lucia Nader, Marta Lucia Palacio, Alonso Acuña, and Pedro Guerrero initiated another program, titled Its Time to Live. This program touched on all aspects of human sexuality. It was a popular program that also served as a basis for a book by the same name. Lucia Nader developed a magazine titled In Private (1996). Its theme was fundamentally sexuality. Accent was a magazine geared towards the gay community, published in 1997. Both publications have since gone off the market, because of financial difficulties.
Erotic autostimulation is rather common among children. Ardila (1986a) interviewed 700 mothers, pertaining to different Colombian subcultures, and found that three out of four mothers reported masturbatory behavior among children of 4 years of age. Acuña and associates (1986) explored the existence of this behavior and the anxiety that it causes for parents. In general, this type of autoexploratory and sexual gratification behavior is repressed by the adults.
Autoerotic behaviors are also common among adolescents. Masturbation generally starts between the ages of 13 and 15 (Alzate 1989; Domínguez et al. 1988; González 1995; Giraldo 1981; Gutiérrez & Franco 1989; Useche 1999). Among the adolescents, between 60 and 95 percent of men and 14 and 68 percent of women have masturbated at least once in their lives (Alzate 1989; Domínguez et al. 1988; González 1995; Giraldo 1981; Gutiérrez & Franco 1989; Useche 1999). In general, feelings of guilt and anxiety are reported with respect to masturbation (Domínguez et al. 1988; González 2000; Gutiérrez & Franco 1989).
Sexual autostimulation is also very common among adults. About 90 percent of men and 70 percent of women report having masturbated at least once in their lives (Alzate 1989; Elijaike et al. 1987; González 1979, 1985, 1995, 2000). The majority of those studies report a greater incidence of masturbatory behavior in those who are less religious.
A relationship between the personality, as measured by Eysencks MPI test, and masturbation has been detected by González (1979). Men with high scores in introversion have confirmed a higher frequency of masturbatory behavior. Women with high scores for neuroticism have demonstrated a lower frequency of masturbatory behavior as compared to woman with normal scores. With relation to age, it has been reported that in people over 60 years of age, single women masturbate more than men (Bardugo & Segura 1988, González & González in press).
Sexual autostimulation generates many negative feelings. There are many myths and misinformed beliefs on the subject (Giraldo 1981; González 2000). In a recent survey done in the four biggest cities of Colombia, it was found that only 32 percent of women and 53 percent of men find masturbation to be a healthy sexual behavior. The rest believe that it is a crazy conduct that should be avoided, because it is a sexual deviance and a sin (Semana 1999).
Childhood sexual rehearsal play and sexual exploration are quite common. One out of every two mothers reported observing sexual rehearsal play in their 4-year-old children (Ardila 1986). Still, childhood sexuality is a theme that produces great anxiety in adults (Acuña et al. 1986; González 2000).
There are no widespread rituals of initiation to puberty. In some rural areas on the Caribbean coast of Colombia, it is common for adolescents to engage in sexual acts with animals, namely mules (González 2000).
Sexual activity among adolescents occurs frequently and functions according to the traditional male-dominant cultural pattern. Forty-four percent of Colombians initiate sexual interactions between the ages of 11 and 18. By 18 years of age, 72 percent of males and 40 percent of females have had sexual intercourse, according to Ministry of Health of Colombia (Ministerio de Salud 1994). Generally, female adolescents first sexual encounter occurs with their boyfriends. Often, sexual relations between Colombian adolescents stem from an intimate relationship and not from an encounter with a prostitute (Bonder et al. 1999; González 1995; González et al. 2000; Useche 1999).
Premarital sex is quite common in Colombia. In recent studies, it was found that 90.4 percent of males and 62.8 percent of females have engaged in premarital sex prior to starting college life (González et al. 2000). Love is usually on the forefront. It is a fundamental part of Colombian culture: music, magazine articles, soap operas, and movies (Bodnar et al. 1999; González 1998; Guerrero 1996a, 1996b). In recent years, initiating friendships and intimate relationships has become easier. Formal introductions are no longer required. People have become more direct in their approach.
In recent studies, González (2000) found that men experience difficulties in expressing love and affection. It is common that people have unrealistic expectations regarding love, and, as a consequence, great frustrations and clashes between fantasy and reality in relationships. Frequently, the expectation is that the lover will satisfy all of their needs, provide unconditional love, and be who they want them to be and not who they actually are. They believe that pain, suffering, and jealousy are essential parts of a relationship. Generally, the woman is expected to be responsible for the affective part of the relationship. She is often expected to prove her love by engaging in sex with her partner. It is also believed that a sure way of keeping a man, or winning him back, is through sex. All the conditions aforementioned make choosing an appropriate mate difficult. Frequently, a partner is not chosen on reality-based merits. Instead he or she is chosen on unrealistic expectations, which inevitably will lead to a failed relationship.
Among adults, there exists a misconception of what sexual pleasure is. Generally, they do not understand the physiological and/or psychological concepts of eroticism. As a result, there exist irrational and unhealthy beliefs (González et al. 2000). Sex is commonly seen as bad, dirty, ugly, and degrading. This sex-phobic mindset distorts and impedes a healthy sexual lifestyle (González 1981). Often egotism is perceived as a process leading towards reproduction. Anything else is seemingly considered illegal, promiscuous, and guilt-ridden (González 1999a).
According to the machismo ideology, males tend to initiate sexual activity earlier than females. It tends to be more intense and promiscuous (Alzate 1989; Bodnar et al. 1999; González et al. 2000; Institute of Social Securities 1993; Useche 1999). Adult males will have more sexual partners than their female counterparts: One out of every three males reported having two or more sexual partners in the last twelve months, whereas only three out of every one hundred females reported multiple partners (Institute of Social Securities 1993). Generally, the male initiates sexual interactions within the relationship. Couples engage in sex frequently: 2 percent reported daily sexual activity, 19 percent reported sexual activity several times a week, 41 percent reported weekly sexual activity, and 16 percent reported monthly sexual activity (Ministerio de Salud 1994). The sexual positions most frequently practiced were the missionary man-on-top/woman-on-bottom position, the straddle where the woman sits on top of the man, and the rear-entry position with the man behind the woman (González 1994).
