中文翻译：彭晓辉(中国 武汉 华中师范大学生命科学学院，430079)完成时间：2006年3月
Peng (Life Science College of CCNU, Wuhan, 430079, China)
校 对：吴敏伦(中国 香港 香港大学医学院)完成时间：2006年8月
策略 2.2: 把性教育适当地整合于公共教育机构的普通课程
策略 2.3: 为精神和身体残障者提供全面的性教育
策略 2.4: 为特殊群体(例如:囚犯、非法移民、被收容者和无家可归者)提供他们有权得到的全面的性教育
策略 2.5: 为其它群体(例如：合法移民、持少数民族语言群体和难民)提供他们有权得到的全面的性教育
策略 2.6: 整合大众媒体的力量，让其做出努力以传播和促进全面的性教育
目标 3: 对工作在性健康相关领域的专业人员提供教育、培训和支持
策略 3.1: 为卫生保健及其相关人员提供性健康教育和培训
策略 3.2: 为学校教师提供性健康教育和培训
策略 3.3: 促进性科学(性学)成为一个专业/学科
目标 4.: 为全区域人口制定和提供他们有权享用的全面的性卫生保健服务
策略 4.1: 把性健康事务整合于现有的公共卫生保健计划
策略 4.2: 为全区域人口提供他们有权享用的全面的性卫生保健服务
策略 4.3: 为精神和生理残障者提供他们有权享用的全面的性卫生保健服务
策略 4.4: 为特殊群体(例如：囚犯、非法移民、受收容者和无家可归者)提供他们有权享用的全面的性卫生保健服务
策略 4.5: 为其它群体(例如：合法移民、少数民族语言群体和难民)提供他们有权享用的全面的性卫生保健服务
目标 5: 促进与赞助性*和性健康领域的研究和评估，传播由性与性健康所衍生的知识
策略 5.1: 促进性*研究和性评估。
策略 5.2: 促进性科学成为一门理论学科。
策略 5.3: 促进性科学的跨学科 (例如：护理学、社会学、人类学、心理学和流行病学等等)研究。
策略 5.4: 确保在性科学的研究成果充分地传播给政策制定者、教育家、健康保健服务提供者，以给他们的工作提供研究基础。
attainment of health is a priority in all societies. For
comprehensive health to be achieved, Sexual Health must be
promoted and maintained. The considerable advances in the Region
of the Americas in many areas of health care would be reinforced
by a renewed emphasis on the prevention and care of sexual
concerns and problems. In particular, there have been
significant efforts in the area of reproductive health and the
prevention and control of HIV/AIDS. The expert working group
agreed that the basic goal of improving health could be achieved
in a more efficient manner if a more comprehensive approach to
sexuality, such as the conceptualization proposed in this
document, is taken.
health is a comprehensive concept. Actions and strategies aimed
to its attainment and maintenance should improve health and,
therefore, increase personal and societal well being.
addition to a comprehensive approach to improving health, the
expert working group agreed that recognition of human rights is
an effective way of promoting social, political, legal, and
cultural changes. The WHO has recognized health as a basic human
right 40. Promotion of Sexual Health required changes
in society, policies, laws and culture and therefore its
promotion within a human rights approach is recommended.
example, the United Nations Development Program (UNDP)
established an official policy that states:
rights are based on respect for the dignity and worth of all
human beings and seek to ensure freedom from fear and want.
Rooted in ethical principles (and usually inscribed in a
country's constitutional and legal framework), human rights are
essential to the well being of every man, woman and child.
Premised on fundamental and inviolable standards, they are
universal and inalienable 41.
expert working group recommended the following five goals for
governmental and non-governmental agencies and institutions
including the health sector of the Region of the Americas:
expert working group also identified a number of strategies for
the implementation of the above list of goals. They are
considered in the following sections.
health is to be promoted in all members of society. The expert
working group stressed the need to recognize the sexual rights
of all individuals, including persons with mental and physical
to promote Sexual Health will be more efficient if all
components of sexuality are taken into account, instead of
utilizing only partial approaches. Accordingly, integration of
Sexual Health into public health programs should include
provisions for the dimensions of Sexual Health (e.g., emotional
attachment/love development, gender development and,
pleasure is a dimension of the human being that has been
frequently denied as a positive, rewarding, health promoting and
basic human need. Recent evidence has shown that the importance
of erotic experience has implications even at the physiological
pleasure has been even more strongly stigmatized when it is
experienced as autoeroticism (usually referred to as
masturbation). However, there is no evidence in the scientific
literature of the deleterious effects of this behavior.
