International Journal of STD & AIDS 1995; 6: 35-41

ORIGINAL ARTICLE

Sexual behaviour in the city of Lisbon

Fausto Amaral, Ana M. Dantas? and
Louise da Cunha Teles RN PhN2
1Technical University of Lisbon and Bom Sucesso Foundation
280m Sucesso Foundation, Lisbon, Portugal

Summary: This study of sexual behaviour in the city of Lisbon is based on data
obtained from 2 random samples, one of individuals aged 16-20 (n=400) and another
of individuals over the age of 20 (n=400). Samples have been stratified by district,
gender and age. Data were obtained by personal interview and by questionnaires
completed confidentially by the interviewees.
The data include the age of first sexual intercourse, the number of sexual partners,
the prevalence of casual relations and the type of sexual practices according to sex
and age group. Results show that despite the high risk of exposure to HIV in a
significant percentage of the population, AIDS is seen as a personal threat by only
20% of the population. Six per cent of the adults (aged 21 and over) and 12% of
the young people (16-20) replied that they had not yet considered the problem; 73.5%
of the adults and 67.4% of the young people stated that they did not feel threatened
by the disease. Data suggest that the differences between men and women have
decreased.
Among the sexually active population, only 12% of individuals under 21 and 8%
of the adults use condoms regularly. The awareness of infidelity among couples
is much lower than in reality. A significant discrepancy was found between the
'awareness' and 'reported reality' for men and women who carry on casual
extramarital relations: 14.9% of the women were convinced that their husbands or
companions are unfaithful; 27.7% of the men reported they had been unfaithful in
the years preceding the study; 3.7% of the men believed their wives had been
unfaithful, whereas 8.9% of the women admitted to having been unfaithful over
the same period.
Data on sexual initiation reveal that contrary to young people (3.5%), 25.0% of
the men over 20 begin their sexual life by resorting to prostitutes.
At least one of the following behaviours can be attributed to two-thirds of the adults
(21 and over) in the year preceding the study; extramarital relations; 2 or more sexual
partners; did not use condoms; sexual relations with prosititutes, sexual relations
with people whose sexual past they did not know.
In conclusion, our study illustrates that the pattern of sexual behaviour in this
population is associated to a significant risk of exposure to HIV and that a marked
unawareness of such risk prevails. The differences in sexual behaviour patterns
between men and women and between young and older people are important to
formulate appropriate educational programmes.
Keywords: Sexual behaviour, AIDS, Portugal

INTRODUCTION Consequently, information has been limited to birth

As the AIDS pandemic progresses, it has become
obvious that in most of the affected countries there
is a considerable lack of knowledge on current
patterns of sexual behaviour. In Portugal, this
knowledge has been acquired in the past mainly
from family planning and STD clinics and from
information on sexual attitudes among studentsl - 3 .
Correspondence to: Dr Fausto Amaro, Bom Sucesso Foundation,
Av. Dr. Mario Moutinho (ao Restelo), 1400 Usbon-Portugal
control practices and to attitudes on dating. marriage,
prostitution, masturbation and disturbed sexual
function. With the acknowledged growth of the
AIDS epidemic in Portugal, the need to acquire
relevant and valid data on sexual behaviour has
come to be recognized, its first purpose being to
assess the impact of national prevention campaigns4.
In a country with values closely linked to a
traditional Catholic education and a strong influence
of the Catholic church and other religious institutions,
the acquisition of reliable data on sexual behaviour

