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HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
1 
HIV/AIDS in Crimea: 
SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS 2011 
Research findings 
Maksym Zhumenko, GfK Ukraine Prepared for: UN Development Program
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
2 
Research goals 
Analysis of epidemic dynamics data and factors, contributing to the HIV/AIDS spread, in comparison to other regions of Ukraine; 
Evaluation of the level of awareness and knowledge about HIV/AIDS within general population of Crimea, perception of the importance and scale of the problem; 
Analysis of the perception of People living with HIV/AIDS by general population; 
Definition of the main problems within systems of medical service and social adaptation for PLWH 
Preparation of recommendations for improving the situation
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
3 
Research methods 
Desk research of the official statistical and open research data on the topic; 
Quantitative research among general population in Crimea (1243 F2F PAPI interviews); 
Qualitative research among PLWH in Crimea (10 depth interviews); 
Qualitative research among experts working in NGO’s, medical institutions and authorities (15 expert interviews).
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
4 
Time to act 
Epidemics 
60 and 5 by *iconistas
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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During last five years there’s slow growth trend in epidemic dynamics in Crimea, and in Ukraine on the whole 
34.5 
38.2 
41.2 
43.2 
44.7 
40.8 
49.1 
51.3 
57.1 
55.4 
70.9 
60.4 
58.8 
67.4 
68.2 
2006 
2007 
2008 
2009 
2010 
Ukraine 
Crimea 
Sevastopol 
New HIV/AIDS cases in Crimea and Ukraine, 2006-2010. (cases per 100 ths. people).
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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Among most influenced by HIV are northern industrial districts of Crimea (Dzhankoy, Krasnoperekopsk) and Feodosia 
New cases of HIV-infection to general population of the districts of Crimea, 2009 
≤ 0,10% > 0,25% ≥ 0,50% 
≤ 0,15% > 0,50% 
≤ 0,25% 
% of new cases of HIV-infection in population
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
7 
146,524 
170 015; 116% 
171 011; 
101% 
186 055; 
109% 
180 338; 
97% 
2006 
2007 
2008 
2009 
2010 
804 
959 
1004 
1111 
1085 
119% 
105% 
111% 
98% 
HIV-tests and positive results, 2006-2010. In comparison with the previous year, AR Crimea 
Histogram shows the number of HIV-tests conducted in 2006-2010 and percentage of rise of the number of tests in comparison to the previous year. 
Line graph shows the number of positive results of HIV-tests and percentage of rise of the number of positive results in comparison to the previous year. 2006 is a starting point. 
Existence of the direct dependency between the number of newly diagnosed HIV-infection cases and the number of tests done allows to suggest, that the real scale of HIV spread in Crimea is still underestimated
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
8 
32,742 
32 160; 
98,2% 
32 120; 
99,9% 
32 142; 100,1% 
31 258; 
97,2% 
2006 
2007 
2008 
2009 
2010 
269 
229 
222 
255 
258 
85,1% 
96,9% 
114,9% 
101,2% 
HIV-tests and positive results, 2006-2010. In comparison with the previous year, AR Crimea 
Histogram shows the number of HIV-tests conducted in 2006-2010 and percentage of rise of the number of tests in comparison to the previous year. 
Line graph shows the number of positive results of HIV-tests and percentage of rise of the number of positive results in comparison to the previous year. . 2006 is a starting point. 
Different situation is observed in Sevastopol, where the quantity of 31-32 thousands tests is probably quite enough for discovering all the new HIV-infection cases.
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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Most experts agree on the evaluation of the current stage of epidemic dynamics, as an interim stage between concentrated and generalized stages, although there are polar views on the problem 
“It’s still a decease of vulnerable groups only" 
“… there are no vulnerable groups any more, as it’s a decease of the general population now” 
«Starting to spread outside of vulnerable groups" 
Experts’ views on the current stage of epidemic spread in Crimea 
CONCENTRATED 
GENERALIZED 
INTERIM
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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| 2011 
Social perception of the epidemic 
Going for an HIV-test? 
Bring friends!