Moreover, there is consensus among clinical sexologists that
promotion of autoerotic behavior is beneficial in the treatment
of a variety of sexual dysfunctions. In addition, the value of
autoeroticism has been found to be an important tool in the
promotion of safer sexual behavior 43.
the stigma about sexual pleasure has caused the elimination of
any mention to pleasure in many sexuality education programs.
This omission affects health care seeking behavior. People with
problems or concerns regarding their sexual pleasure seek
professional help with much less frequency than would be
expected in view of the prevalence of Sexual Health problems 44.
importance of healthy emotional attachment/love cannot be
underestimated. There is a long-standing awareness among
behavioural scientists of the importance of a healthy and loving
environment. In more biologically oriented studies, early life
experiences involving touching have been shown to be necessary
component of development and critical for maturation of the
central nervous system 45.
is abundant evidence that public health concerns and problems
are better approached if actions for prevention and treatment
are integrated into broader health programs. Although specific
actions implemented in specific programs are required, it is
indispensable to have Sexual Health integrated into public
following specific actions for this strategy were identified:
specific national Sexual Health strategies and plans.
legislation that ensures the feasibility of the national Sexual
a Sexual Health approach into existing health programs.
indicators of Sexual Health to be used in policy and program
development and evaluation.
consensus in the definition and classification of sexual
best practice guidelines for sexual problems 46.
the groundbreaking work of theoretical and empirical feminism,
more and more evidence has emerged as to the links between
gender and health 47. Particularly the ICPD and
Beijing Conferences have contributed to the idea than unless
gender is taken into account, health-related developmental goals
achieve this strategy, actions are required that cover a very
wide spectrum from changes in policies that seem not related to
health issues, to awareness building as to the specific health
needs of women and men. These actions go beyond the recognition
that sexual relations are gender relations. Notwithstanding the
debate that places conceptually gender within sexuality or
gender and sexuality as part of one system, it is obvious that
Sexual Health cannot be approached without due consideration to
gender and its power implications.
of the components of this strategy include:
to introduce and change public policies that have an impact on
gender disparities such as promoting schooling and formal
education for girls
of a gender perspective in the planning and implementation of
Sexual Health services. For example such simple matters as
taking into account the differences in time availability for men
and women to attend health care facilities.
that comprehensive sexuality education always includes gender
analysis and particularly stresses the right of men and women to
sexual equity and equality.
actions that facilitate men to discuss and understand changes in
gender roles and “the new masculinity.” This is an important
area due to the possible threat that changes in the status of
women may pose to male sexuality, particularly in those
societies in which the latter is linked to dominance and
for all health providers as to their own biases regarding
sexual behavior is expressed at individual, interpersonal and
community levels. It is characterized by autonomy, honesty,
respectfulness, consent, protection, pursuit of pleasure, and
wellness. The person exhibiting responsible sexual behavior does
not intend to cause harm, and refrains from exploitation,
harassment, manipulation, and discrimination. A community
promotes responsible sexual behaviors by providing the
knowledge, resources and rights individuals need to engage in
be sexually healthy, persons must behave in a responsible
manner; therefore, responsibility is one of the most important
values to be promoted. Focusing on responsible sexual behavior
can produce cost-effective results reducing burdens on society
in terms of morbidity and improving well being. Components of
this strategy are:
of responsibility as a value to be promoted in all sexuality
of adult education programs, specifically addressing the needs
of parents, as they are the most immediate and efficient agents
in promoting sexually responsible behavior.
of mass media in introducing the issue of responsible sexual
behavior in their messages, via addressing the issue directly in
specific broadcasts or publications, or establishing specific
legislation to promote sexually responsible behavior.
Strategy 1.4: Eliminate fear, prejudice, discrimination, and hatred related to sexuality and sexual minorities (minority groups).
prejudice, discrimination and hatred related to sexuality and
sexual minority groups are obstacles to Sexual Health. Fear
arises from ignorance and misinformation. There is abundant
evidence that individuals develop healthier behavior as their
knowledge increases 48.
has shown that persons with fears and negative attitudes have a
greater risk of behaving in unhealthy ways. Erotophobia is a
negative affective-evaluative response to the pleasurable
components of sexuality. Erotophobic persons are less likely to
plan on having sexual intercourse in the future and have been
shown to have more negative reactions to talking openly about
sexuality, and to fail to acquire contraceptives prior to sexual
is the irrational fear of persons with homosexual orientation.