35
 36 International Journal of STD & AIDS Volume 6 January/February 1995
poses specific and sensitive problems. The aim of
this study is to investigate sexual behaviour patterns
and attitudes that may be relevant in the education
on AIDS of the general population.
MATERIAL AND METHODS
Eight hundred individuals from the city of Lisbon
were selected by a random sampling of the
population of Lisbon proper (808,000). Individuals
were selected according to sex and age groups in
accordance with the demographic structure of the
city and were interviewed in their homes. The 53
districts of the city of Lisbon were classified in 5
strata according to the number of inhabitants.
Among them 20 were chosen at random and the
homes were selected by the 'random route
technique'. Two sub-samples were taken: one
including individuals between the ages of 16 and
20 (n=400) and the other individuals over the age
of 20 (n=400). Only one person per home was
interviewed. Two questionnaires were used. One
containing questions of a general nature, to be filled
in by the interviewer (questionnaire A with 25
questions) and the other containing more intimate
questions, to be completed confidentially by the
interviewee (questionnaire B containing 58 questions
for adults and 65 for youths). Confidentiality was
secured by the interviewee filling in the form
without the interviewer looking on. The completed
questionnaire was then placed in a sealed ballot box.
Even in these highly confidential conditions, large
percentages of men (29%) and women (32.8%) did
not reply to questions on oral and anal sexual
practices.
The field work took place in March and April of
1990. The 2 questionnaires covered attitudes on
AIDS as a social and health problem, risk awareness,
information on AIDS prevention, attitudes and
values regarding sexuality, reported sexual practices,
behaviour and attitudes with regard to sexual
activity, fidelity, sexual contacts with drug addicts
or HIV infected people and homosexual relations.
RESULTS
Age of first sexual intercourse
The mean age of first sexual intercourse was 17.0
for men born in 1930-40 and 15.6 for those born
between 1970 and 1974. In women, the mean age
of first sexual intercourse was 19.9 for those born
before 1930 and 17 for those born between 1969-74.
The age mode is 16 for males (27.2%) and 17.0 for
females under 21 (24.7%) (Figure 1). In the 16-20
age group, 58.4% of men and 37.8% of women have
experienced sexual intercourse before the age of 20.
Sexual initiation after the age of 20 in the various
age groups is highest in men of 30-39 (95.3%) and
women of 25-29 (71.4%) (Table 1) (Figure 2).
With regard to the mode of initiation of sexual
intercourse, it is important to note that 45.0% of the
60 "
50
40
30
10
/ v~ '<,
, ----' ~ <, <,
r:::::-
10
o
<11 12
---'
13 14
~
15 16 17 18
<.19/20
Ale
s..
* Masculine - Feminine
Figure 1. Age of first sexual activityof persons under 21 years of age
(n=19.1)
men who were 60 or older had their first sexual
intercourse with a prostitute, whereas this only
applied to 3.5% of the men between the ages of 16
and 20. On the other hand, 90.9% of the women
who were 60 or older and 11.1% of those between
the ages of 21 and 24 had their first sexual
intercourse when they got married. The remaining
9.1 % of the older women had their first intercourse
with their boyfriend or fiance.
The most common form of initiation in females
of 16-20 was with their boyfriend or fiance (81.8%).
First sexual contact with someone they had only
known for a short time was reported by 35.1% of
the young people (16-20), whereas 5.2% indicated
that initiation had taken place with someone they
had met on the same day.
Number of sexual partners
Of those who were sexually active in the past year,
48.2% of the males and 81.7% of the females in the
16-20 age group, in addition to 63.9% of the adult
males and 85.3% of the adult females (21 and over),
said they had had only one sexual partner. 19% of
the adult males and 4.0% of the adult females
reported to have had 2 or 3 sexual partners; 12.9%
of the young males, 8.8% of the adult males and
1.3% of the adult females had four or more partners
(Table 2). Analysis by gender reveals significant
differences between men and women, among
both the young and the adults. Men more often
than women had two or more sexual partners
(x2 =19.7645, 1 df, P<0.01 (youth) and x2 =27.8468,
1 df, P<0.01 (adults».
Casual relations
Questions on this subject were put to men and
women over the age of 20 who maintained a regular
sexual relationship, whether they were married or
living together. An attempt was made to determine
not only how many men and women had sexual
relations with someone other than their usual
 Amaro, Dantas and da Cunha Teles. Sexual behaviour in Lisbon 37

Table lA. Age of first sexual intercourse (male)

