Objective. To present, through an evaluation in Latin America and the Caribbean, the current regulatory and curricular landscape of sexuality and HIV prevention in the school setting, and contrast it with sexual behaviors as reported by demographic and health surveys. Methods. In May 2008, with the support of the United Nations Population Fund (UNFPA), a survey was conducted involving key contacts in 34 countries of the Region. The self-administered questionnaire sought in-depth information on schoolbased HIV/AIDS prevention programs from the staff of various stakeholders, including ministries of education and of health. Results. Twenty-seven countries responded to the survey, representing 95.5% of the target population (6-18 years of age). Most countries reported having at least one textbook or one specific chapter devoted to teaching sex education and HIV prevention. Many, but not all of the important sex education topics, were covered in secondary school; for example, the issue of discrimination based on sexual orientation/ preference is not included in school curricula. Conclusions. Sex education materials should be reviewed and updated periodically to reflect progress being made on the issues and the handling of the subject matter. In each country, the curriculum should address the issue of respecting differences in sexual orientation, preference, and identity, and especially, an appropriate approach toward sexually-transmitted infection (STI) prevention education among males who have sex with males. Efforts to assess the programs' effectiveness should consider outcomes, such as biomarkers (STI incidence and prevalence and pregnancy), not just indicators of self-reported sexual knowledge and behavior. [ABSTRACT FROM AUTHOR]