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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Among social and economical issues of the day, HIV/AIDS epidemic troubles minds of 17% of local population (7th rank among other problems) 
1 
4 
6 
8 
10 
12 
17 
18 
24 
32 
38 
38 
59 
2 
3 
12 
7 
10 
16 
25 
16 
19 
32 
37 
42 
48 
Immigration from other countries 
Environmental pollution / global warming 
Education quality 
Economical inequality 
Pricy housing 
Spread of drug addiction 
HIV/AIDS 
Pricy medical services 
Corruption and bribery in governmetal institutions 
Crime rates, lack of lawfulness 
Lack of money 
Economical recession 
Inflation and rise of consumer prices 
15-24 y.o. (N=205) 
Total (N=1243) 
Here’s the list of problems, troubling people, as many of them say. Read this list, please, and mark the problems, troubling you (%)
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
12 
1 
3 
4 
5 
5 
5 
6 
17 
25 
29 
6 
2 
5 
5 
6 
8 
23 
24 
20 
Others 
Road accidents 
HTA 
Obesity 
NONE 
Depression 
Sexually transmitted infections, except HIV 
HIV/AIDS 
Cancer 
Cardiac disorders 
15-24 y.o. (N=205) 
Total (N=1243) 
Which of this factors of risk for the health worries you more than others? (%) 
Among major factors of risk for the health HIV/AIDS is mentioned by 17% of crimeans, which is 3rd ranked problem
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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For each statement please mark your opinion whether this is a main reason, a secondary reason, or not a reason of HIV/AIDS spread in Ukraine? (%) 
18 
19 
22 
31 
31 
35 
36 
38 
44 
50 
68 
68 
68 
39 
37 
33 
35 
39 
38 
33 
28 
31 
27 
15 
16 
18 
26 
31 
34 
23 
20 
20 
21 
20 
15 
17 
10 
8 
8 
People think, that there's a medicine which can cure HIV/AIDS 
There's lack of programs for free-of-charge injectors' exchange 
Condoms are pricy 
Sex is a tabooed topic 
Parents doesn't tell kids enough about safe sex 
Lack of informational efforts in schools 
People doesn't understand how HIV is spread 
Low quality condoms 
People think, that they're out of risk 
Lack of efforts from authorities 
Prostitution 
Homosexuals 
Drug trafficking 
Main 
Secondary 
Not a reason 
Total N=1243 
In public opinion, the main reasons of HIV/AIDS in Crimea are the illegal injection drugs trade, homosexuals and prostitution
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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Which categories, in your opinion, make up a significant share among people living with HIV?? (%) 
71 
60 
55 
52 
26 
4 
73 
60 
54 
51 
34 
5 
Injection drug addicts 
Homosexuals 
Promiscuous people 
Sex workers 
People just like me, who were unlucky to get infected 
HTA 
Total (N=1243) 
15-24 y.o. (N=205) 
Majority of population has a general idea of the most vulnerable groups’ structure. Though, the role of sex workers is underestimated. Also, only 26% said that there could be a large number of “people just like me” among PLWH
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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| 2011 
What do you know about HIV?! 
HIV awareness 
AIds Sucks by twistedscorpio
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
16 
45 
50 
63 
65 
28 
25 
16 
18 
If you don't change sexual partners often, you shouldn't worry 
about HIV 
If you don't inject drugs, you shouldn't worry about HIV 
You can get HIV even after one unsafe sexual act 
Condom usage significantly reduces the risk of HIV infection 
 Right answers  Wrong answers 
I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%) 
Behavioral practices 
About half of the Crimean population gave us right answers to the questions regarding the risks of HIV infection 
Total N=1243
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
17 
24 
45 
67 
52 
11 
14 
HIV-infected and ill with AIDS are the same 
In most cases, HIV-infection shows itself right after you get infected 
You can get HIV, and you wouldn't know about it 
 Right answers  Wrong answers 
I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%) 
HIV/AIDS illness stages and visible symptoms 
Majority of people are aware, that you can get HIV and wouldn’t know about it. Although, only 45% know that on the initial stage the illness doesn’t show itself in any way 
Total N=1243
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
18 
28 
34 
64 
69 
46 
34 
15 
13 
HIV infection means sure death 
If pregnant woman is HIV-infected, therapy can seriously reduce 
the risk of child infectioning 
HIV/AIDS isn't serious problem today, as there are effective means 
of treatment 
For now, there's no medecine which can treat HIV/AIDS completely 
 Right answers  Wrong answers 
I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%) 
Possibility of HIV/AIDS therapy and vertical transmission prevention 
Majority of Crimeans know that HIV/AIDS can’t be cured completely . Though it’s not a death sentence – but only half of respondents know this last fact 
