AFEW: Projects >> 2^nd Mass Media Campaign on Safer Sex (Russian Federation) >> Research

Research

Knowledge and Attitude of 'Safe Sex' in Moscow, Results of a Survey, December 1999.

By Russian non governmental organisation Focus and international humanitarian medical organisation Medecins sans Frontiers-Holland

Background:
HIV (the virus that causes AISD) was first detected in the Russian Federation in 1987, with a total of 24 reported cases among an estimated population of approximately 170 million persons. Mass testing was instituted for surveillance, and AIDS centres established in 86 regions of Russia. By the end of 1996 a cumulative total of over 200 million tests had been performed. As of December 1995, the total number of HIV positive individuals registered in Russia was relatively small at 1,061 persons. The year 1996 proved to be a turning point in the epidemic. During this year 1,546 new infections were officially registered, a number exceeding the total of all previous years combined. The next year, 1997, the number of infected people, 4,399, nearly tripled. In the middle of January 2000, a total of 26,414 cases of HIV infection were registered. (All data are from the Russian Federal AIDS Centre and the Ministry of Health of the Russian Federation)

Russian youths are increasingly at risk of acquiring HIV/AIDS. There has been such new freedom towards sexuality in Russia that some Muscovites use the term "sexual revolution" to describe the recent changes. At the same time, intravenous drug use has become widespread and represents the greatest route of HIV transmission at this moment. Most injecting users in Moscow are students and young workers, and are part of "mainstream" society. Being sexual active they represent an important risk for sexual transmission of HIV to other groups of youth. It is not only HIV/AIDS that is spreading dramatically; there is an epidemic of sexually transmitted diseases across Russia. Syphilis for example, has increased 70-fold within the last several years.

The international humanitarian medical organisation Medecins sans Frontiers-Holland (MSF-H) selected mass media campaigning as an instrument to reach young Russians in order to improve awareness and attitude toward sexual health and condom use. The first campaign was launched in June 1997 and run for one and a half year under the slogan 'Safe sex, my choice' reaching far beyond Moscow youth.
In January 1999 a second safe sex campaign under the slogan 'Reasonable person, reasonable choice' was launched in Moscow, this time a close co-operation between MSF-H and the national non-governmental organisation Focus. Like with the first campaign international experts were involved. Assessments were carried out to measure the impact of the first campaign and to define the level of knowledge and awareness among young Muscovites. Target group discussions led to a message and a design in which lessons learned from the first campaign were used and which was well appreciated and understood by the target group.
Two subtle animated messages, one with a male and one with a female leading character, focusing on attitude rather than knowledge promotes healthy lifestyle, personal responsibility and condom use.

Again this campaign like the previous one was launched with full support of the Russian Ministry of Health. The campaign consists of two 35 second commercials on TV and radio, advertisements in print media, leaflets, billboards on public transport, and a web-site. In the period January 1999 - December 1999 the campaign video, initially designed for Moscow, has been shown free of charge over 2000 times Russia wide, representing over $15 million in broadcasting time. 200,000 informational leaflets and 50,000 calendars were distributed via clinics, clubs and universities. Two big youth events were organised and visited by more than 8,000 people. The cities of Kazan, Penza and Vologda implemented during this year also this campaign.

This paper summarises findings of a survey conducted among Muscovite youth to assess knowledge, attitude and behaviour towards HIV/AIDS and safe sex and to measure the impact of the 'Reasonable person, reasonable choice' campaign.

Methods:
The survey was conducted by Market to Market, a Moscow based market research firm. Muscovites from the ages of 15-25 were eligible to participate in the survey. 1,200 surveys were completed.

Results
Media campaign
When asked to complete the slogan "reasonable person . . ." 50% gave the correct response, "reasonable choice". However, 75% said they had seen the "reasonable person . . . " advertisement on television, 29% on metro posters, and 12% in newspapers/magazines. Four percent reported seeing the advertisement at events such as discos or concerts, and 4% had seen the leaflet.

Of those that saw the campaign, 91% thought the commercial was clear, and 68% said it was interesting. Sixty percent said the commercial was personally useful, and 55% said the commercial persuaded them to use condoms. However, only 19% felt the commercial contained new information.

Ninety percent said safe sex campaigns should continue, 89% said sex education should be given in schools.

Knowledge
Respondents were asked about how STD/HIV/AIDS could be passed from one person to another. While unprotected sexual intercourse was recognised as risky, other false routes of transmission were not as well understood (see table I). Shaking hands and coughing were thought to carry some risk of transmission by about a third of respondents. The majority of persons said that eating from the same plate (44% low risk; 9% high risk) could transmit STDs.

Table I.
Routes of STD transmission (n=1200)

Similarly, modes of HIV/AIDS transmission were largely known but compromised by beliefs in risks in incorrect modes of transmission (see table II). Ninety-seven percent said unprotected sexual intercourse was highly risky, and 94% that sharing needles was highly risky. As with STDs, false routes of transmission such as eating from the same plate or coughing were thought to be risky.