Eljaiek et al. (1987) found that almost 50 percent of the couples surveyed did not engage in sexual relations during menses, and almost 10 percent discontinued sexual activity during pregnancy. There also exists a great irresponsibility, for both men and women, in practicing safe sex and using some form of contraception. There is a high rate of sexual dissatisfaction for both genders (González 1998).
Colombians place a great importance on feeling as though one is in love. Love is the primary motivating factor for matrimony, as reported by 87 percent women and 69 percent men (Eljaiek et al. 1987).
The marriage rate has decreased while the rate of cohabitation has increased, especially in the younger population. Mature couples in their mid-80s reported that 84 percent were married through the Catholic Church, while 15 percent cohabitated. Married couples in their mid-30s reported that 44 percent were married through the Catholic Church, while 54 percent cohabitated (Rojas 1997). The average age for matrimony or cohabitation has decreased for males and has increased for women (Presidential Council for Youth, Women, and Their Families 1994).
Rojas (1998) found that couples feel unfulfilled in their relationships. They feel that their counterparts do not demonstrate affection both physically and verbally, that they do not support their efforts, and that they do not make them feel valued. Additionally, they feel that there is a lack of communication with regards to problems, misunderstandings, and resolutions. Rojas also noted that of the couples surveyed, 50 percent did not have a set time in which to communicate.
The marital union in Colombia tends to be non-democratic and lacks equality between the partners. Often women seek gender equity, only to be met with violence from their counterparts. There also exist religious beliefs that support submissiveness and perpetuate this unjust marital relationship (González 2000). Misinformation pertaining to masculinity, femininity, and their interrelatedness permeates societal expectations. Men are perceived in terms of money, power, bravery, and freedom. Women, on the other hand, are perceived as tender, submissive, tolerant, able to bear suffering, and having a need to sexually satisfy their partner at the expense of her own sexual needs. These machismo-based values are believed to be biological in nature, disregarding educational, physiological, and/or psychological cultural factors (González 1998, 2000).
There has been an increase in separations and multiple sequential marriages in Colombia: 35 percent of all couples surveyed have been separated at least once (Presidential Council for Youth, Women and Their Families 1994). Zamudio and Rubiano (1991b) found that the primary causes for separations among Colombian couples were: infidelity, jealousy, or falling in love with another person, falling out of love or falling into a rut, and financial difficulties, in that order.
According to Gutierrez de Pineda (1975), there are four types of family structures: Andino, Santandereano, Negroide, and Antioqueno. These are characterized by the following factors:
Although these discrepancies are no longer as rigid as they once were, the general tendency continues to follow these traditional patterns (Gutierrez de Pineda 1975).
Infidelity is an important element in a Colombian marriage (González 1998). Murillo (1993) found that there were three males for every one female who engaged in extramarital sexual relationships. Nadar and Palacio (1989) found the same results. Nadar and Palacio also found that 30 percent of separations were a result of infidelity. Findings indicate that there is a greater incidence of infidelity for men as the socioeconomic levels rise higher. For women, infidelity is more common at the upper-middleclass levels (Rojas 1997). A common misconception is that a mans infidelity is less serious because he is biologically driven, whereas womens infidelity is not.
Colombian sexology has little literature regarding disabled and elderly persons. The prevailing attitude is that this population is nonsexual and has no need for sexual intimacy. In a recent study of adults over the age of 60, González and González (in press) found that 94 percent of the men and 24 percent of the women maintain sexual interactions with their mates; males engaged in sex every two weeks, whereas women engaged in sex on a monthly basis. Seventy-six percent of men and 36 percent of women reported that there was a decrease in gratifying sexual intercourse after the age of 60. It was reported that 88 percent of these older men and 30 percent of the women are satisfied with their sex life. Eighty-two percent of the men and 18 percent of the women reported that they continue to seek out their partners for sexual activity. Forty percent of the men surveyed reported having sexual relations with someone other than their regular partner. Eighty percent of men and 52 percent of women reported that relations with their partners are at least cordial. Forty percent of all women surveyed reported that they do not have a good relationship with their partners. Seventy-two percent of men and 50 percent of women reported that they continue to be affectionate with their partners. The authors believe that the predominant machismo values distort a couples lifestyle, resulting in resentful women.
Although there are no laws prohibiting anal sex and oral sex, they continue to be highly criticized in public and frequently practiced in private. Almost 80 percent of men and 70 percent of women have engaged in oral sex, now a regular part of foreplay (Eljaiek et al. 1987; González 1994, 1998).
There has long been an interest in homosexuality in Colombia. Behaviors that can be categorized as homosexual have been noted within the cultures that existed in Colombia during the arrival of the Europeans. However, the study of homosexuality is filled with methodological ambiguities. There are certain behaviors that may or may not be considered homosexual by todays societal standards. Even so, these behaviors existed long before the arrival of the Spaniards. As in other cultures, homosexual behaviors were found more frequently among men than women.
From the onset of studies on sexuality amongst Colombians, homosexuality was always an interest (Alzate 1978, 1982; Botero 1980; González 1985). It was found that there were differences in homosexual activity between men and women. In Bogotá, 28 percent of the men and 13 percent of the women reported having had same-sex relationships. Interestingly, there was a marked difference between the various cities in Colombia. These ratios are not limited to homosexual activities exclusively. It reflects the number of individuals who engaged in some type of sexual activity with someone of the same sex. It could have been an isolated incident and/or the regular practice of homosexual or bisexual behaviors.
José Fernando Serrano (1997, 1998), an anthropologist, has pointed out that the formation of the homosexual identity, as described by societal constructs, has been a long process. He reviewed sociological studies originating in Colombia and indicated which ones supported the argument of sexual orientation. He also argued the problem of collective identities at the international level.