In many cases it is the basis of criminal acts. There are
reports that link homophobia to cognitive inhibition. Overt
rejection, discrimination, or violence towards gays and lesbians
have been linked to a variety of health and development problems
50, use of denial and isolation as coping styles 51,
the ability to develop intimacy 52, more frequent
risk taking sexual behavior 53 and a diminished
quality in the health care provided by health professionals 54.
Among the other characteristics that represent threats or
obstacles to health, the concept of homonegativity has been
suggested to increase understanding of the psychosocial dynamics
of the development of negative attitudes towards homosexual
of the components and specific actions of this strategy include:
the understanding of the spectrum of female and male identities
along a range including heterosexual, homosexual, bisexual,
homophobia both among individuals of all sexual orientations.
deleterious effects of sexual violence have been well documented
56. The promotion of Sexual Health and sexual rights
as human rights will contribute to the reduction and elimination
of sexual violence. Specifically, the promotion of gender
equality and equity, and the elimination of gender based
discrimination, which have been specifically linked to the
generation and maintenance of sexual violence, as well as
comprehensive sexuality education, will lower rates of violence.
Actions towards the elimination of sexual violence include:
of sexual violence in its various forms.
of effective legislation to reduce sexual violence.
of a culture of reporting sexual violence.
of health seeking behavior for victims of sexual violence.
of health care for sexual aggressors that in many instances
could benefit from treatment.
was a clear consensus among the expert working group that
comprehensive sexuality education, considered as a life-long
process that informally and formally provides and transforms
knowledge, attitudes, skills and values related to all aspects
of human sexuality 57, is one of the best investments
a society can make when promoting Sexual Health among its
sexuality education should begin early in life, should be age
and developmentally appropriate, and should promote a positive
attitude towards sexuality 58.
education must provide people with a knowledge base of human
sexuality. In addition, it is recognized that sexual information
alone is not adequate. Sexuality education must also include
skills development in addition to acquisition of knowledge.
school-based sexuality education acts as a building block for
Sexual Health across the lifespan of an individual and therefore
requires particular attention. School, in most countries, is the
single institution that nearly every person comes in contact
with at some stage in their life. This is the ideal setting for
providing sexuality education; hence governments need to mandate
this kind of education in schools. There has been a considerable
amount of research that has identified the characteristics of
effective sexuality education59, 60, 61. A summary of
these characteristics of comprehensive sexuality education is
presented in Appendix III.
Strategy 2.2: Integrate sexuality education into the general curriculum of educational institutions as appropriate.
addition to school based sexuality education, to reach the goal
of providing comprehensive sexuality education to the population
across the life span, all education institutions must play a
role. In particular, tertiary institutions can promote Sexual
Health by establishing adult human sexuality curricula.
Strategy 2.3: Provide comprehensive sexuality education to persons with mental and physical disabilities.
with mental and physical disabilities have the same rights to
comprehensive sexuality education as other persons. Because
persons with mental and physical disabilities may have special
needs and circumstances, and may sometimes be at increased
vulnerability regarding the ability to make sexual decisions,
comprehensive sexuality education should be a priority for these
Strategy 2.4: Provide access to comprehensive sexuality education to special populations (e.g., prisoners, illegal immigrants, the institutionalized, homeless).
the sexuality education needs of two groups have been neglected.
Institutionalized persons (prisoners, the hospitalized, and
those in long-term “care” situations) and those with no or
only marginal access to education (including illegal immigrants
and the homeless).
institutionalized persons are concerned, those legally
responsible for these persons have an ethical responsibility to
provide access to education that assists the person to advance
his/her Sexual Health while avoiding serious risks (e.g., HIV
and other STDs). For those lacking access to educational
opportunities, the government has an ethical responsibility to
provide appropriate outreach and education.
Strategy 2.5: Provide access to comprehensive sexuality education to other populations (e.g., legal immigrants, minority language groups, refugees).
institutionalized persons and persons without access to
education, another group of persons-those with greater barriers
to accessing education-has been identified at higher risk for
Sexual Health concerns. Immigrants (including refugees), those
persons who do not speak the dominant language of a country,
have a right to comprehensive sexuality education. Where
possible, education should be integrated into existing
educational programs for these populations.