Age of initiation ~20 21-24 25-29 30-39 40-49 50-59 ~60 Total
10-13 14 1 6 1 1 23
13.0% 4.2% 14.3% 3.4% 4.3% 9.1%
14-15 27 7 3 9 14 6 8 74
25.0% 29.2% 30.0% 21.4% 48.3% 26.1% 44.4% 29.1%
16-17 52 10 3 13 5 5 4 92
48.1% 41.7% 30.0% 31.0% 17.2% 21.7% 22.2% 36.2%
18-19 15 6 3 13 4 6 2 49
13.9% 25.0% 30.0% 31.0% 13.8% 26.1% 11.1% 19.3%
~20 1 1 5 5 4 16
10.0% 2.4% 17.2% 21.7% 22.2% 6.3%
Have had intercourse
before 20 58.4% 80.0% 81.9% 95.3% 75.0% 58.1% 70.0%

Table lB. Age of first sexual intercourse (female)

Age of initiation ~20 21-24 25-29 30-39 40-49 50-59 ~60 Total
10-13 1 1 2
1.3% 3.2% 0.9%
14-15 12 2 1 3 3 21
15.8% 11.1% 5.3% 9.7% 7.9% 9.0%
16-17 32 6 2 3 2 2 47
42.1% 33.3% 10.5% 9.7% 5.3% 6.5% 20.1%
18-19 29 7 12 8 8 2 1 67
38.2% 38.9% 63.2% 25.8% 21.1% 6.5% 4.8% 28.6%
~20 2 3 4 17 25 26 20 97%
2.6% 16.7% 21.1% 54.8% 65.8% 83.9% 95.2% 41.5%
Have had intercourse
before 20 37.8% 68.2% 71.4% 42.4% 31.7% 14.7% 4.2%

... Table 2. Number of partners in the past year by sex and age
60

so / Male Female
%
40 / No No %

30 / One person 52
2 or 3 persons 29
48.2
26.9
58
8
81.7
11.3
zo / ~20
4 or 5 persons
Six or more
5
9
4.6
8.3
1/
10

o
~u
v
13
-"

14
- 17
~~
~

18
<, ~
19 20. +
No reply
Total

One person
13
108

101
2 or 3 persons 30
12
100

63.9
19
5
71

128
6
7
100

85.3
4
5.. 4 or 5 persons 10 6.3 2 1.3
* Mall:ullne - F.mlnln. ~21
Six or more 4 2.5
No reply 13 8.3 14 9.4
Figure 2. Age offirst sexual activity of persons over 20 years of age Total 158 100 150 100
(n=362)

sexual partner, but also their awareness of their

partner's infidelity.
Results indicated that 14.9% of the women were
convinced that their husbands or companions were
unfaithful, although 27.7%of the men reported they
had been unfaithful. As for the men 3.7% were
convinced that their usual sexual partners had been
unfaithful, whereas 8.9% of the women admitted
to having been unfaithful (Figure 3). The analysis
of men's responses show the differences between
awareness and reality to be statistically significant
(X2=7.3211, df=1, P=0.0036). On the other hand,
women's responses reveal a trend to be statistically
different (x 2 =3.2489, df=1; P=0.0685).
With regard to the importance of age, Figure 4
shows that men over 30 as well as women between
the ages of 40 and 49 are most likely to be unfaithful.
On the other hand, in the analysis according to age,
the perception of infidelity is higher in women of
30-40 (18.2%), of 40-49 (15%), 50-59 (17.6%) and
of 60 and over (12.6%).
Men reveal a tendency to share this opinion in the
30-39 (4.6%),40-49% (6.3%)and over 60 (5.0%)age
groups, but there is also a large percentage of no
replies from men (22.7%) whereas this percentage
is 16.7% for women.
 38 International Journal of sro & AIDS Volume 6 January/February 1995

men being higher than those for women. The

MALE I FEMALE I analysis of the age groups reveals that anal sex is
practised mainly by men between the ages of 25 and
39 and women of 25 to 29. The practice of oral sex
is most common for men between the ages of 21 and
39 and for women between the ages of 21 and 29.

