Bosnia & Herzegovina

(1)   A Survey on "Risky behavior in relation to HIV prevalence among populations at higher risk of exposure” was conducted together with the Institute of Public Health (IPH) of both the Federation of BiH and the Republic of Srpska.  The survey involved four local NGOs to do the outreach work: Action Against AIDS, Margina, UGPROI and XY and targeted sex workers and MSM, as part of the BiH Global Fund surveillance.  The Programme co-financed this survey with a contribution of EUR 10,000.  The other donors were UNAIDS, UNDP/GFATM and UNICEF. 

Using the snowball methods, this survey collected information to get a better understanding of the demographic profile of MSM and SWs in BiH, learn more about their sexual behaviors, particularly prevention and risk-taking, and find out more about their health status and use of health services.  Such data had not been available in the country prior to this survey.

Since the IPH did not have the capacity to conduct this survey on its own, FPH became the coordinating partner in this venture. 

Sample size            : 150 SWs and  224 MSM from four urban locations
Target areas           : Banja Luka, Bijeljina, Mostar, Prnjavor, Sarajevo, Tuzla and Zenica.

 Some of the key findings obtained were as follows:

MSM

• Only about 1/3 of MSM thought they were at moderate or high risk for HIV

• Close to half (44%) had never talked about the partner’s HIV status, and only
  about a fourth (27%) knew that their partner was HIV negative

• Almost all (98%) knew that condom use reduces their risk of transmission, but more than half had not changed any high risk behaviors

• Of those who reported changes in the past six months, 42% often used condoms, 28% reduced the number of partners, and 30% had relations with only one partner

• Condom use with the current partner during anal intercourse was higher than with an accidental partner (75% vs. 57%, respectively); and only about half (49%) used condoms during every sexual intercourse. Primary reasons for not using condoms were lack of availability or trust in the partner.  In addition, 22% of respondents reported having had sexual intercourse under the influence of drugs and 56.1% under the influence of alcohol during the preceding month.

• 10% reported having had an STI, and 45% had been tested at least once for HIV

• Of the 152 that agreed to be tested, two individuals tested positive for HIV, 2 for syphilis and 11.5% for HCV.

Sex Workers

• More sex workers considered themselves at moderate or high risk (53%) for HIV

• Almost half (47.2%) had provided sexual services for money for 3-5 years, and only 49.3% had less than 5 clients per week

• 57.2% had been exposed to sexual, physical, or psychological abuse

• Condom use was inadequate with 36.2% reported for the last oral, 75% during the last vaginal and 58.2% during the last anal intercourse

• More than a quarter (28.8%) of the 45 respondents using drugs, were injecting drugs and more than half of these (53.8%) occasionally shared injection equipment

• Of the 42 respondents agreeing to testing, 7.2% were positive for syphilis and 4.3% for HCV.

The findings indicate considerable risk-taking in both populations, in view of a general understanding of HIV and STIs and condom use.  This indicates a need to personalize the epidemic, i.e., increase the understanding of the risk involved during every intercourse with an increased willingness to reduce this risk.

(2) The Survey “Knowledge and attitudes towards HIV/AIDS in BiH“ was conducted by Remzija Šetić, a psychologist, with 662 police officers and 178 prison guards, across BiH (Banja Luka, Sarajevo, Mostar, Prijedor, and Tuzla), as well as 149 military cadets in training to determine their knowledge and attitudes about HIV and AIDS.  The results were also presented at the 5^th HIV and AIDS Conference in Zagreb.

The main findings indicate:

-        The respondents had relatively good knowledge about the routes of HIV transmission, except for mother-to-child (only a bit more than half are familiar with MTCT), but poor knowledge about how HIV is not transmitted (e.g., mosquito bites, sneezing, coughing, sharing toilet and dishes and utensils, and kissing)

-        Media were the primary source of HIV information, followed by education, the latter more important with younger respondents and in respondents with higher than secondary level education.  

-        Only about one-third of the respondents expressed an interest in their HIV status, with women more interested than men, and younger respondents more interested that older respondents.  Around two-thirds of the respondents were willing to consider testing at the time of the survey. 

-        With respect to methods of protection against STIs and HIV, the vast majority knew that condoms provide effective protection, but, about one-quarter of respondents has never used a condom; and almost half use condoms only occasionally.

-        On average, prison guards had the most knowledge on HIV, and military cadets the least.  There were also some significant differences between urban and rural locations and urban centers, which would have programmatic implications.

-        Most respondents do not know where they can get voluntary, confidential and free HIV testing.  Lack of information is strongest in urban areas with no VCT centers.