Total N=1243
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
19 
21 
28 
29 
44 
47 
33 
People living with HIV now get the necessary meds and can live a 
normal life 
The majority of PLWH in our country have no access to the quality 
treatment of the HIV/AIDS 
Effective meds and therapy for HIV/AIDS are available only to those 
who can pay for them 
Right answers  Wrong answers 
I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%) 
Level of availability of ARVT and possibility for the PLWH to live a normal life 
Relative majority aren’t aware about the level of availability of ARVT and possibility for the PLWH to live a normal life 
Total N=1243
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
20 
67 
68 
71 
73 
74 
76 
86 
93 
7 
11 
11 
14 
15 
5 
2 
3 
26 
21 
18 
13 
11 
19 
13 
3 
Oral sex without condom 
Piercing, tattoo, permanent 
makeup 
Razors, toothbrushes 
Syringes or needles 
Any "blood-blood" contact 
Anal sex without condom 
Vaginal sex without condom 
Blood transfusion 
Right 
Wrong 
Not sure 
Total N=1243 
Which ways of HIV transition among following do you consider possible, and which not? True ways (%) 
Only 67% know that you can get infection through oral sex, also very worrying is the fact that 14-15% consider “blood-blood” contacts, including contacts through syringes as not dangerous – this needs strong informational response
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
21 
The level of knowledge about sexual ways of HIV transmission rose among youth from 2007 till now, meanwhile level of knowledge about danger of transmission through syringes and needles fall from 94% to 75% 
81 
95 
71 
75 
94 
77 
56 
83 
5 
2 
7 
6 
3 
12 
13 
7 
13 
2 
21 
18 
2 
10 
31 
10 
GfK Ukraine (2011) 
KIIS (2007) 
GfK Ukraine (2011) 
KIIS (2007) 
GfK Ukraine (2011) 
KIIS (2007) 
GfK Ukraine (2011) 
KIIS (2007) 
GfK Ukraine (2011) 
KIIS (2007) 
GfK Ukraine (2011) 
KIIS (2007) 
GfK Ukraine (2011) 
KIIS (2007) 
GfK Ukraine (2011) 
KIIS (2007) 
Which ways of HIV transition among following do you consider possible, and which not? True ways (only population 15–29 y.o., %) 
GfK Ukraine sample N=310, KIIS sample N=400 
95 
94 
83 
82 
75 
71 
70 
69 
1 
3 
8 
5 
14 
12 
12 
15 
3 
3 
10 
13 
11 
17 
18 
16 
Vaginal sex without condom 
Blood transfusion 
Anal sex without condom 
From mother to child during pregnancy 
Syringes or needles 
Razors, toothbrushes 
Oral sex without condom 
Piercing , tattoo, permanent makeup 
 Right  Wrong  Not sure
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
22 
10 
12 
15 
16 
16 
16 
16 
17 
17 
70 
65 
56 
53 
53 
58 
58 
53 
51 
17 
21 
26 
28 
26 
21 
23 
28 
29 
Touch or hug 
Living in the same place with PLWH 
Sharing food with PLWH 
Sneeze or cough 
Using the same bathroom with PLWH 
Animal or insects bites 
Kiss 
Sharing towels or soap with PLWH 
Sharing dishes or fork with PLWH 
Wrong 
Right 
Not sure 
Which ways of HIV transition among following do you consider possible, and which not? False ways (%) 
The most common fallacy about HIV transmission are that you can get infection though shared dishes, forks, towels, and so on – and this mistake could lead to everyday exclusion and discrimination of HIV 
Total N=1243
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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During period from 2007 to 2011 the percent of youth who share false ideas about ways of HIV transmission fall, so here we can only say good about informational efforts and suggest to follow this course of action 
GfK Ukraine (2011) 
КМИС (2007) 
GfK Ukraine (2011) 
КМИС (2007) 
GfK Ukraine (2011) 
КМИС (2007) 
GfK Ukraine (2011) 
КМИС (2007) 
GfK Ukraine (2011) 
КМИС (2007) 
GfK Ukraine (2011) 
КМИС (2007) 
GfK Ukraine (2011) 
КМИС (2007) 
GfK Ukraine (2011) 
КМИС (2007) 
GfK Ukraine (2011) 
КМИС (2007) 
Which ways of HIV transition among following do you consider possible, and which not? False ways (only population 15–29 y.o., %) 
17 
16 
16 
15 
15 
14 
13 
10 
9 
53 
55 
56 
61 
55 
60 
53 
73 
70 
30 
29 
29 
24 
31 
26 
33 
18 
21 
 Wrong  Right  Not sure 
Sharing towels or soap with PLWH 
Sharing dishes or fork with PLWH 
Sharing food with PLWH 
Animal or insects bites 
Using the same bathroom with PLWH 
Kiss 
Sneeze or cough 
Touch or hug 
Living in the same place with PLWH 
33 
27 
17 
40 
30 
33 
14 
6 
22 
50 
50 
59 
37 
48 
48 
68 
87 
72 
15 
23 
23 
22 
21 
17 
17 
6 
15 
GfK Ukraine sample N=310, KIIS sample N=400
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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How real is in your opinion the risk for you to get HIV? (only population 15–29 y.o., %) 
12 
12 
11 
28 
14 
24 
3 
5 
18 
42 
18 
9 
Real 
Probable 
50/50 
Not very probable 
Absolutely improbable 
Hard to answer 
GfK Ukraine (2011) 
KIIS (2007) 
In comparison with 2007 among Crimean youth the share of those who consider the risk of infection as probable (from 5% to 12%) or real (from 3% to 12%) 