The modernization of Colombia, which took place in the latter half of the twentieth century, enabled people to look outside their immediate society and expand their provincial traditions. It enabled them to study ideas from other countries, primarily from France and other regions of Europe, and the United States. The gay and lesbian liberation movements of Germany, several other European nations, and later from the United States slowly made their way to Colombia. Nevertheless, they had a great impact on the organization of the gay and lesbian movements. Modernization gradually brought about internationalization, globalization, and societal changes that influenced peoples private lives.
The beginnings of organized homosexual groups in Colombia began in 1970. Manuel Antonio Velandia, a sociologist and philosopher, initiated them. He associated with people who were interested in human rights, social change, and the general counterculture of the 1960s and 1970s on an international level. These gay and lesbian movements were difficult to organize, and were at times very short lived. Finally, in the late 1980s and 1990s, gay and lesbian groups succeeded in uniting and achieving their goals (Velandia 1999).
Velandia founded the Gay Liberation Group and the Homosexual Liberation Movement of Colombia in 1976. He also organized the first Gay Pride March in 1983 in Bogotá. These movements gained importance in 1998 and 1999 and included weeklong lectures on sexual diversity, collective identity, human rights, legislation, and other related topics. However, gay and lesbian communities are slow in coming. Although gay meeting places have been established since the 1970s, homosexual literature remains unseen. The first writings pertaining to the gay lifestyle - poetry, novels, theater, and soap operas - surfaced in the 1980s. This is not to discount earlier works by P. Barba Jacob. Today, soap operas and movies frequently touch on homosexuality.
The Constitution of Colombia, passed in 1991, prohibits discrimination in any form or manner. It recognizes that all people have the right to free personal development. The Constitution stipulates that homosexuals may not be discriminated against based on their sexual orientation. Sexual orientation that is not shared by the majority does not justify unequal treatment.
The rights given by the Colombian Constitution pertaining to sexual orientation during the 1990s have been favorable for homosexuals and bisexuals. For example, in April 1991, a law was passed that protects an individuals rights to free sexual identity. It affirms that homosexuality should be considered valid and legitimate. The Colombian Constitution also addressed the debate regarding homosexual educators. They determined that homosexuality has no bearing on an individuals ability to teach (in September 1998). Additionally, in July 1999, the Colombian legislature passed a law protecting homosexuals in the military. It states that individuals may reveal their status as homosexuals and continue to be held to the same norms and expectations as heterosexuals.
The Colombian legislature has defined the family as a union of a man and a woman (March 7, 1996). However, it went on to acknowledge the rights of partners, including same-sex couples, in terms of inheritance, transfer of assets, and financial support, among other things. There have been several attempts to legalize homosexual marriages, as has been done in several other areas, e.g., Denmark since 1989, Norway since 1993, Sweden since 1995, Iceland since 1996, Hungary since 1996, and Holland since 1997. In some cases, there exist legal sanctions against same-sex marriages because of the possibility of adoption. There are, however, gay activist groups who support the legalization of the gay family in all aspects, including adoption. The Family Pride coalition is one of the most important advocates of this movement.
One of the most recent proposals, in September 1999, sought to equalize the rights of homosexual couples with those of heterosexual couples. For instance, after two years of cohabitation, the couple may apply for Social Security benefits. Additionally, should the relationship end because of death, one partner may inherit the assets of the other. There already are companies in the private and public sectors that will allow an employees partner of the same sex to register for benefits.
Psychological studies regarding homosexuality, bisexuality, and homoeroticism have been conducted by Octavio Giraldo and his team (1979, 1981, 1982) at the University of El Valle. Similar studies have been lead by Ruben Ardila (1985, 1986, 1995, 1998) at the National University of Colombia.
Ruben Ardila has focused on sexual orientation in the studies he has conducted for the past 15 years. Some of the issues he has researched have been: adaptation of homosexual males, lesbianism, sexual orientation, heterosexual attitudes towards homosexuals, stability of the homosexual couple, the life cycle of homosexuals and lesbians, the biological aspects of homosexuality, politics as they pertain to homosexuality, and other related topics.
One such study looked at the adaptation of male homosexuals (Ardial, 1998). There were 100 subjects, between the ages of 18 and 52 years of age. They all scored a five or six on the Kinsey Scale (indicating predominantly or exclusively homosexual). The following factors were studied: depression, solitude, timidity, social alienation, interrelations with heterosexuals, interrelations with homosexuals, sexual practices, traditional values, religion, morals, conformity, acceptance of homosexuality, emotional stability, guilt, concept of homosexuality as a mental illness, effeminacy, responsibility, interrelations with the opposite sex, secretiveness of homosexuality, personal adjustment, and psychosomatic symptoms.
The results indicate that Colombian homosexuals are well adapted and do not present any pathological qualities. However, 10 percent manifested signs of severe depression, while 44 percent were highly stable. Only 4 percent reported feeling guilty about their homosexuality. Fifty-nine percent stated that they had positive interpersonal relations, and 48 percent accepted their homosexuality. For further material on diverse aspects of sexual orientation for both women and men, see the References and Suggested Readings section.
Our society, based on the Judeo-Christian faith, has a very negative attitude towards homosexuality. Homosexuality is viewed as a violation, an illness, or a deviation from the norm that threatens normal behaviors and society. This homophobic view has permeated Colombian society throughout its history, although, there have been different levels of acceptance, depending on the individuals level of education, rural-versus-urban setting, age, and their affiliation with the Catholic Church. There is a deeply rooted belief that homosexuals are a threat to society, good upbringing, and family values. Similarly, homosexuality is thought to be related to child sexual abuse, AIDS, substance abuse, delinquency, and other serious social problems.
Homosexuals are discriminated against in education, in the workplace, in housing, in the mass media, and generally in daily living. This homophobia has its origins in the Latin-American cultures, which practice machismo, emphasize the importance of the family unit, and are highly influenced by the Catholic Church. In spite of this, the situation has considerably improved in recent years, from the homosexual liberation movements in the 1970s to the legislative, medical, and psychological advances that occurred later. In the larger cities of Colombia, especially those with higher levels of education, homosexuals are accepted. They are respected and are considered equal to heterosexuals. In these areas, discrimination is hardly noticeable. It is no longer believed that male homosexuals are less masculine than heterosexual males or that lesbians are any less feminine than female heterosexuals are. Additionally, there are certain groups within the Church who have worked towards improving the quality of life for gays and lesbians. Social support has shown improvement, which will then lead to a more pluralistic, diversified, and egalitarian society.