Strategy 2.6: Integrate mass media into efforts to deliver and promote comprehensive sexuality education.
importance of the mass media in influencing social norms has
been widely recognized. Any effort in promoting health should be
accompanied by the involvement of the mass media, using all
current and future channels of communication: electronic (radio
and television), printed and internet based media. Mass media
professionals have a responsibility to their communities and, in
the case of Sexual Health, this responsibility should not be
of the utilization of mass media for promoting reproductive
health and the prevention of sexually transmitted infections
already exist and the results reported indicate that good
benefits to health promotion can be achieved 62.
3. Provide education, training and support to professionals
working in Sexual Health related fields.
goal of providing education and training in Sexual Health for a
wide range of specialists, other professionals, and
paraprofessionals involved in the promotion of Sexual Health,
including physicians, nurses, therapists, HIV/AIDS specialists,
family planning staff, as well as educators and community
advocates is necessary to effectively promote Sexual Health
among the population.
Strategy 3.1: Provide education and training in Sexual Health for health and allied health professionals.
health education for health professionals should be promoted at
least at four different levels:
Sexual Health education for all health professionals included
both in their basic training and in continued educational
programs. Health professionals include medicine, nursing,
clinical psychology, social work and health practitioners and
health education for health professionals specializing in
reproductive health programs.
health education for professionals specializing in STIs and
HIV/AIDS prevention and control programs.
health education and training for professionals specializing in
sexology, including education for sexuality, clinical sexology
(sexual medicine, sexual surgery, sexual counseling and, sexual
psychotherapy) and, basic research sexology.
recommendations regarding the training needs for each of these
four groups are provided in Appendix IV. These recommendations
describe a general interdisciplinary approach to the training of
must receive, as part of their training, the knowledge and
skills to deliver effective sexuality education. Since sexuality
education is proposed as a universal and integrated part of
education curricula, such training should be viewed as a
compulsory part of any teacher-training curriculum.
as a discipline was first proposed in 190763. In the
last fifty years, great strides have been made in the area of
sexology. Historically, there have been three main areas in
sexology-education, research and clinical service - mainly
focusing on the treatment of sexual dysfunctions. Today, new
disciplines are aligned with sexology. The Sexual Health needs
of the population have expanded our understanding of sexology.
The emergence of HIV, among other serious sexually transmitted
pandemics, has led to the specialization of behavioral
epidemiologists and infectious disease public health
professionals in the study of sexual risk behaviors. In turn
this has led to large population studies of sexual behavior.
From communities at greatest risk for HIV there have emerged
community health educators, paraprofessionals specializing in
HIV risk reduction counseling and case management for those at
risk. In many clinics, nurse-educators play a key role in
promoting preventive health care related to physical health
(e.g., breast exams), sexual knowledge (e.g., education on
Sexual Health risks related to illness), and reproductive
counseling. Advances in assisted fertility techniques, and
pharmacological innovations in the promotion of sexual
functioning have brought specialists from other disciplines
together to focus on the Sexual Health needs of patients. Women's
and sexual minority health centers have targeted health care to
minorities and the underserved, while at the same time,
promoting Sexual Health at a community level. An outgrowth of
sexual minority movements has been the emergence of lawyers
specializing in the rights of minorities, and advocacy groups
promoting safe behaviors. Recently, new approaches in the
management of the sexual aggressor have expanded the field of
clinical sexology to the treatment of sex offenders.
is evident that the future of sexology will involve many new and
diverse disciplines collaborating at different levels and
serving different functions in addressing Sexual Health needs.
As an interdisciplinary science, sexology is uniquely placed to
bring together the knowledge and expertise of specialists, the
diverse agendas of various advocacy groups, the health concerns
of communities, and the methodologies and interests of diverse
disciplines. For this reason, it is critical that sexology is
promoted as a discipline/profession. It is not sufficient for
specialists from other disciplines to apply their fields of
expertise to the study of Sexual Health. We also need trained
Sexual Health specialists who focus exclusively on Sexual Health
concerns to address the diverse and specific concerns raised by
sex and sexuality.
specifically, there is a need to:
training standards for sexual educators, sexuality specialists.
to governments for sexuality training programs for
the current incidence of many sexual problems makes current
prevention efforts insufficient. A large number of persons have
sexual problems that demand clinical care. It is also
unrealistic that prevention will be able to eliminate all sexual
problems in the future. The development of comprehensive Sexual
Health care is therefore a critical necessity in all societies,
as is the provision of access to this care to the population.