GfK Ukraine sample N=310, KIIS sample N=400
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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Why do you think, that there’s an actual risk of getting infected? (only those, who said that the risk is real, probable or 50/50)? (%) 
44 
25 
21 
2 
8 
38 
30 
23 
3 
6 
I know how to protect myself from HIV and I take all necessary 
precautions, but anything could happen still 
I know how to protect myself from HIV, but sometimes I can't take 
all precautions 
I don't know how to protect myself from HIV 
It's all useless, you can even get an infection in hospital 
Hard to answer 
Total (N=354) 
15-24 y.o. (N=68) 
21% of respondents among those, who consider the probability to get HIV said that they don’t know how to protect themselves. This shows that there still are important gaps in informational preventative policy
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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ARMED & (NOT)DANGEROUS 
Behavioral practices 
Sex is Dangerous 2 by timtak
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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How often do you use condoms when you have sex? (all respondents excluding those who had no sex, %) 
10 
3 
8 
5 
48 
2 
24 
16 
3 
9 
4 
40 
28 
Always 
Almost always 
From time to time 
Rarely 
Don't use, I have sex with only one partner 
Don't use, for other reasons 
Refuse to answer 
Total (N=1080) 
15-24 y.o. (N=152) 
Only 10% of people (and 16% among youth) said that they always use condoms while having sex. 13% - use condoms from time to time or rarely, so the risk group is pretty large.
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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Why don’t you use the condoms at all times? (only whose, who don’t have stable partner and still don’t use condoms at all times, %) 
18 
17 
14 
10 
7 
7 
5 
3 
1 
1 
51 
17 
19 
13 
7 
7 
2 
2 
3 
54 
Don't use when I trust partner 
I don't like the feel 
Don't have them at the time 
Condoms are not relaible protection (can rip) 
Condoms are too expensive 
I use other means of protection 
Don't think it's necessary 
My partner refuse to use condoms 
I feel ashamed to ask partner for this 
I feel ashamed when I buy condoms 
Hard to answer 
Total (N=462) 
15-24 y.o. (N=69) 
The main reasons for not using condoms are trust to partner and decrease of pleasure level. Also they’re too expensive for 7% of respondents, so the real way to increase the condom use would be a massive info campaign with free condoms spread.
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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Have you been ever tested for HIV/AIDS? If yes, why did you decide to pass this test? (%) 
19 
20 
10 
38 
13 
19 
19 
8 
40 
14 
I do this regularly 
Passed several times, but don't 
do this regularly 
Passed once 
Hadn't passed 
Refuse to answer 
Total (N=1243) 
15-24 y.o. (N=205) 
38% of Crimeans have never been tested for HIV, 19% indicated that they do it regularly. At the same time, among those who passed the test for HIV, only 11% did that voluntarily and consciously with clear goal 
85 
11 
4 
2 
86 
13 
3 
2 
It was mandatory to get 
the document 
For my own peace of 
mind 
During the special 
promotion  in company 
with somebody 
Upon the request of my 
partner 
Total (N=605) 
15-24 y.o. (N=94)
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
30 
Why you never passed the test? (among those who hadn’t passed HIV testing, %) 
65 
19 
6 
4 
3 
2 
1 
66 
18 
6 
2 
3 
I am sure that I could not possibly 
get the infection 
Refuse to answer 
I do not know where it can be done 
I do not want others to know that I 
passed the test 
I'm afraid of possible test results 
I do not believe in the reliability of 
the test 
I do not want to pay for it 
Total (N=477) 
15-24 y.o. (N=81) 
Would you like to pass a free test for HIV/AIDS if such was offered? (among those who hadn’t passed HIV testing, %) 
56 
25 
19 
48 
30 
22 
No 
Refuse to answer 
Yes 
Total (N=638) 
15-24 y.o. (N=220) 
Among those, who have never passed the test, about 65% are sure that the probability for them to get the infection is zero. The study revealed high barriers to HIV testing especially among people aged 24 and over
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
31 
The main recommendation for HIV spread prevention 
Popularization of voluntary testing for HIV, testing for partners in pairs, spreading information about organizations which provide VCT and other related info 
Introduction of mandatory HIV testing for various procedures / medical examinations with restrictions on results disclosure to anybody except tested person 
Popularization of the basic rules of safe behavior 
Promotion and distribution of high-quality condoms
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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| 2011 
Erase The Ignorance 
Life with HIV. 
