Demografic
a thorough review of the scientific literature uncovered no studies that specifically evaluated the HIV-related knowledge and attitudes of men and women attending Russian STD clinics. Because of the potential for this group to be severely affected by the burgeoning HIV epidemic in Russia and to serve as a core transmitter group facilitating the wider dissemination of HIV, a thorough characterization of the knowledge, sources of HIV/AIDS information, attitudes, and beliefs of this group is warranted in preparation for the development of behavioral risk reduction interventions to help stem the further spread of HIV in Russia.
Because condoms are relatively expensive in Russia, and because high-quality condoms are difficult to obtain (Lunina and Lunin, 1994; Meade et al., 1998), we expected to find substantial variation in attitudes toward condom use in Russia as compared with the United States and other Western countries.
The St. Petersburg Municipal Skin–Venereal Dispensary is the largest STD clinic in St. Petersburg, Russia’s second largest city. The clinic sees nearly 200,000 outpatients each year and also maintains 150 inpatient beds. The clinic is funded by the municipal government of the city of St. Petersburg and provides both free services and paid for services.
Over two-thirds of respondents had obtained HIV/AIDS-related information from each of the three media sources (89.6% from a magazine or news- paper article, 80.4% from television, and 67.0% from radio). Fewer respondents (61.6%) had talked with family and friends about HIV/AIDS and only 20.1% had heard about HIV/AIDS from a teacher
Women reported significantly more sources of information than did men. The number of sources decreased steadily with increasing age
Most respondents (71.3%) said that they would like to learn more about HIV and AIDS. A large majority reported that they believe the government and the media are not telling the truth about AIDS (68.4% and 62.5%, respectively). Only 10.7% of the sample personally knew someone with HIV or AIDS.
Women’s knowledge scores were significantly greater than men’s
Knowledge scores steadily increased with increasing educational attainment, and decreased with in- creasing age for participants older than 18 years of age.
Participants who said they believe that the government is telling the truth about AIDS, and those who believe the media are telling the truth, scored higher on the knowledge scale than did respondents who distrusted the government, the media, or both.
Also, participants who wanted to learn more about HIV/AIDS had higher knowledge scores than those who did not want to learn more
However, there was no difference in knowledge between respondents who knew someone with HIV/AIDS and those who did not.
Condom Attitudes
Members of this high-risk population showed significant deficits in HIV transmission knowledge, with a mean score of 55% correct on the HIV/AIDS knowledge test.
Nearly half of the participants in this study did not know that HIV cannot be transmitted through kissing, almost one fourth did not know that it cannot be transmitted by mosquitoes, and more than one third did not know that oral contraceptives offer no protection against HIV.
In this sample of STD clinic clients, the women were more knowledgeable and re- ported more sources of HIV/AIDS information than the men, suggesting that Russian women may be more likely than their male counterparts to seek out HIV/AIDS information from multiple sources.
Also, younger respondents reported greater numbers of sources of HIV/AIDS information and demonstrated greater HIV/AIDS knowledge.
greater knowledge was associated with younger age, higher educational attainment, positive attitudes to- ward condoms, having more sources of information about HIV/AIDS, and believing that the government is telling the truth about AIDS.
One challenge facing educational efforts in Russia is that many citizens report substantial mistrust of media and government information sources. More than half of our participants were skeptical that the government and Russian media could be trusted to provide accurate information concerning HIV. Establishing trust with relevant, vulnerable populations is a cornerstone of good clinical and public health practice and will be an especially important component of HIV prevention interventions for this population.