-        While the mean response shows sympathy and awareness about HIV and AIDS in general, a substantial number of respondents have a discriminatory attitude toward persons living with HIV.  Almost two-thirds of the respondents still completely or mainly believe that HIV infection happens only to homosexuals, prostitutes and drug addicts.  Confidentiality is likely to be low as a large percentage of respondents either completely or partly assume they should be informed of an individual’s HIV status. There is similarly a strong expectation that health care workers should inform the family of a person about his/her HIV status.

-        Better knowledge about HIV and AIDS was linked with more favorable attitudes statistically, and respondents with higher levels of education and younger respondents had more liberal attitudes towards HIV and AIDS.

-        There were also significant differences individuals reporting no religious practice vs. some religious practice, with the former being more tolerant towards HIV and AIDS than the latter.

Serbia 

FPH and the NGO NSHC (Novi Sad Humanitarian Center) Serbia, jointly developed a community conversation approach to engage the Roma population in a research study by stimulating the possibility of specific gender transformation in five Roma settlements in Serbia.  The goal of this study was to support community conversations in order to raise awareness and identify potential areas for action to reduce HIV vulnerability.  

The “We are Equal” – Initiative for gender transformation to build HIV resilience research study was implemented in 3 locations in Vojvodina: Novi Sad, Beočin, Bački Monoštor (Sombor municipality), Serbia.

The project explored ways in which the social environment defines and influences the rights, responsibilities and identities of men and women in their interrelations, expectations and assigned roles.  It also explored the potential gender construct in the Roma culture from these settlements that might contribute to both female and male HIV vulnerabilities.  Understanding the gender construct of a community is a pre-condition for its transformation to reduce HIV vulnerabilities of members of a community.

In addition to gathering the self-perceived notion of gender among the Roma in these communities, standard questionnaires were administered to key stakeholders who interact with these Roma communities to obtain perceptions from non-Roma. These stakeholders included representatives of educational, health, and social welfare institutions; representatives of local self-governances; and staff from non-governmental organizations (NGOs) dealing with Roma issues. 

In all, 197 Roma participated in focus group discussions, 101 women and 96 men. Questionnaires were completed by 38 representatives from schools (9 representatives), social welfare centers (15), health centers (4), NGOs (3) and local self-governance structures (7 representatives).  27 of these representatives were women, 11 men),

Findings from the survey on the subjects of reproductive health and knowledge of HIV, showed:

Reproductive Health

When it comes to reproductive health issues, there is some ignorance, passivity, prejudice, fear and shame in the older Roma community, and numerous prejudices and ignorance related to contraceptives:

• Women in most cases do not use any kind of contraception. They have heard of condoms, coils and pills.  Men do not think of these issues but leave it to women to think about contraception

• There is a negative attitude towards condoms and other means of contraception

• Abortion is considered an acceptable and frequently used form of birth control and is discussed openly

• Muslim focus group participants believe that proper hygiene is sufficient protection from all STIs and they added that there are no STIs among them.

“Domination of Roma men over Roma women is noticeable when it comes to reproductive health and rights of women.” one Service providers’ impression about Roma.

However:

·    Some young Roma men said that they do use condoms to protect themselves from STIs when they have sex with a girl for the first time or with somebody they do not know. All of them have heard of AIDS, gonorrhea, and syphilis

·    Some elderly men have heard of condoms as a protection from STIs and they know that their young people use condoms

HIV and AIDS

• It was noted whilst in some communities the elders were well-informed about HIV, in some they have only heard of AIDS and they considered it to be very dangerous

• Mostly the adults (male and female) were very interested in the issue of sexuality, HIV and STIs. They expressed their opinions very openly

• The youth from Novi Sad and Beočin are very well-informed about HIV and gender roles

“I think that the Roma do not consider HIV an important issue.  Educating the Roma is essential”……Jelena Jovanović, age 30

“Roma people don’t think about HIV, or about the consequences. No one even wants to get tested. They use condoms only to prevent pregnancies, but they don’t consider HIV”……
Božidar Stojkov young Roma from Novo Miloševo, University educated and now working with an NGO.

Each group were asked to suggest what behavioural change communications they would like to see for their own communities.  Some of these were implemented via a grant to NSHC from the Trust Fund. Suggestions were: organizing educational workshops for young people on HIV and gender issues; posters, theatrical plays or a handbook on HIV and other STDs.

To read transcripts from the community group discussions which took place in Beocin with middle aged women and older women please click the hyperlinks.