Attitude and adoption
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
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Level of social tolerance towards PLWH and groups of high risk in comparison with different ethnic and racial groups (Bogardus scale, means) 
1.4 
1.6 
3.0 
4.1 
5.4 
5.4 
5.6 
5.7 
5.8 
5.9 
6.0 
6.1 
Ukrainians 
Russain 
Crimean Tartars 
Jews 
Americans 
Asians 
Africans 
People living with HIV 
Homosexuals 
Chechens 
Sex workers 
Drug users 
Socially close 
Neutral 
Acceptable 
Xenophobic attitude 
The problem in perception of people living with HIV in society is still quite significant, especially in comparative perspective with the level of "social tolerance" towards PLWH and groups of high risk
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
34 
Are there PLWH among your acquaintances? (%) 
Yes 10% 
No 90% 
56 
42 
2 
79 
21 
I treat them as all other people 
I don't show it, but I try to avoid contact 
Hard to answer 
Total (N=122) 
15-24 y.o. (N=25) 
How you feel about them? (only those who have acquaintances among PLWH, %) 
At the same time, most of those who have friends among PLWH indicated that they treat them as ordinary people. Experts also believe that the mere fact of the disease does not necessarily lead to social exclusion in Crimea
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
35 
22 
21 
19 
12 
6 
20 
26 
23 
28 
11 
18 
16 
19 
17 
23 
9 
14 
16 
12 
25 
32 
23 
23 
31 
35 
Strongly Agree 
Somewhat Agree 
Somewhat Disagree 
Strongly Disagree 
HTA 
Total N=1243 
The share of those, who thinks that PLWH have a right to preserve their status confidential, and those, who thinks, that they must warn other are almost equal in Crimea – 42% and 40% respectively 
Indicate, please, for each of the following statements regarding PLWH to which measure do you agree with it, (%) 
People living with HIV/AIDS have the right to keep this in secret 
Rights of people living with HIV  AIDS violated in Crimea 
Most people with HIV  AIDS are to blame for the fact that infected 
People with HIV  AIDS must warn others about the disease 
HIV  AIDS - a punishment from God
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
36 
•Quite often, after the discovery of HIV-positive status, people alienate themselves from the world, from society, even from close friends, lock themselves in the problem. This behaviour can be provoked also by the desire to protect one’s family from him/herself 
Self-isolation Self stigmatization 
•The physical consequences of HIV infection can be severe enough to deprive a person of the opportunity for active employment and self-realization in some professional fields. On the other hand, the opportunities for retraining and employment are quite small 
Disability 
•PLHIV often suffer from concurrent disorders such as drug addiction and contagious co-infections. The degree of social tolerance to such problems is significantly lower than even to HIV itself, which affects the perception of PLHIV with such problems in the first place as a drug addicts (the image of which is strongly associated with delinquent behaviour), tuberculosis-infected (TB is contagious by droplet contact). A similar mechanism applies to the CSW, whom people also often associate with delinquent behaviour. 
HIV-related medical and social problems such as drug addiction, tuberculosis coinfection 
Изменения в жизненном мире ЛЖВ после сообщения о статусе очень велики, и для полноценной адаптации нужна активная психологическая и социальная помощь для принятия своего положения и предупреждения самоизоляции
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
37 
Changing attitudes toward people living with HIV status 
Assistance in rehabilitation, self-realization 
Overcoming negative institutional background 
Improving the overall situation with perception of PLWH and HIV AIDS by the general population 
Authors of photos (left to right): 
Romainguy, Walt Stoneburner, Keith Allison, Julie McLeod 
All photos are used under Creative Commons license conditions 
Our response to epidemic should cover all stages - from the psychology and behaviour of people living with HIV to the broad understanding of problem by society. Very important step would be overcoming the negative institutional background.