health is a key public health issue. Although specific actions
implemented in specific targeted programs (as outlined in the
sections above) are required, it is indispensable to have Sexual
Health integrated into existing public health programs. For this
reason the expert working group recommends as components the
a Sexual Health approach into existing health programs, related
directly or indirectly to Sexual Health (e.g., cardiovascular
health promotion programs, anti-smoking programs (benefits of
not smoking on erectile performance), cancer prevention programs
(early detection of CA on mastectomies, cervical cancer
screening), health education programs (link between preventive
health and sexual performance).
part of general health assessments, address sexual issues when
clients come into contact with public health programs. This can
be advanced by review and, where necessary, reform of existing
protocols to ensure adequate addressing of Sexual Health
concerns. For example, general practitioners, family physicians,
and physicians in public health clinics should incorporate
Sexual Health screening/history taking into general health
to comprehensive health care services is essential. Whilst the
expert working group fully recognizes the relevance and cost
effectiveness of a preventive approach to Sexual Health, there
exist an unfortunately large number of persons already suffering
from Sexual Health concerns and problems that create an urgent
need for care services to ensure effective treatment.
concerns and many sexual problems can and should be addressed
and solved in primary care settings. Unfortunately, lack of
training of primary care providers can be an obstacle to this
Sexual Health problems require the intervention of specially
trained individuals for their solution. Therefore, special
clinics for the treatment of sexual problems are necessary to
address the range of severity of sexual problems.
Strategy4.3: Provide access to comprehensive Sexual Health services to persons with mental and physical disabilities.
health services, wherever possible, should be integrated into
existing services for persons with mental and physical
Strategy 4.4: Provide access to comprehensive Sexual Health services to special populations (e.g., prisoners, illegal immigrants, the institutionalized, the homeless).
health services, wherever possible, should be integrated into
existing services for special populations (e.g., prisoners,
illegal immigrants, the institutionalized, the homeless).
Strategy 4.5: Provide access to comprehensive Sexual Health services to other populations(e.g., legal immigrants, minority language groups, refugees).
health services, wherever possible, should be integrated into
existing services for other populations (e.g., legal immigrants,
minority language groups, and refugees).
Goal 5: Promote and sponsor research and evaluation in sexuality and Sexual Health, and the dissemination of the knowledge derived from it.
is needed to increase understanding of sex, sexuality, Sexual
Health, and sexual behavior and to evaluate the efficacy of
prevention strategies, programs, courses and treatments.
research and evaluation are urgently needed to advance the
Sexual Health of individuals and populations. Research is
defined here as the systematic study of an area, including the
testing of hypotheses, for the purpose of acquiring new
knowledge. Evaluation is defined here as the gathering and
analyzing of data for the purposes of decision-making,
particularly the assessment of Sexual Health program
in comparison to other areas of health research, has been
neglected in terms of funding, respect, and quality of
investigation. These dimensions are not independent. It is an
absolute imperative that research on sexuality and sexual
behavior of the highest quality be undertaken. To achieve this,
as a field, sexology needs to develop the competence and
capabilities of researchers at every level.
Strategy 5.3: Promote sexological research across disciplines (e.g., nursing, sociology, anthropology, psychology, epidemiology, etc.)
on sexuality and Sexual Health is not limited to sexology
trained researchers. Promotion of research among other related
disciplines is beneficial to the construction of a greater
knowledge base and usually permits new and fresh insights of
issues related to the complexity of sexuality and Sexual Health.
Promotion of this kind of research can improve efforts towards
achieving and maintaining Sexual Health.
Strategy 5.4: Ensure that research findings in sexology are adequately disseminated to policymakers, educators, and service providers to provide a research base for their work.
alone is not sufficient. Dissemination of findings is a crucial
strategy to ensure that those working in Sexual Health benefit
from the knowledge base that sound research creates.
Dissemination of research findings is particularly necessary in
most of Latin America, where
there is a need to create and promote a culture of reporting
41 United Nations Development Programme. Integrating human rights with sustainable human development. UNDP policy document United Nations Development Programme New York, NY January 1998. Available at: http://magnet.undp.org/Docs/policy5.html
42 Komisaruk, B.R. & Whipple, B. Love as sensory stimulation: physiological consequences of its deprivation and expression. Psychoneuroendocrinology 1998 Nov;23(8):927-44.