Interventions designed to promote knowledge and increase awareness about HIV are the among the most realistic sustainable interventions for a country with modest resources and in the midst of dramatic social change (Kalichman et al., 2000; Kelly and Amirkhanian, 2003)
Artikel 2: HIV Risk Behavior in Male and Female Russian Sexually Transmitted
Disease Clinic Patients (artikel van Nermin)
Inleiding/conclusies (door de auteurs)
Alcohol use in
conjunction with sexual activity was common in this sample (85%)
One-third of study participants had more than 1 partner in the past 3 months, and about half (48%) of the sample had previously been diagnosed with an STD. However, despite this evidence of high-risk behavior, most participants (67%) reported using condoms less than half the time.
our research has documented low perceptions of vulnerability among at-risk groups in Eastern Europe, poor understanding of how the virus is transmitted, and low acceptance of protective measures such as condom use or limiting the number of sexual partners
Future risk reduction intervention
efforts for this group must be grounded in a solid understanding of the factors associated with risky behaviors
High-risk behavior was associated with substance use and lower perceived severity of AIDS. Self-protective strategies differed by gender: men reported higher condom use rates whereas women reported efforts to limit their number of sexual partners
Resultaten
Demographic Characteristics
For the 400 participants, the mean age was 29.4 years (SD = 10.6), with a range of 14 to 64 years old.
Participants reported a median monthly income of 2000 rubles, less than half of the median Russian
monthly income of 5600 rubles
Forty percent reported at least some university- level education.
The majority of participants (57.8%) reported that they currently were single, but a substantial number reported that they were married (31.9%) or living with someone (10.3%).
Almost half of the sample (48%) reported a past history of STDs, with the most frequent being chlamydia(24%), gonorrhea (19%), syphilis (18%), and herpes (5%)
Six participants (1.5%) reported that they were HIV-positive. Thirteen percent of the sample reported a history of multiple lifetime STDs. past history of STDs reported more lifetime sexual partners and lower rates of condom use
Perceived Severity of HIV/AIDS
The substantial majority of participants perceived AIDS as severe; 78% indicated that being diagnosed with AIDS was the worst thing that could happen to them. Men reported significantly lower perceptions
of the severity of AIDS than women
Perceived Vulnerability/Worry About
Contracting HIV/AIDS
31% “not at all”,
35% “little worried
22% “somewhat worried
12% “very worried”
Our work has found that many Russian citizens continue to believe themselves insulated from the epidemic, and therefore do not believe it is important to take measures to protect themselves
Five percent of the men and none of the women reported
same sex partners during their lifetime.
Condom Use During Sexual Activity
18% “never”
49% “some of the time”
12% “half of the time”
21% “most or all of the time”
Male STD clinic patients were more likely than female patients to report that a condom was used during their most recent sexual intercourse act, 63% versus 48%
Participants who reported that their sexual partners regularly used alcohol in conjunction with sexual activity were less likely to use a condom during their most recent sexual encounter.
Participants who perceived AIDS as more severe also were more likely
to use a condom during their last sexual act
Multiple Sexual Partners During 3 months
33% of the sample reported multiple sexual partners
during the previous 3 months, with a mean of 1.87 partners
men 42%
women 24%
single individuals 52%
married 24%
men with men 88%
Having multiple sexual partners was significantly associated with personal alcohol use in conjunction with sexual activity
Having multiple partners also was associated with lower perceived severity of AIDS
One positive finding was that participants reporting multiple sexual partners reported higher rates of condom use than participants not having multiple sexual partners
Strategies to Avoid HIV in the future (suggested by participants)
61% “use condoms”
50% “fewer sex partners”
43% “choose partner more carefully”
42% “have sex only with a main partner”
9% “staying abstinent”
Individuals who were more worried about contracting HIV endorsed more future strategies to avoid the virus
Discussion
Russian STD clinic patients in this study reported relatively high rates of HIV risk behavior, including
having multiple sexual partners over the previous 3 months, consuming alcohol in conjunction with sexual
activity, and low condom use rates. Almost half of the patients had experienced a past STD, yet only 21% reported protecting themselves with consistent condom use.
Marital Status, Monogamy,
and HIV Risk
One surprising finding of this study was the substantial number of participants who reported being married or living with a long-term partner (42%). This number is much higher than the percent of married or partnered individuals reported in published studies of American STD clinic patients (10–28%)
only 47% of married/partnered individuals indicated that they would reduce their risk
for HIV in the future by limiting themselves to having sex only with their primary partner.