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
38 
Recommendations for improving tolerance to PLHIV. To improve the tolerance towards PLHIV it’s recommended to spread in the media, as well as through the civil organizations the following information: 
The epidemic has moved beyond the groups of drug users and promiscuous people – so people are often not to blame for the infection; 
Life stories of adults and children living with HIV, who can (with the necessary treatment ) live a normal life (in particular, in popular programs, movies, TV series); information about human rights and violations of the rights of PLHIV. According to the research, people who have friends among PLHIV better treat them than those who doesn’t; 
Intolerance towards PLHIV promotes the spread of HIV / AIDS epidemic; 
Stories about healthy children which can be born to PLHIV thanks to effective treatment; 
Communication with adults and children living with HIV is absolutely safe, HIV can be only transmitted through blood and sex.
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
39 
| 2011 
Keep fighting 
HIV-service and prevention
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
40 
All respondents are satisfied with the services for PLHIV in the AIDS centres in Simferopol and Sevastopol. Stated the following suggestions: 
Increase numbers of full-time medical stuff; 
Enlarge the list of available medical services – there is high demand for treatment of cardiovascular, services of dentists, gastroenterologists, neurologists, other specialized doctors; 
Provide free analysis on the immune status and viral load, as well as opportunistic infections; 
Provide free medicines for the treatment of opportunistic infections; 
Divide the flows of patients (testing, issuing of ART for patients with opportunistic diseases, etc.); 
Improve facilities (larger premises in Simferopol, separate room in Sevastopol); 
(only for Sevastopol) Create own laboratory for analysis on the immune status and viral load.
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
41 
Most PLHIV are satisfied with the services provided by public organizations. Made the following suggestions regarding social services: 
The main need of all respondents - to increase the volume of humanitarian aid (medicines, rations); 
Expand the services in area of the care of seriously ill patients (transportation of patients to the hospital or visits by doctors at home, presence of social workers in hospitals); 
Organize assistance in employment search; 
Provide the services of professional lawyers; 
Organize recreational programs for children; 
Organize creative workshops; 
Provide services like haircuts, manicures;
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
42 
The shortage of qualified doctors (especially those, specializing in infectious diseases and dentists) and the unavailability of drugs for the treatment of opportunistic infections are the main challenges in the area of medical services 
Problems with medical services for PLWH 
Infrastructural 
Problem with access in distant areas 
Lack of qualified doctors-specialists 
Lack of premises, insufficiency of equipment and facilities 
Availability and quality of the meds 
Lack of ARVT meds, only several combinations available 
Outdated drugs with negative side effects 
Unavailability of drugs for opportunistic infections treatment 
Availability of special services 
Unavailability of artificial insemination for discordant couples 
Main problems with medical services for PLWH
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
43 
Opinions PLHIV and experts agree that at present NGO’s operate more effectively than government in the fields of prevention of infection and care & support for people living with HIV 
The main problems in the area of HIV / AIDS prevention and non-medical services for people living with HIV 
NGO 
Governmental agencies 
Scope 
Relatively small, mainly in big cities 
Relatively large 
Resources 
Better equipment and resources, but lack the premises 
Worse equipment and resources, enough premises 
Finances 
Relatively bigger project-based finance from multilateral sources 
Relatively smaller budget-based 
Work Organization 
Project-based organization of work, more flexible, but not always successive 
Planned work, relatively inert and less effective, though more permanent 
Monitoring & Evaluation 
Effective and established 
No systematic M&E 
Motivation 
High 
Low 
PLHIV involvement 
Large % of workers are PLHIV 
No systematic involvement 
Trust 
PLHIV and people from risk groups access NGO more often. The high level of confidence is caused by the previous experience in referent groups and activity in the provision of services 
Rarely apply to state non-medical organizations. Many bureaucratic procedures, delays. IDUs and CSWs often had in the past experience of the arrests and generally do not trust the state authorities
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
44 
Achievements of the HIV-service organizations in Crimea 
Raising awareness about the threat of HIV / AIDS and safe behaviour practices among young people under 30 years old in 2007. At the moment, the most informed and cautious group of Crimean population are people aged 15-24, which apparently is the target audience of many prevention programs; 
Advances in prevention work among IDUs, to a lesser extent – among CSW, and least of all - MSM; 
Increasing the number of HIV tests performed in 2007 (16% compared to 2006) and in 2009 (9% compared to 2008) in the ARC (in Sevastopol in 2008-2009, the number of tests is stable). Overall, at the end of 2010, 47% of Crimean aged 15-29 were tested for HIV, compared with 37% in 2007 .; 
Expansion of the branch network of AIDS centers and offices for ART provision 
Provision of ART for the absolute majority of those in need; 
Satisfaction of respondents with the work of HIV / AIDS centres and NGO’s, which is a key indicator of the effectiveness of their work.
HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 
45 
Priorities for the future 
The relatively low level of awareness about the threat of HIV / AIDS and safe behaviour practices among the sexually active age group of 25-49 years, which receives the relevant information less often; 
Lack of preventive work among CSWs and MSM; 
The low popularity of regular voluntary HIV testing (of all respondents who are tested for HIV, 85% have done it because they needed a certificate for some purpose and only 11% were tested deliberately for their own peace of mind). 
The low level of tolerance towards people living with HIV in the general population (40% of them wouldn’t allow PLHIV into the territory of the peninsula, 42% believe that they are to blame for their fate) and, in particular, among health care workers and employees of state organizations, including law enforcement services. In 2010 compared to 2007 tolerance to PLHIV decreased, even among young people 15-29 years old, which is the most tolerant group: in 2007, 52% claimed that their attitude towards somebody whom they know, would not change if such person will get infected, or they will try to help him, in 2010 only 37% claimed the same.

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HIV/AIDS in Crimea: Social Perception and Authorities Actions' | 2011

  • 1. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 1 HIV/AIDS in Crimea: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS 2011 Research findings Maksym Zhumenko, GfK Ukraine Prepared for: UN Development Program
  • 2. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 2 Research goals Analysis of epidemic dynamics data and factors, contributing to the HIV/AIDS spread, in comparison to other regions of Ukraine; Evaluation of the level of awareness and knowledge about HIV/AIDS within general population of Crimea, perception of the importance and scale of the problem; Analysis of the perception of People living with HIV/AIDS by general population; Definition of the main problems within systems of medical service and social adaptation for PLWH Preparation of recommendations for improving the situation
  • 3. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 3 Research methods Desk research of the official statistical and open research data on the topic; Quantitative research among general population in Crimea (1243 F2F PAPI interviews); Qualitative research among PLWH in Crimea (10 depth interviews); Qualitative research among experts working in NGO’s, medical institutions and authorities (15 expert interviews).
  • 4. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 4 Time to act Epidemics 60 and 5 by *iconistas
  • 5. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 5 During last five years there’s slow growth trend in epidemic dynamics in Crimea, and in Ukraine on the whole 34.5 38.2 41.2 43.2 44.7 40.8 49.1 51.3 57.1 55.4 70.9 60.4 58.8 67.4 68.2 2006 2007 2008 2009 2010 Ukraine Crimea Sevastopol New HIV/AIDS cases in Crimea and Ukraine, 2006-2010. (cases per 100 ths. people).
  • 6. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 6 Among most influenced by HIV are northern industrial districts of Crimea (Dzhankoy, Krasnoperekopsk) and Feodosia New cases of HIV-infection to general population of the districts of Crimea, 2009 ≤ 0,10% > 0,25% ≥ 0,50% ≤ 0,15% > 0,50% ≤ 0,25% % of new cases of HIV-infection in population
  • 7. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 7 146,524 170 015; 116% 171 011; 101% 186 055; 109% 180 338; 97% 2006 2007 2008 2009 2010 804 959 1004 1111 1085 119% 105% 111% 98% HIV-tests and positive results, 2006-2010. In comparison with the previous year, AR Crimea Histogram shows the number of HIV-tests conducted in 2006-2010 and percentage of rise of the number of tests in comparison to the previous year. Line graph shows the number of positive results of HIV-tests and percentage of rise of the number of positive results in comparison to the previous year. 2006 is a starting point. Existence of the direct dependency between the number of newly diagnosed HIV-infection cases and the number of tests done allows to suggest, that the real scale of HIV spread in Crimea is still underestimated
  • 8. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 8 32,742 32 160; 98,2% 32 120; 99,9% 32 142; 100,1% 31 258; 97,2% 2006 2007 2008 2009 2010 269 229 222 255 258 85,1% 96,9% 114,9% 101,2% HIV-tests and positive results, 2006-2010. In comparison with the previous year, AR Crimea Histogram shows the number of HIV-tests conducted in 2006-2010 and percentage of rise of the number of tests in comparison to the previous year. Line graph shows the number of positive results of HIV-tests and percentage of rise of the number of positive results in comparison to the previous year. . 2006 is a starting point. Different situation is observed in Sevastopol, where the quantity of 31-32 thousands tests is probably quite enough for discovering all the new HIV-infection cases.