Table II.
Routes of HIV/AIDS transmission (n=1200)

Behaviour
Seventy-nine percent of respondents had ever had sexual intercourse. By age, 45% of 15-18 year olds had sexual experience, and by 18-19 years of age 80% of persons had sexual experience. The majority of respondents knew of a peer that had experienced an unplanned pregnancy (68%) or a STD (55%). Eight percent said they knew a peer that had AIDS. A history of injecting drug use was not uncommon: 8% had ever injected drugs, usually men (4% of females versus 12% of males had injected drugs). Two percent of respondents had injected drugs in the last month.

For contraception the last time they had intercourse, the most frequent method was condom use at 47%. Other methods named were withdrawal (interrupting sexual intercourse) (14%), rhythm method (5%), and oral contraceptive pill (5%). About one fifth, 22%, used no contraceptive method at all. A stable partner and other forms of contraception were the main reasons not to use a condom. However, not having a condom at the right moment and reducing pleasure were also frequently named by many respondents.

Attitude
Respondents with sexual experience were asked to estimate, according to the life they lead, their risk of unplanned pregnancy, STD, and HIV/AIDS (see table IV). Interestingly, persons rated their risk highest for HIV/AIDS. Unplanned pregnancy was considered a risk for the majority (51%) of respondents, and STD the lowest with 10% citing high risk and 40% citing some risk.

Table IV
Self-assessed risk of unplanned pregnancy, STD, HIV/AIDS (n=948)

Sixteen percent felt that the AIDS problem in Russia was exaggerated, 64% did not think it was exaggerated, and 21% did not know. Almost half, 45%, said that AIDS was basically a problem for risk groups. This perception was more common among men (52%) than women (39%).

Condoms were regarded as reasonable (93%), but fewer respondents considered their use a modern tendency (66%) or fashionable (24%). Just under one third, 30%, felt that condom use is not necessary.

Fourteen percent said they would be uncomfortable to bring up the subject of condoms with a partner. Exactly half, 50%, said they would like it if a sexual partner offered to use a condom, 22% would not like it, and 28% did not answer. Twelve percent felt that to ask to use a condom implies distrust or disrespect, while 76% did not think so, and 12% did not know.

Conclusions
Half of the respondents being able to complete the slogan is a strong indicator of success. The coverage of the campaign, especially via the TV clip is extensive and in general the campaign was well liked and understood. However, the theme of safe sex and condom use has had considerable exposure, with nearly all respondents reporting having seen some such advertisement on TV, and this is at least part of the reason that relatively few persons thought the "reasonable person, reasonable choice" campaign contained new information. Another challenge is that 42% stated the purpose of the TV clip was that reasonable people should use a condom; to raise this percentage may entail a more direct message, although this method can be very controversial in the Russian setting.

It is very significant that young persons think safe sex campaigns should continue and that 89% support sex education in schools. The evidence for the demand for detailed information on reproductive health is very strong.

Persons are generally well aware of the routes of transmission of STDs and HIV/AIDS. However the many misperceptions such as transmission by coughing or sharing the same plate can undermine the perceived need for safe sex. If, for example, sharing a plate can transmit an STD, the preventive value of safe sex is limited. In addition, there remains some doubt on the efficacy of condoms in preventing pregnancy; STDs, and HIV/AIDS. Addressing the false routes of transmission and reinforcing the effectiveness of condoms is critical. Awareness is high, but there are gaps in knowledge that may be significant obstacles to behaviour change. Yet this will likely require the distribution of more detailed information, certainly more than can be given in a 30-second TV spot. Leaflets are difficult to distribute widely, but perhaps posters in schools, medical clinics of all types, and pharmacies can support a future campaign with more depth.

The risk behaviour of youth has certain clear realities: youth are sexually active and partner exchange is frequent. It is not uncommon for a person (or their partner) in this survey to have multiple sexual contacts in the past 6 months.

Condom use appears to be high, (although this must be examined by number of partners and marital status, especially among the 20% that used no contraception the last time they had intercourse). But condom use appears to be quite situation specific. The recognition that a condom is needed for a new partner is strong, but drops quickly, which may indicate that after the first few contacts, a sexual couple will feel that condoms are no longer necessary. Many persons use an alternate form of contraception or none at all. There are important barriers to condom use that are not easily overcome (not having one at the right time, reduction in pleasure, not comfortable discussing condoms) by increasing awareness. In case someone does not have a condom at the appropriate time or a partner will not use it, negotiation (safe sex or no sex) techniques; especially for women, would be helpful.

The generally high self-assessed risk of unplanned pregnancy, STDs, and HIV/AIDS is unsettling. Knowledge of the risks of unprotected sex is high, and so are levels of risky behaviour such as frequent partner exchange and inconsistent use of condoms. Yet the high self-assessed risk suggests that young persons are aware of the risk and choose to take the risk. Perhaps the consequences of unprotected sex are known but not well understood, or they are understood and accepted and youth are apathetic to them.