Mutual monogamy between two healthy individuals is an effective disease- prevention strategy, but does not appear to be a goal of a substantial percentage of this high-risk sample. (9%)
In this sample of Russian STD clinic patients, 5% of the men and none of the women reported same-sex sexual contact.
Weinig sex workers en drug users:
2 women (1%) and 4 men (2%) reported 10 or more sexual partners in the previous 3 months, suggesting the possibility that these individuals were engaging in formal commercial sex work.
17% of participants reported such use and 15% indicated that their sex partners used illicit drugs in conjunction with sex.
Prevention models developed in the United States frequently rely upon negotiating condom use with partners, sexual assertiveness skills, and refusing to engage in unsafe activities. Such approaches may not be safe
and practical for Russian women. Domestic abuse and violence toward women in Russia is a pervasive problem (Horne, 1999). Women who insist upon condom use with a long-standing sexual partner may be placing themselves at risk for assault and may raise suspicions regarding their own fidelity. Russian women are taking another route to reduce their risk for disease. Reducing the number of sexual partners can be an effective means of disease prevention, but only if these partners are also sexually monogamous, a condition that does not appear to be widespread in this sample.
!!!In addition, interventions targeted to Russian men to promote condom acceptance,
reduce domestic violence, and increase awareness of the increasing dangers of HIV also will have a positive impact on women in Russia.!!!
The Information–Motivation–Behavioral Skills (IMB) model asserts that individuals engage in AIDS preventive behavior when they have accurate information regarding the disease, are sufficiently motivated to avoid it, and have skills adequate to implement healthy behaviors (Fisher & Fisher, 1992).
The IMB model also addresses the importance of motivation to engage in HIV preventive behaviors. The relatively low perceived vulnerability to HIV in the sample is notable given that these individuals were
presenting for STD testing and treatment at the time of the survey. Simply increasing patient knowledge about the heightened risk of HIV in Russia may serve to motivate some individuals to engage in protective behavior.
Artikel 3: COMPARISON OF HIV/AIDS KNOWLEDGE AND ATTITUDES OF STD CLINIC CLIENTS IN ST. PETERSBURG, RUSSIA AND MILWAUKEE, WI, USA (samenvatting is van vorige week)
Parallel surveys were conducted at the St. Petersburg Municipal Skin-Venereal Dispensary and the Milwaukee Central Health Clinic. At each clinic, consecutive samples of 200 men and 200 (St. Petersburg) or 201 (Milwaukee, WI) women were asked to complete self-administered questionnaires regarding their personal characteristics and HIV-relevant knowledge, attitudes, and behavior. Although not every participant answered every question, no one refused to participate.
The St. Petersburg Municipal Skin-Venereal Dispensary is the larg- est STD clinic in St. Petersburg, which is Russia’s second largest city with a metropolitan population of approximately 5 million people. The clinic serves nearly 200,000 outpatients each year. The clinic is funded by the municipal government of the City of St. Petersburg, and provides both free services and paid-for-services.
Six Russians (1.5%) reported that they were HIV-positive.
Conclusions:
nterventions for Russian and American STD clinic patients may well take different forms. Russian patients in particular appear to need information-based and awareness raising approaches and also may benefit from efforts to provide at-risk individuals with a more accurate understanding of their vulnerability to HIV. Media campaigns, peer interventions, and school-based informational approaches in Russia would seem appropriate to more widely disseminate the facts concerning HIV/AIDS.
Both American and Russian STD clinic patients have difficulty trusting government and media sources of information regarding HIV. These patients may place greater trust in their health care providers than in (apparently) suspect govern- mental sources of information. Service providers should take advantage of the opportunity to educate patients, heighten their awareness of HIV, and advocate for testing.
COMPARISON OF HIV/AIDS KNOWLEDGE AND ATTITUDES OF STD CLINIC CLIENTS IN ST. PETERSBURG, RUSSIA AND MILWAUKEE, WI, USA
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