In the first group, one encounters heterosexual and homosexual transvestites and a few male-to-female transsexuals who were born and raised in lower-class environments and have socially isolated themselves in areas dedicated mostly to prostitution. Because of the almost non-existent control over the sale of hormones in the country, it is quite easy for such people to seek physical changes through auto-medication with estrogen. This type of hormonal auto-medication normally starts during adolescence and has the effect of changing the body type to the feminine phenotype, even though the vast majority of this group will not seek surgical sex reassignment.
Given the context of the social problems encountered by people living in poverty, members of this first group become sexually active at a very early age and soon transition to promiscuity and prostitution. A few work as strippers in the clubs that are very common in the prostitution areas of the big cities. A few others, under the auspices of transformists, work as singers or actresses in nightclub shows. Very seldom, and only if sex-reassignment surgery is involved, will someone from this group obtain some type of professional therapy through the almost non-existent public health system. Members of this group also have received some help and orientation from non-governmental agencies involved in the prevention of HIV infection.
The following quote perfectly demonstrates what happens to members of this group:
I began to dress permanently as a woman and take hormones when I was 18, and that provoked adverse emotional reaction from my parents who kicked me out of the house. They accepted me as a homosexual but not as a transsexual. The only place that accepts me as I am is the brothel where I go to work when I need money. (Authors clinical notes)
The second group is composed of those who belong to the upper classes, many of whom have college degrees and work as professionals. This group is currently composed of transvestites, fetishist transvestites, and some transsexuals who have access to information regarding their sexual identity, especially through the Internet. Some have their own Web pages and communicate among themselves, taking advantage on the initial anonymity of cyberspace to better understand themselves. Even though this group has the means to obtain professional help and counseling through private practice, they seldom do so. This is because of the fact that many therapists have no knowledge on the subject, and some even have a negative attitude to those who approach them with these problems. In the words of one client in this group:
In the anguish of my situation I went to a psychiatrist who referred me to the best sex therapist in this city. In our first meeting, the sexologist was very frustrating and I felt offended and attacked. I never returned. (Authors clinical notes)
In recent years, sex-reassignment surgery has been performed in large cities like Bogotá, Cali, and Medellín.
Colombian law considers child sexual abuse a crime under Articles 303, 304, and 305 of the Penal Code. It is calculated that one Colombian child is sexually molested every six hours (Afecto Foundation 1999). In the great majority of cases, the aggressor is a person the victim knows (Florez & Consuegra 1998). These authors studied the cases of 80 girls under the age of 15 in the urban area of Barranquilla. In 53 percent of the cases, the aggressor was someone the victim knew but was not a family member, 41 percent of the perpetrators were family members, and only 6 percent were complete strangers. In 1.25 percent of the cases, pregnancy was a consequence.
Incest is also considered a crime under Article 259 of the Penal Code. Even though there are no reliable statistics, it is widely calculated that incest is a common phenomenon. In a recent survey conducted in the four largest cities, Semana (1999) found that 3 percent of males and 1 percent of females had had sexual relations with the father, mother, or a sibling. In Colombia, 2 million children are victims of abuse, 850 of whom were in critical condition at the time of the Afecto Foundation survey (1999).
In Colombia, an estimated 148 of every 1,000 Colombian children are abused in some way. Of these 148, 100 are verbally abused, 40 are physically abused, and 8 are sexually abused (El Tiempo 1999).
Rape is considered a crime under Article 298 of the Penal Code and does happen with some frequency. Profamilia (Planned Parenthood of Colombia; 1995) found that 5.3 percent of women in the fertile age group have been forced to have sexual relations. Before 1996, forced sexual relations within married couples were not considered a crime. With the creation of Law 294 under Article 25, forced sexual relations within married couples are now a crime.
Spousal abuse is a very common phenomenon. In 1996, of the 42,963 cases seen by the Legal Medicine group, 71 percent involved spousal abuse. Of those cases, 95 percent of the victims were women, with a ratio of 18 women for every man. The group at most risk of abuse are women between the ages of 25 and 34. In a 1998 study in several Colombian cities, 14.3 percent of the persons interviewed said that they had been attacked by their spouses (El Tiempo 1998). Further interviews showed that 60 percent of the women had been verbally, physically, psychologically, or sexually attacked by their husbands or partners. Twenty percent were physically attacked and 10 percent were forced to have sexual relations with their husbands (Profamilia 1995). Most of these women tried to solve their problems without the intervention of the police or other governmental agencies. Most of these women were completely passive regarding the attacks of their partner. Most battered women say that the main causes of the aggression are drunkenness and jealousy on the part of their partners. The most common physical abuses are punches 88 percent, kicks 27 percent, and shoves and pushes 24 percent. In 35 percent of the cases, the episode is observed by a child (Profamilia 1995).
Prostitution is considered a crime under Articles 308, 309, 311, and 312 of the Penal Code. In 1998, the Renacer Foundation estimated 30,000 Colombian boys and girls were engaged in prostitution. At the same time, the Foundation estimated that there were 90,000 sex workers in the country. The sex trade seems to be increasing in the past five years, particularly in the tourist areas and with minors. In the most recent government administrations, there has been a greater emphasis on efforts to combat situations, such as the sex trade, that are problematic to the community.
Pornography possession and its use among adults are not crimes. Article 312 of the Penal Code does limit and penalize the circulation of pornographic material for minors under age 18 years. Pornographic movies can be seen or rented with great ease in the cities. Pornographic magazines circulate all over the country. A 1999 survey by Semana shows that 48 percent of men and 35 percent of women think that pornographic movies and magazines make their sexual life more interesting. Regarding pornographic magazines, 13 percent of men and 3 percent of women reported having read one in the previous 30 days. It is also interesting to note that 16 percent of men and 44 percent of women had never read a pornographic magazine in their lives. As for pornographic movies, 21 percent of men and 6 percent of women confirmed having had seen a pornographic movie in the previous 30 days. Also, 14 percent of men and 39 percent of women stated that they had never seen a pornographic movie in their lives. In the large cities, live sexual shows are performed, but 65 percent of men and 85 percent of women claimed they had never seen one (Semana 1999).