43 Cfr.. Kaplan, H.S. The New Sex Therapy Brunner Mazel, New York 1974.
44 In the recent report on prevalence of sexual dysfunction when the help-seeking behavior was analyzed it was found that 10% and 20% of the afflicted men and women, respectively, sought medical consultation for their sexual problems. Laumann, E. O., Paik, A. & Rosen, R. C.. Sexual Dysfunction in the United States: Prevalence and Predictors JAMA. 1999;281:537-544.
45 Nicolelis, M.A., De Oliveira, L.M., Lin, R.C. & Chapin, J.K. Active tactile exploration influences the functional maturation of the somatosensory system. J Neurophysiol 1996 May;75(5):2192-6. Fleming, A.S., O'Day, D.H. & Kraemer, G.W. Neurobiology of mother-infant interactions: experience and central nervous system plasticity across development and generations. Neurosci Biobehav Rev. 1999 May;23(5):673-85.
46 Best Practice, the continuous process of learning, feedback, reflection and analysis of what works (or does not work) and why, is the basis from which UNAIDS, its Cosponsors and partners identify, exchange and document important lessons learned. Best Practice has been shared through exchange forums, networks, Best Practice Collection publications, and technical assistance. In 1998, the Best Practice Collection expanded to over 190 original publications and videos, including joint and Cosponsor publications. The collection includes Technical Update, Point of View, Case Study, Key Material and the Summary Booklet. The collection can be accessed at: http://www.unaids.org/bestpractice/collection/index.html
47 Several sources register the fact that women live longer than men, but also that they fall ill more frequently and make use of health care more often than men, even if motherhood related services are excluded. These authors propose hypothesis that can be broadly grouped in four categories: 1.differential risks, which are associated to the ways men and women are socialized; 2. differences due to psychosocial factors, for example, women being more capable (socially) to perceive, evaluate and report illness symptoms, also to better adopt the role of “being ill” and to follow medical treatment.; 3. differences due to a sexist bias on part of physicians who tend to perceive women as more fragile than men, and therefore more prone to fall physically of psychologically ill; 4. possible biological differences. (Cfr. Castro, R. y Bronfman M. Teoría feminista y sociología medica: bases para una discusión. En J.G. Figueroa (ed.) La condición de la mujer en espacio de la salud. México D.F. El Colegio de México. 1998. In Mexico research at the Health Ministry in 1992 revealed that women present more malnutrition and related problems when compared with men (Corona E. & Corona A. La salud en las mujeres en México: Situación actual y algunas propuestas. Presented in the Pre-Conference Seminar of the World Conference on Women. UNIFEM, 1995.
48 Grunseit, A. & Kippax, S., Effects of Sex Education on Young People's Sexual Behaviour. 1993. Unpublished review commissioned by the Global Programme on AIDS, World Health Organization, July, 1993. Moore, K. A. et al. Adolescent Pregnancy Prevention Programs: Interventions and Evaluations, Child Trends, Inc., Washington, DC. Frost, J. J. & Forrest, J. D.. Understanding the Impact of Effective Teenage Pregnancy Prevention Programs. Family Planning Perspectives 1995, 25(5): 188-96; and Kirby, D. et al. School-Based Programs to Reduce Sexual Risk Behaviors: A Review of Effectiveness. Public Health Reports, 1994,109(3), pp. 339-60.
49 William, F. A. A Psychological Approach to Human Sexuality: The Sexual Behavior Sequence. In D. Byrne & K. Kelley (Editors) Alternative Approaches to the Study of Sexual Behavior. 1986. Lawrence Erlbaum Associates, Publishers, Hillsdale, New Jersey.
50 Ferraro, F. & Dukart, R. A Cognitive inhibition in individuals prone to homophobia. J Clin Psychol 1998 Feb;54(2):155-62 .
51 Johnson, M.E., Brems, C. & Alford-Keating, P. Personality correlates of homophobia. J Homosex 1997; 34(1):57-69.
52 Monroe, M., Baker, R.C. & Roll, S. The relationship of homophobia to intimacy in heterosexual men. J Homosex 1997;33(2):23-37.
53 Meyer. I.H. & Dean, L. Patterns of sexual behavior and risk taking among young New York City gay men. AIDS Educ Prev 1995;7(5 Suppl):13-23.
