PART 1

CHAPTER V 

AWARENESS, KNOWLEDGE AND PERSONAL BELIEFS ABOUT ABOUT SEXUALLY TRANSMITTED DISEASES, INCLUDING ACQUIRED IMMUNODEFICIENCY SYNDROME

1.5.1. Awareness

The UN conferences in Cairo and Beijing that took place in 1994 and 1995 highlighted the importance of men’s involvement in all spheres of family and community life, and to encourage and enable them to take responsibility for their sexual and reproductive behavior. The incidence of STDs is rising, in part because in the last few decades, young people have become sexually active earlier yet are marrying later. The net result is that sexually active people today are more likely to have multiple sex partners during their lives and are potentially at risk for developing STDs. The biological differences between two sexes mean that sexual health needs of men and women vary and should be addressed in a gender appropriate manner. As a result of some sexually transmitted infections, men have potential risk of testicular cancer, prostate problems and infertility.

However, in Armenia men’s sexual health needs and responsibilities are largely ignored. The ongoing research and educational projects, as well as available SRH services mainly focus on women and children, and men’s needs are not adequately met. The fact that sexually transmitted diseases occur among both sexes makes it important for both sexes to be aware of possible problems.

This survey shows that the large majority of Armenian men are aware of Acquired Immunodeficiency Syndrome (98%) and Syphilis (97%). Most of respondents were aware of Gonorrhea (79%), but the remaining 21% had never heard about this disease. Only 8% of men ever heard about infection with Chlamydia, a common cause of both female and male infertility  (Figure 1.5.1).

1.5.2. Knowledge

For further analytical purposes we analysed the level of knowledge of survey respondents about STDs and HIV, by mean of calculation of a “score of knowledge”, which was based on the number of correct answers on related questions. The scores varied from 0 up to 36, and the mean was 14.6 (SD=6.62), while the highest possible value was equal to 42 points. According to the score of knowledge about STDs/HIV, respondents were subdivided to the three groups: 1) with good knowledge, 2) with an average knowledge, and 3) with lack of knowledge. The assessment shows that only about 2% of men had good knowledge about the STDs/HIV (Figure 1.5.2).

In order to find out the factors that determine the level of knowledge of men about STDs/HIV, we compared the mean scores of knowledge by men’s age, education and level of urbanization. We found that the knowledge of men did not improve with advancing age. The mean score of knowledge on STDs/HIV was even slightly higher in men below 24 years of age (Figure 1.5.3).

The levels of men’s education and urbanization, however, have significant influence on their knowledge of STDs/HIV. The mean score of knowledge was higher in men having a university level of education, as compared with lower educated respondents. However, even among university graduates, the average score was lower then might be expected  (Figure 1.5.4).

The comparison of STDs/HIV knowledge of men, according to the levels of their urbanization, showed that men who live in city of Yerevan had significantly better knowledge as compared with men living in other urban and rural areas (Figure 1.5.5).

In most of the regions of Armenia the score of knowledge on STDs/AIDS was below the average possible level, with exception of Yerevan (1.8), Aragatsotn (1.6) and Gegarkunic (1.5) Marzes, (Figure 1.5.6).

1.5.3. Personal Beliefs

Table 1.5.1 and Figure 1.5.7 give summarized personal beliefs of the respondents about the possible routes of HIV transmission. Most of them were aware that it is possible to be infected by HIV through vaginal (96%) and anal (91%) intercourse, using a needle already used by someone else (72%) and receiving transmission of infected blood (30%).

There were some prevalent false ideas mentioned by men, such the high probability of HIV transmission through shaking hands (19%), using domestic objects of an infected person (32%), using public bathrooms (28%), or by mosquito bite (23%). Among the startling observations of this study was the fact that most of the respondents had fears of a high probability of infection with HIV (60%) in the health facilities. This finding indicates an existing mistrust by Armenian people concerning the safety of health facilities in Armenia.

Most of the men, who were aware of Syphilis, Gonorrhea and Chlamydia infections, knew that these diseases are sexually transmitted. However, a significant number of men had the wrong impression about the other possible ways of transmission of these infections. The summary of personal beliefs of men about routes of Syphilis, Gonorrhea and Chlamydia transmission is given in the Figures 1.5.8, 1.5.9, 1.5.10, and Tables 1.5.2, 1.5.3. 1.5.4.

As demonstrated below, among the most prevalent false ideas mentioned, were assumptions about the high probability of STD transmission during treatment by physician or dentist, through shaking hands, using domestic objects of an infected person, public bathrooms, or through a mosquito bite.

The unlikely notions of survey respondents about the possible routes of STDs/HIV transmission indicate a general fear of these infections by Armenian men. Such fears are probably based on the lack of men’s education and medical counseling concerning sexual and reproductive health related issues, as well as mistrust as to the safety of the public health facilities. Understanding the basic facts about STDs, the ways in which they are spread, their common symptoms, and how they can be treated is the first step toward their prevention.