The new digital media, Internet, and World Wide Web have also been affecting sexual relationships: 17 percent of men and 4 percent of women affirmed having visited a pornographic site on the Internet. Also, 14 percent of men and 4 percent of women admitted to having engaged in phone sex.
Birth control, more commonly known as family planning, was introduced in Colombia in 1964. It was managed under the sponsorship of population and medical specialists. The objective was to improve the health of women and their children, to facilitate the growth of women in areas related to motherhood, and population control.
Although the majority of Colombians practice Catholicism, which prohibits the use of any type of artificial birth control, economic and social needs, marital instability, and constant changes in the family structure have led to the acknowledgment of the civil rights of all couples and their children. Thus, the contradiction between what is forbidden by the Catholic Church and what is practiced by the general public has led to an appreciation of the right to the enjoyment of sexuality without the burden of pregnancy. The majority of people continue to practice Catholicism without feeling the guilt put upon them by the Church regarding birth control. Close to three quarters of all women in a relationship, 72.2 percent, utilize some method of birth control. However, for every six women using birth control, only one man uses a contraceptive (Profamilia 1995). Table 2 shows a comparison of the use of birth control worldwide and the usage in Colombia in 1995.
The most commonly used methods of birth control are tubal ligation and vasectomy. Recently, Colombias Social Security System and medical service providers, the equivalent of Medicaid in the United States, now fund these procedures. In the past, they may not have been funded by the government out of deference to religious authorities rather than for economic reasons. Nonetheless, the cost of unwanted pregnancies and abortions reinforces the current position.
Oral contraceptives are the second most frequently used contraceptive method. According to Article 100 of the Social Security act, provision of oral contraception is mandatory. However, 70 percent of Colombians who use oral contraceptives obtained them through the private sector, whereas 30 percent obtained them through the public sector. This evident lack of active participation by the state would suggest that most families prefer to incorporate the cost of oral contraceptives into the family budget rather than rely on the government.
Colombia has several laws that protect the rights of women and children; however, implementation is often lacking. Family planning is viewed as an individuals right and an obligation of the state. The Constitution of 1991, Articles 17 through 30, denounces all forms of discrimination against women: Women have civil rights as they pertain to reproduction and the judicial system equal to men in education, nationality, employment, health, matrimony and family. Two other articles deal with pregnancy and children:
The aforementioned legal structure allows us to reflect on how little the state is actually doing to defend the rights of individuals, and, in failing to acknowledge the discrimination, women suffer within Colombias poorly organized health system.
One out of every ten adolescents has had sexual relations between the ages of 13 and 14 years. Four out of every ten adolescents have had sexual relations between the ages of 15 and 17 years. Seven out of ten have had sexual relations by the time they reach the age of 18.
One out of every three adolescents believes that abortion is unacceptable; however, 70 percent feel that it may be necessary in certain situations. Sixty-two percent have had some discussion on sexually transmitted diseases and 95 percent understand that anyone can contract AIDS. The contraceptive methods most commonly used by adolescents are: the condom (94 percent), oral contraceptives (77 percent), and contraceptive suppositories (60 percent). The rhythm method is the least-used method (42 percent), which coincides with womens lack of awareness of their menstrual cycle (Profamilia 1995).
There has been an increase in birth rates among adolescents. This may be because of several factors: earlier onset of puberty, earlier onset of sexual activities, low socioeconomic levels, low levels of education, increased age for marriage, changes in value system because of urbanization, and the increased ability of communication.
According to a study conducted by the University of Colombia (Universidad Externado de Colombia 1992), one third of all women between the ages of 15 and 19 years, of low educational level, and who had at least one child, were single, lived in an urban area, and were more fertile than their counterparts living in rural areas.
Profamilia (1995) reported that 17 percent of women between the ages of 15 and 19 years were mothers or were pregnant at the time of the study. At the age of 19, four out of every ten women surveyed were mothers and 9 percent already had at least one child. It was also reported that 33.6 percent did not utilize birth control because they believed that they were infertile. Ten percent of these women and 2.8 percent of their contemporaries are opposed to the use of birth control. Three percent were unfamiliar with birth control methods and 7.9 percent were afraid of the side effects. These results reflect the lack of adequate information, existing myths, unawareness, and a lack of responsibility in spite of knowing the consequences.
Pregnancy in adolescents brings with it many consequences, including compromised physical and mental health and both economic and social challenges, which affect the mother, father, and child, as well as the family and society as a whole. The education dropout rate in this population is very high, leading to limited employment opportunities. Children born of adolescents show a higher incidence of prematurity, lower birthweight, more congenital diseases, and a higher incidence of abandonment and abuse. It is estimated that about 10 percent of children of teenage mothers are given up for adoption (Pardo & Uriza 1991).
The actual incidence of abortion in Colombia is unknown. It is estimated that 24 percent of all pregnancies end in abortion and 26 percent result in unwanted pregnancies (Profamilia 1995). In a 1992 study, The Incidence of Abortion in Colombia, researchers at the Universidad Externado de Colombia found that 30 percent of urban women between the ages of 15 and 49 years had had at least one abortion, with the highest incidence among women between ages 20 and 29 years. In at least 78 percent of those cases, no birth control was utilized; the remaining 22 percent had used a birth control method that failed and resulted in pregnancy. There is a 22-percent incidence of abortion among women ages 45 to 49 years of age, and a 19.4-percent incidence of abortion among women ages 50 to 55. A third of the women surveyed reported that they had been pressured by their partners to abort.