casual
relations
(14.9%)
_ Admlned bY' men C::J Admlnad by woman
~ Women' ••• Uma'a 0'
p.rtne,'. lntldallly
(±±tIJ ".n'• • •lImal. af
p.rtn.,'. Infidelity
Figure 3. Extramarital sex: people aged 21 orover, married or with a
permanent relationship
Oral and anal practices
A high percentage of men (29.0%) and women
(32.8%) over the age of 20 did not reply to the
question on oral and anal practices. Of those who
did, 61.0% of the women over the age of 20 accept
oral sex and 39.7% practise it. As for men over the
age of 20 who replied to the question, 76.0% accept
and 48.8% practise oral sex (Table 3).
With regard to anal sex, there was also a large
number of men (33.5%) and women (36.0%) who
refused to answer this question. Anal sex is accepted
by 59.3%of the men and 47.8%of the women over the
age of 20. Those who practise it are 23.0% of the men
and only 10.8% of the women over the age of 20.
The data on anal and oral sex show a significant
difference between its acceptance and practice in
people over the age of 20. Moreover, there are
differences between the sexes, the percentages for
Practice of homosexual relations
The replies to the questions on homosexual
behaviours revealed that 4.6% of the males and 1.5%
of the females under 21 had sexual relations with
individuals of the same sex sometime in their life.
For adults (21 and over) the percentages were of
4.0% for women and 3.2% for men. With regard to
sexual practices with individuals of the same sex,
3.1% of the males and 0.5% of the females under
the age of 21 in addition to 2.3% of adult men and
0.5% of adult women had such relations in the
course of last year.
Use of condoms
As can be seen in Figure 5, only 12.9% of the
population under the age of 21 and a mere 8% of
the adults (21 and over) always use condoms. Young
people mentioned 2 main reasons for not using
condoms: they prefer other birth control methods
(44.0%) and they believe that condoms reduce the
pleasure of sexual intercourse (24.8%). The third
reason was that condoms are not very practical and
spoil sexual intercourse. Adults object for the same
reasons in the following order: use of other methods
(26.2%); less pleasure (13.5%); spoil sexual
intercourse (12.3%) and impractical (11.2%).

Present
Masculine Feminine
age
21-24

25-29

30-39

40-49

50-59

60 or over
I:======::!:::="""
100% 50% 0% 50% 100%

_ Have been loyal ,"t~'i~f'm;\f::w:1 Have not been loyal 1:::::::1 No reply

Figure 4. Adults behaviour in reference to fi{1elity toward the habitual partner, according to age
 Amaro, Dantas and da Cunha Teles. Sexual behaviour in Lisbon 39

Table 3. Practice of oral and anal sex by age and at 18 for males over the age of 20. Females begin
later; predominantly at 17 in the 16-20 age group
~20 ~21
and at 20 in the 21 and over age group (Figures 1
Male Female Male Female and 2).
(n=74) (n=66) (n =121) (n=121) With regard to the frequency of sexual relations,
Oral sex 21 13 59 48 the majority response was once a month for young
28.4% 19.7% 48.8% 39.7% people and 2 or 3 times a week for adults. These
Male Female Male Female frequencies differ considerably from those mentioned
(n=74) (n=66) (n =113) (n=111) in a recent study in Spain'', but they are close to
Anal sex 4 1 26 12 the frequencies found for all age groups in studies
5.4% 1.5% 23.0% 10.8% made and quoted by Bancroft". In Francel'' there is
a similar trend, as both men and women are
reported to have had sexual contact 7 to 8 times in
the last 4 weeks.
DISCUSSION
The number of partners is an important indicator
This is the first study on sexual behaviour carried in terms of AIDS risk. It is not easy to evaluate the
out in Portugal, based on a random sampling of the position of our data in relation to the results of other
Lisbon population. The data suggest trends similar studies, mainly because different temporal criteria
to those reported in other industrialized countries, were applied in those studies: 27.8% of men in the
especially when it comes to the earlier age of first older and 39.8% in the younger age groups had had
intercourse and the disappearing differences 2 or more heterosexual partners in the previous
between the sexes, as noted by various year, contrasting with the figures from studies in
authors5-8,15. For example, a cross-cultural study by Britain (13.8%)10 and France (11.3%)11. The analysis
John Bancroft (1985) showed a universal trend of data collected in Paris reveals that the percentage
towards premarital sex in the 1960s, which of men who have 2 or more partners is higher
accelerated rapidly in the 1970s and stabilized in the (18.3%) than in the rest of France (11.3%)and closer
80s9 • However, in our study, among the group that to the percentages seen in Lisbon (27.8%), thus
commenced sexual activity in the 80s, the emphasizing the differences between urbanI
percentages of those that had had intercourse before cosmopolitan and other social environments. There
21 suggests the hypothesis of a slowing-down in the are 5.3% of women (aged 21 and over) who have
progressive decrease of the age of sexual initiation more than 2 partners. The ACSF study (Analyse des
in the 80s-perhaps owing to the inhibiting Comportements Sexuels en France) found the
influence of AIDS on the sexual behaviour of the percentage applicable to women to be 5.4%.
young (16-20). International comparisons in this In spite of all the precautions taken to ensure
area are somewhat difficult because of different confidentiality, a large number of the men and
criteria in defining aims and methods. Moreover, women (particularly the older women) did not reply
there are differences in the sexes with regard to the to the questions on the number of sexual partners.
age at which they first had sexual relations. Males Taking the studies carried out in Spain" and
begin earlier; usually at 16 in the 16-20 age group Brazil? into account, our study presents a higher