54 Lohrmann, C., Valimaki, M., Suominen, T., Muinonen, U., Dassen, T. & Peate. German nursing students' knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS cases. J Adv Nurs 2000 Mar; 31(3):696-703.
55 Herek, G.M. (1984). Beyond “homophobia”: A social psychological perspective on attitudes toward lesbians and gay men. Journal of Homosexuality, 10 (1/2), 1-21.
56 The statistics mentioned in the importance of Sexual Health problems section illustrate: In 1993, the World Development Report of the World Bank estimated that “women ages 15 to 44 lose more Discounted Health Years of Life (DHYLs) to rape and domestic violence than to breast cancer, cervical cancer, obstructed labor, heart disease, AIDS, respiratory infections, motor vehicle accidents or war.” Studies show that rape survivors have high rates of persistent post-traumatic stress disorder and make up the largest single group diagnosed with the disorder. And rape victims are nine times likelier than non-victims to attempt suicide and to suffer major depression. Furthermore, 50 to 60 per cent of the victims experience sexual dysfunction, including fear of sex and problems with arousal. A study based on the records of the Maternity Hospital of Lima, Peru, revealed that 90 per cent of young mothers aged 12 to 16 had become pregnant because they had been raped. In Costa Rica, an organization working with adolescent mothers reported that 95 per cent of its pregnant clients under 15 were victims of incest. Interactive Population: Violence against Girls and Women: http://www.unfpa.org/modules/intercenter/violence/gender2f.htm
57 Corona, E. Resquicios en las Puertas: La Educación Sexual en México en el Siglo XX in: CONAPO (Editor). Antología de la Sexualidad Humana Vol. 3. CONAPO, México 1994.
58 Coleman, E. (1998). Promoting Sexual Health: The Challenges of the Present and Future. In J J. Borras Valls & Conchillo, M. P. (Ed.). Sexuality and Human Rights. Valencia, Spain.
59 Cerrutti, S.1993 Salud y Sexualidad desde una Perspectiva de Género. Global Reproductive Health Forum: http://www.hsph.harvard.edu/grhf/_Spanish/course/sesion1/saludsexual.html
60 Grunseit, A. & Kippax, S., Effects of Sex Education on Young People's Sexual Behaviour. 1993. Unpublished review commissioned by the Global Programme on AIDS, World Health Organization, July, 1993. Moore, K. A. et al. Adolescent Pregnancy Prevention Programs: Interventions and Evaluations, Child Trends, Inc., Washington, DC. Frost, J. J. & Forrest, J. D.. Understanding the Impact of Effective Teenage Pregnancy Prevention Programs. Family Planning Perspectives 1995, 25(5): 188-96; and Kirby, D. et al. School-Based Programs to Reduce Sexual Risk Behaviors: A Review of Effectiveness. Public Health Reports, 1994,109(3), pp. 339-60.
61 Franklin, C. Grant, D., Corcoran, J., O'Dell Miller, P. and Bultman, C. (1997). Effectiveness of prevention programs for adolescent pregnancy: A meta analysis. Journal of Marriage and the Family, 59, 551-567
62 See for instance Israel, R.C & Nagano, R. Promoting Reproductive Health for Young Adults through Social Marketing and Mass Media: A Review of Trends and Practices. Education Development Center, Inc. (EDC) 55 Chapel Street, Newton, MA 02158 available at: http://www.pathfind.org/RPPS-Papers/Social%20Marketing.html
63 In 1907 Iwan Bloch published his first truly sexological work under the title Das Sexualleben unserer Zeit (The Sexual Life of Our Time) and stated in its foreword: “The author of the present work . . . is. . . convinced that the purely medical consideration of the sexual life . . . is yet incapable of doing full justice to the many-sided relationships between the sexual and all the other provinces of human life. To do justice to the whole importance of love in the life of the individual and in that of society, and in relation to the evolution of human civilization, this particular branch of inquiry must be treated in its proper subordination as a part of the general science of mankind, which is constituted by a union of all other sciences of general biology, anthropology and ethnology, philosophy and psychology, the history of literature, and the entire history of civilization . . . Hitherto there has existed no single comprehensive treatise on the whole of the sexual life . . . .The time is indeed fully ripe for an attempt to sift. . . the enormous mass of available material, and to present the result from a centralized standpoint”. Bloch, I. The Sexual Life of Our Time. Translated by Eden Paul, New York: Allied Book Company 1908.