Abortion is illegal in Colombia, and women go to health clinics much too late in the pregnancy when they show complications that cannot be resolved on their own. Complications are the most common reason for aborting, and abortion is the leading cause of death for Colombian women. There is an estimated 300,000 illegal abortions yearly. In other words, for every 10 births, there are four illegal abortions, and one out of every 100 women between the ages of 15 and 49 years old has had at least one abortion. The women most likely to abort are those who failed to use contraceptives.
The majority of families in Colombia are rooted in the traditional patriarchal family structure, based on economic, political, and religious power, which conditions women to utilize family planning methods. However, contraception should not be limited only to birth control. The meaning and implications of contraception should also include the significance, attitudes, and values people place on relationships, affection, and sexuality. These factors should take us beyond the stereotypes created by patriarchal gender roles, thus facilitating a better understanding of the individual, their health, and their relationships (Londoño 1996). In this extended meaning of contraception, it is necessary for women to acquire higher educational levels to attain better employment opportunities. They should be able to access better social security and health systems. The medical assistance model should not be solely based on doctors and technology, but also on the premise of caring for ones self and gaining the knowledge women need to balance, preserve, and improve their health.
Since the introduction of contraceptives in the mid-1960s, Colombias population growth rate has decreased steadily. Between 1980 and 1995, Profamilia estimates the population growth rate decreased by 23 percent. On average, there were 7 children born per family in the 1960s. In early 2001, the average Colombian family has 2.8 children per family. However, the averages vary from region to region. In the mountainous regions, the average family size is 4.3 children. Education level also plays an important role in determining the number of children per family. On average, there are 5 children per family for women with no formal education versus 1.8 children per family for women with higher levels of education (Profamilia 1995).
A true evaluation of the incidence of sexually transmitted diseases (STDs) is very difficult in any country, because the percentage of actual cases is considerably higher than the number of cases reported to health officials. In 1994, the Institute of Social Security found that 2 percent of Colombian males and 1.1 percent of females had some type of STD. The most common infections were gonorrhea, condylomas (warts), genital herpes, and syphilis. The majority of cases occurred in people between the ages of 15 and 44. Useche (1999) found that 4 percent of male students in high school reported some type of STD. Zuluaga and contributors (1991) found that 16.4 percent of male and 2.4 percent of female Mendellin University students had had some type of STD, the most common being gonorrhea and condylomas. Among university students from Baranquilla, González (1985) found that 13 percent of males and 1 percent of females had had some type of STD. In a follow-up study ten years later, González (1995) found that 12 percent of males and 2 percent of females had had some type of STD, with gonorrhea being the most prevalent. In the last few years, the incidence of STD cases has grown considerably. This is in part because of teenagers having sexual relations earlier that in previous times, teenagers having sex without protection, and cultural stereotypes that only sex workers can get STDs and not promiscuous men. When the increase in STDs is compared to the increase in the population, however, one can actually see a slight decrease in the overall percentage of STDs in the population.
Although the actual incidence of STD infections is not known, there has been a large increase in the number of new diagnosed cases, in conjunction with other infections like gonorrhea, syphilis, non-gonococcal urinary tract infections, trichomonas, and HIV. Ninety percent of the pre-cancerous lesions in the uterine matrix test positive for the papilloma virus. Between 75 and 80 percent of the atypical cell cultures in women between the ages of 15 to 25 show infections of the human papilloma virus. Based on this, when tested, 40 percent of their partners are also infected by the disease.
The number of congenital syphilis cases has decreased in Colombia. In 1998, the following number of cases were reported in Colombia by region. Costa Altántica, 64; Amazonia, 25; Orinoquia, 21; Oriente, 193, including Boyacá, Cundinamarca, Satanderes, Tomolina, and Bogotá; and Occidente, 347, including Caldas, Antioquia, Chocó, Quindío, and Valle. Two cities in the Occidente must be highlighted: Antioquia with 99 cases and Valle with 149 cases. The incidence of reported cases of congenital syphilis is 36.6 cases per 100,000 live newborns (Ministerio de Salud 1998, 1999).
There are some formal programs available for the treatment of STDs. However, they are poorly organized and not fully developed as of early 2001.
On January 5, 1983, a 23-year-old woman, a known prostitute, was hospitalized at the University Hospital of Cartagena. She died four months later. She was the first person to be officially diagnosed with AIDS in Colombia (González 2000). According to the Colombian Coalition Against AIDS, there are 200,000 people living with HIV (González et al. 2000). Every hour someone new is infected.
In 1997 and 1998, 81 percent of all reported cases were between the ages of 15 and 44 years (Ministerio de Salud 1998). Even though the group most at risk for contracting AIDS are adolescents, the general public continues to remain unaware of the dangers involved. Of households with children under the age of 18 years, 63.3 percent believe that they were not at risk of contracting HIV/AIDS. There was no discussion on AIDS prevention in 39 percent of households where there were minors under the age of 18 years.
According to the Colombian Ministry of Health, in 1986, there was one woman for every forty-seven men infected with HIV. In 1997, the ratio was one woman to four males. It is estimated that in 2001, the ratio will be 1:1. The risk among women is quite high and is believed to be related to the social inequity between men and woman. Women are kept at the subordinate level socially, by marital status, and economically, which contributes to their inability to adequately protect themselves. Consequently, religious beliefs that reject the use of condoms, anal sex at the insistence of the male, failing to acknowledge adultery for fear of being accused of infidelity, all these factors and other similar ones lead to an increase in HIV/AIDS-positive women (Penagos 1997).
Sexual contact constitutes the primary mode of transmitting HIV/AIDS (Ministerio de Salud, 1998). For females, heterosexual contact accounted for 91.5 percent of cases of HIV infection, blood transfusions for 1.7 percent, and 6.8 percent became infected during delivery or perinatally. (No percentage was given for other modes of transmission, notably intravenous drug usage.) In men, 56.1 percent contracted HIV through heterosexual relations, 41.8 percent through homosexual/bisexual contact, perinatal transmission was 0.7 percent, and by transfusions were 1.4 percent.