22.8% 19.3%

8.0%

11.3%

~ 20 (n = 167)
> 21 (n =362)
_ Always ~ Almost always
1::::::::1 Occaslonaly ~ Never ~NO Reply

Figure 5. Frequencq of condom lise in past year

 40 International Journal of SID &: AIDS Volume 6 January/February 1995
percentage of individuals having had only one
sexual partner in the past. In the Lisbon study,
44.8% of the men and 64.5% of the women in the
16-20 age group had no sexual partners in the
'previous year'. This trend is similar to that
reported by Spira et al. 15 for subjects between the
ages of 18 and 19, where the fiwres are of 32.8%
for men and 41.2% for women 1.
Extramarital sexual relations are reported by about
1/3 of the men and nearly 10% of the women in the
21 and over age group. These figures are lower than
in other studies, namely with regard to women'".
However, similar fi~es were found in the Brazilian
study by Cavallieri and in the Gorer study quoted
by John Bancroft (1985)9.
Our research provides certain data not included
in other studies. Of particular interest in the context
of HIV infection, is the fact that there is a great
discrepancy between men and women's extramarital
sexual relations and their partner's awareness. This
could signify that some men and women may run
the risk of being infected by their usual companion
or their husband/wife with whom they maintain a
trusting relationship. This points to the need of
more research due to the increased likelihood of
acquisition of HIV infection through heterosexual
transmission17.
With regard to the practice of anal sex, there are
significant differences in the behaviour of the sexes
from a statistical standpoint: only 5.4% of the young
males and 0.8% of the young females reported the
practice of anal sex, although the 'no reply' to the
question is 35.1% for young males and 36.4% for
young females.
As for oral sex, the statistical difference is not
as high. However, we noted a trend for this
practice to be lower in young people when
compared to adults: only 28.4% of young men and
10.6% of young women said they engaged in oral
sex (Table 3).
Sexual practices that are particularly relevant in
the AIDS context reveal generally lower percentages
among the population studied than in other studies
that have been published15, except oral sex
practised by women, the percentage of which is
higher than that shown in the Spanish study6.
With regard to anal sex, the figures are also lower
than those contained in the above publications.
But in the case of men, they are similar to those
of the Simon study conducted in France some
30 years ago 12.
The figures for homosexual relations are similar
to those contained in other studies in Western
Europe and the United States and vary, depending
on the author, between 3 and 5% of the adult
population13,15.
The figures for male (lifetime) homosexuality are
of 4% for men and 3.2% for women. These figures
can compare to those in the study prepared by Spira
et al. in France (4.1 % for men and 2.6% for women)
and are much lower than the one for men in the
Johnson et ai. study (11.9% in Greater London)".
For the practice of homosexual relations in the past
year, our figures are of 2.2% for men and 0.5% for
women. In the French study'", the percentages
are of 1.1% for men and 0.3% for women. Although
the average of 1.1% is common to the French and
British studies, the latter shows a 3.5% for Greater
Londonl".
The systematic use of condoms is quite low among