One of the most important factors contributing towards the transmission of AIDS is the lack of adequate information. González (2000) conducted a study with university students, in which the following information was found:
The study also found that 80.2 percent of men and 88.5 percent of women believe that there is a high risk of contracting AIDS while having unprotected sex with someone you do not know. Fifty-six percent of men and 66.9 percent of women believe that there is a high risk of contracting AIDS while having unprotected sex with an occasional partner; 14.8 percent of men and 16.1 percent of women believe that there is a high risk of contracting AIDS while having unprotected sex with a regular partner. As is evident, there is a popular misconception that AIDS can only be transmitted through unprotected sex with a one-time partner or an occasional partner. Consequently, people who are in new (exclusive) sexual relationships fail to practice safe sex. They do not take into account previous sexual partners nor have they taken an AIDS test (González et al. 2000). Generally, there is minimal use of condoms. González and colleagues (2000) found that 33 percent of males and 53 percent of females have never used condoms during vaginal penetration. It was also reported that 48.4 percent of men and 63.2 percent of women never used condoms during anal sex.
The Colombian Constitution of 1991 enacted laws that protects the rights of all citizens. These laws stipulate that anyone living with HIV/AIDS, with or without financial means, can receive social security benefits. Although there exists budgeting and administrative problems that may delay the process, everyone has the fundamental right to medical care, psychological care, and pharmacological care. Generally, those individuals living with HIV/AIDS have access to antiviral medication.
On June 12, 1997, the Colombian Ministry of Health passed Decree #1543. It provides a standardized protocol for people with AIDS that indicates their rights and obligations. The protocol is as follows:
The decree also created CONASIDA (National Council on AIDS). It is comprised of the Ministry of Health, Ministry of Education, Ministry of Communication, Ministry of Employment, Colombian Institute of Family Wellness, National Institute of Health, Public Defendants, the Institute of Drug Administration and Regulations, ONUSIDA (AIDS Organization of the United Nations), representatives from non-governmental organizations (ONGs), and advocates for AIDS victims. Generally, people who are living with AIDS are involved in political development and decision-making processes, as recommended by ONUSIDA. Presently, the ONGs are changing the image of AIDS from a terminal disease to a treatable chronic disease.
AIDS-prevention programs and assistance to victims of AIDS are faced with serious financial problems. There have been government budget cuts since 1998. Additionally, discrimination and rejection of AIDS victims are two problems that must be addressed in health and sexuality.
Until the 1980s, sexual dysfunction was unknown as a health-related problem. Traditionally, treatments for sexual problems were seen as something unnecessary and even excessive. Generally, people who suffered from sexual dysfunctions failed to seek professional help because of embarrassment or guilt, even though, for more than 50 years, there have been private institutions in Colombia that provided sex therapy (González 1999c).
In the last five years, there has been an important change in the outlook on sexual dysfunction. The National Program on Sexual Education has generated a change in attitude towards sexuality and sexual health. There are now a few professionals who specialize in clinical sexology. An association of professional sex therapists has yet to be organized. In the next few years, there will be an increase in the quantity and quality of sex therapists because of the high demand for their services.
Dr. Rodriguez A. (sic) was the pioneer in sexual therapy in Colombia (González 1999c). He studied abroad in France, where he specialized in reflexology. In the late 1940s, he returned to Santafé de Bogotá, where he founded a clinic for sexual dysfunctions. He trained prostitutes in collaboratively assisting in his patients treatments. This is what is now called sexual surrogates, or bodywork therapists. However, an animosity developed between Dr. Rodriguez A. and his colleagues that resulted in lawsuits and other legal problems. Consequently, Dr. Rodriguez A. closed his institute in Santafé de Bogotá (Guerrero 1997) and shortly thereafter opened a sexual therapy clinic in Fusagasuga. He died in the late 1970s.
In the late 1960s, a group of doctors and psychologists, including Heli Alzate, Cecilia Cardinal de Martin, Octavio Giraldo, and German Ortiz Umana, developed an interest in sexology and sexual therapy. In 1968, Heli Alzate offered the first formal courses in sexology to medical students attending the University of Caldas in Manizales. Octavio Giraldo offered courses in sexology to medical students at the University of El Valle. In 1971, Celcilia Cardinal de Martin and German Ortiz Umana offered coursework in sexology at the University of Rosario de Bogotá. José Manuel Gonzáles initiated the coursework in sexology in the Metropolitan University of Barranquilla in 1976. Luis Dragunsky offered coursework on sexology at the University of Santo Tomas in Bogotá in 1977. During this time, the first texts on sexology were published: Medical Sexology in Summation (Alzate 1978), Lectures in Sexology (Dragunsky & González 1979), and Exploration of Human Sexuality (Giraldo 1981).
In May 1978, the Colombian Institute on the Development of Advanced Studies (ICFES) brought together a group of specialists to discuss and evaluate the state of sexology as a science: Heli Alzate, Cecilia Cardinal de Martin, Octavio Giraldo, José Manuel Gonzáles, and German Ortiz Umana. They generated an important document, which stated specific recommendations (ICFES 1978). As a result of this meeting, the participants felt a need to develop a committee that would coordinate the efforts and publicize the findings of studies that would support the development of sexology in Colombia.
One year later, the Colombian Association of Sexology was founded in June 1979. The original founders were: Heli Alzate, Maria Clara Arango, Mario Bedoya, Cecilia Cardinal de Martin, Luis Dragunsky, Mario Gartner, Octavio Giraldo, José Manuel Gonzáles, Maria Ladi Londoño, Saulo Munoz, German Ortiz Umana, Francisco Sanchez, and Jorge Villarreal Mejia. The elected president was Heli Alzate. As a consequence, sex therapy has developed its own niche in the larger cities. The group in Manizales has generated the most investigations and published internationally. The Cali group, with Octavio Giraldo, Mari Ladi Londoño, Javier Murillo, Diego Arbelaez, Nelssy Bonilla, Monica Lozada, and other colleagues, has been most active in advocating for the rights of minorities and the oppressed: women and homosexuals. Two other active groups, in Bogotá, Medellín, have pioneered in the treatment of premature ejaculation, erectile problems, patients suffering from various psychosexual dysfunctions, prolonging the pleasure phase, transsexuals, and interesting ways of dealing with infertile couples (Acuña et al. 1997).
Sex therapy in Colombia is marked by several characteristics (González 1999c):
There has been active participation by most sex therapists in the events sponsored by the Colombian Association of Sexology.
Generally, scientific studies in Colombia are very scarce and poorly funded. In 1999, the total budget earmarked by Colciencias, a government body responsible for all studies conducted in Colombia, was approximately US$6,000,000. Only recently have there been doctoral programs in the basic sciences. However, there are no doctoral programs offered in disciplines that could directly contribute towards the study of sexology, such as physiology, anthropology, psychology, or sociology. It is in this context that we must understand the limited development of the study of human sexuality in Colombia.
In recent years, Abel Martinez of the University of Pedagogy and Technology of Tunja has specialized in the study of Colombian Sexual Archeology (unpublished). He presents a poetic description of sexuality during the Spanish Conquest, colonization, independence, and the beginning of the Republic. The study of the mythology of the aborigines and the key role the erotic played in the blending of the races is evident throughout his work. In Daughters, Wives and Lovers, anthropologist Suzy Bermudez discusses the same time frame covered by Abel Martinez, the Spanish Conquest to the Republic. However, she took a feminist perspective, dealing with native women, European women, African slave women, married women, widows, and single women. Although it was not her main objective, Bermudez attempted to clarify how social class, ethnicity, and age play an important role in understanding the history of womens sexuality in Colombia.
In the second half of the twentieth century, Virginia Gutierrez de Pineda (1975) led an important anthropological investigation that set the foundation for the comprehension of human sexuality for Colombians. In her analysis and classification of the various cultural elements that correspond to the different regions of Colombia, Gutierrez explained the logic behind the different types of marriages and polygamy, and the significance of prostitution and homosexuality thought to be tolerated but tacitly encouraged by religious subcultures in hopes of preserving young womens virginity and protecting the institution of matrimony. Her description of families in the second half of the twentieth century is considered to be a key reference for anyone wanting to study the changes in the sexuality of Colombians at the end of the century.
Heli Alzate, another pioneer of sexology in Latin America, developed an extensive and rigorous curriculum for the School of Medicine at the University of Caldas. He also published four books and numerous scientific articles in North American and European publications. A member of the editorial committee of the Archives of Sexual Behavior for a quarter-century, Alzate has theorized a conceptual model of the function of erotica and completed three studies pertaining to sexuality:
Alzate also evaluated the knowledge and sexual attitudes of his medical students with an adapted version of the Sexual Knowledge and Attitude Test, or SKAT, originally formulated by Harold Lief. Later results from his modified SKAT, or ACSEX, indicated that it is possible to impart scientific knowledge and achieve a positive attitude towards sexuality utilizing coursework in sexology, audiovisual media, and active class participation from medical students.
The studies of the sexual behavior of the younger generation with secondary- or university-level education in one of the most traditional and conservative areas of Colombian culture give a fair picture of the evolution of Colombian sexuality in the past quarter-century, the incidence of first sexual encounters, the motives behind sexual activity, the types of couples, and above all the differences in sexual behaviors between genders.
Of particular interest, in view of the significant growth of the womens liberation movement in recent years in Colombia, are several studies on the erogenous zones of the vagina. According to these studies, the majority of women, if not all, have vaginal erogenous zones, frequently located in the anterior vaginal wall, which, if stimulated appropriately, will culminate in orgasm. Colombian researchers consider this a vital factor in the context of normal sexuality of the woman and also as important in the treatment of coital dysfunctions of women. Alzate believes that the theories, that have thus far been conceptualized to explain these sexual dysfunctions, should be revised. He also believes that sex therapists who are confronted with these issues should recognize the necessity of referring clients for gynecological exams so as to locate their erogenous zones (Alzate 1997b). Alzate also introduced modifications of the human sexuality functioning model originally proposed by William Masters and Virginia Johnson and later enriched by Helen Singer Kaplan. Alzates premise was to seek out and responsibly enjoy pleasure. Presently, there are no other systemic studies by Colombians in the field of sexology other than those provided by Alzate.
At the international level, publications by Colombians in the area of human sexuality are very scarce, almost non-existent. However, there have been other unpublished works that originated in Colombia. Florence Thomass 1994 Dissertation on Love and Communication analyzed communications from a gender perspective, and Guillermo Carvajal (1993) completed a psychoanalytic vision of the adolescent. Pedro Guerrero (1985) led a study on the use of erotica in literature by some of the most prominent writers in Colombia, and Maria Ladi Londoño has published numerous articles dealing with sexuality and reproductive rights. In a recent study, also of note, is Ruben Ardilas 1998 study of 100 male homosexuals, which found that generally these individuals did not have serious adaptation problems, nor did they seem to suffer from adjustment issues.
The Latin American Journal on Sexology of Colombia (ISSN 0120-7458), with a base in Colombia, serves as the medium for the Latin American Federation of Sexological Societies and Sexual Education (FLASSES).
The Colombian Society of Sexology, founded in 1979, has organized ten congress meetings, several seminars, and other academic events. These have involved world-renowned researchers, among others, Eli Coleman, John Money, Ira Reiss, Eusebio Rubio, Luis Dragunsky, Joseph LoPiccolo, Andres Flores Colombino, and Ruben Hernandez.
Other sexological studies in Colombia have been conducted by students in their post-graduate studies. These are generally non-funded and usually remain unpublished. Some of these studies have originated from the University of Bogotá (Bodner et al. 1999), University Simon Bolivar of Barranquilla (González 1999b; González et al. 2000), and the University of Caldas in Manizales (Useche 1999). Since the Ministry of Education established the National Project on Sexual Education in 1993, there has been a significant increase in the need for these studies. Private universities have thus developed them.
In terms of the future, we hope that the small group of dedicated and diverse Colombian professionals interested in sexological issues will be able to continue their work with sexological organizations and individuals around the world, and thereby contribute to a more solid and in-depth understanding of human sexuality, if the economic crisis in Colombia allows.
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