the sample population; a mere 12% in the under 21
and 8% in the over 21 age groups. The same trend
was recorded in other countries13,14,16. These
figures are similar to those obtained in previous
surveys conducted by the Portuguese National
Commission for the Fight Against AIDS4.
The low use of condoms could be related to the
fact that only a small part of the interviewees (115
of the sample) regards AIDS as a personal threat.
As a whole, some of the results indicate a low
awareness in Portugal of the morbidity caused by
HIV infection and extent of the individual's
contribution to its spread.
Acknowledgements: We wish to express our gratitude
to Prof. Maria de Sousa for her indispensable
encouragement, help and advice in the initial stages
of this research. We also wish to thank Dr. Delfim
Guerreiro and Dr. Ricardo Jorge Correia da Fonseca
for their kind assistance, particularly during the
exploratory study, as well as Prof. Rui Victorino
who gave us many useful suggestions during the
preparation of this article.
Study supported by a grant from the JNICT
(Portuguese National Board for Scientific and
Technological Research).
References
1 Leitio A, Anijo MP, Oliveira TP, Neto MS. Avalia,tro das
Acfivadades de Planeamento Familiar. Resultados da Colheita de
Dados par Visitaqro DomiciJiliria. Lisboa: DGCS Primarios, 1988
2 Miguel N, Duarte V. Situa,40, Problemas e Perspectivas da
luventude em Portugal. Afectividade e 5exualidade no Novo
Contexto Social e Cultural. Lisboa: lED, 1987
3 Gomes FA, Albuquerque A, Nunes ]5. Sexologia emPortugal.
2 vols. Lisboa: Texto Editora, 1987
4 Lucas,]5. Os Portugueses e a 5IDA. Inqumto National sobre
os Conhecimentos, Atitudes e Comportamentos Associados
com a SIDA. Revista Portuguesa de Saude Publica n", 3/4,
Lisboa: Escola Nacional de Saude PUblica, 1987:89-100
5 Masters WH, Johnson VE, Kolodny RC. Sex and Human
Loving. London: Macmillan, 1987
6 Molina CM, Blanco ]MV, Gomez AP. fA Conducta Sexual de
las Espanoles. Barcelona: Edici6nes BSA 1988
7 Cavallieri A, Gikovate F, Okawara H et al. Pesquisa Acerca
doe Htibitos e Atitudes Sexuais dos Brasileiro«. S. Paulo. Brasil:
Editora Cultrix, Lda, 1986
8 Claes M. Os Problemas da Adolescenda. Usboa: Verbo, 1985
9 Bancroft, ]. Human Sexuality and its Problems, 2nd Edn,
Edinburgh, Churchill Livingstone, 1989
10 Johnson AM et al. Sexual lifestyles and HIV risk. Nature
1992;360:410-2
11 ACSF Investigators. AIDS and sexual behaviour in France.
Nature 1992;360
 Amaro, Dantas and da Cunha Teles. Sexual behaviour in Lisbon
12 Simon P. 0 Comportamento SexUIll dos Franceses. Lisboa,
Publicacdes Europa America, 1975
13 Pollak M. Us Homosexuels et Ie SIDA. Paris: £ditions A.M.
Metailie, 1988
14 Campbell AA, Arthur A, Baldwin W. The response of
American women to the threat of AIDS and other sexually
transmitted diseases. J Acquir Immune Defic Syndr
1991;4:1133-44
15 Spira Alfred, BajosN. ACSFGroup-Lescomportements sexuels
en France. Paris: La Documentation Francaise, 1993
16 Thornton Susan, Catalan Jose. Preventing the sexual spread
41
of HIV infection-What have we learned? Int J STD AIDS
1993;4:311-6
17 Aral Sergi Okten. Heterosexual transmission of IDV: The role
of other sexually transmitted infections and behaviour in its
epidemiology, prevention and control. Ann Rev Publ Health
1993;14:451-67
18 Johnson AM, Wadsworth J, Wellings K, Field J. SexUllI
Attitudes and Lifestyles. Oxford: Blackwell Scientific
Publications, 1994
(Accepted 21 June 1994)