  • 9. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 9 Most experts agree on the evaluation of the current stage of epidemic dynamics, as an interim stage between concentrated and generalized stages, although there are polar views on the problem “It’s still a decease of vulnerable groups only" “… there are no vulnerable groups any more, as it’s a decease of the general population now” «Starting to spread outside of vulnerable groups" Experts’ views on the current stage of epidemic spread in Crimea CONCENTRATED GENERALIZED INTERIM
  • 10. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 10 | 2011 Social perception of the epidemic Going for an HIV-test? Bring friends!
  • 11. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 11 Among social and economical issues of the day, HIV/AIDS epidemic troubles minds of 17% of local population (7th rank among other problems) 1 4 6 8 10 12 17 18 24 32 38 38 59 2 3 12 7 10 16 25 16 19 32 37 42 48 Immigration from other countries Environmental pollution / global warming Education quality Economical inequality Pricy housing Spread of drug addiction HIV/AIDS Pricy medical services Corruption and bribery in governmetal institutions Crime rates, lack of lawfulness Lack of money Economical recession Inflation and rise of consumer prices 15-24 y.o. (N=205) Total (N=1243) Here’s the list of problems, troubling people, as many of them say. Read this list, please, and mark the problems, troubling you (%)
  • 12. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 12 1 3 4 5 5 5 6 17 25 29 6 2 5 5 6 8 23 24 20 Others Road accidents HTA Obesity NONE Depression Sexually transmitted infections, except HIV HIV/AIDS Cancer Cardiac disorders 15-24 y.o. (N=205) Total (N=1243) Which of this factors of risk for the health worries you more than others? (%) Among major factors of risk for the health HIV/AIDS is mentioned by 17% of crimeans, which is 3rd ranked problem
  • 13. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 13 For each statement please mark your opinion whether this is a main reason, a secondary reason, or not a reason of HIV/AIDS spread in Ukraine? (%) 18 19 22 31 31 35 36 38 44 50 68 68 68 39 37 33 35 39 38 33 28 31 27 15 16 18 26 31 34 23 20 20 21 20 15 17 10 8 8 People think, that there's a medicine which can cure HIV/AIDS There's lack of programs for free-of-charge injectors' exchange Condoms are pricy Sex is a tabooed topic Parents doesn't tell kids enough about safe sex Lack of informational efforts in schools People doesn't understand how HIV is spread Low quality condoms People think, that they're out of risk Lack of efforts from authorities Prostitution Homosexuals Drug trafficking Main Secondary Not a reason Total N=1243 In public opinion, the main reasons of HIV/AIDS in Crimea are the illegal injection drugs trade, homosexuals and prostitution
  • 14. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 14 Which categories, in your opinion, make up a significant share among people living with HIV?? (%) 71 60 55 52 26 4 73 60 54 51 34 5 Injection drug addicts Homosexuals Promiscuous people Sex workers People just like me, who were unlucky to get infected HTA Total (N=1243) 15-24 y.o. (N=205) Majority of population has a general idea of the most vulnerable groups’ structure. Though, the role of sex workers is underestimated. Also, only 26% said that there could be a large number of “people just like me” among PLWH
  • 15. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 15 | 2011 What do you know about HIV?! HIV awareness AIds Sucks by twistedscorpio
  • 16. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 16 45 50 63 65 28 25 16 18 If you don't change sexual partners often, you shouldn't worry about HIV If you don't inject drugs, you shouldn't worry about HIV You can get HIV even after one unsafe sexual act Condom usage significantly reduces the risk of HIV infection  Right answers  Wrong answers I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%) Behavioral practices About half of the Crimean population gave us right answers to the questions regarding the risks of HIV infection Total N=1243
  • 17. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 17 24 45 67 52 11 14 HIV-infected and ill with AIDS are the same In most cases, HIV-infection shows itself right after you get infected You can get HIV, and you wouldn't know about it  Right answers  Wrong answers I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%) HIV/AIDS illness stages and visible symptoms Majority of people are aware, that you can get HIV and wouldn’t know about it. Although, only 45% know that on the initial stage the illness doesn’t show itself in any way Total N=1243
  • 18. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 18 28 34 64 69 46 34 15 13 HIV infection means sure death If pregnant woman is HIV-infected, therapy can seriously reduce the risk of child infectioning HIV/AIDS isn't serious problem today, as there are effective means of treatment For now, there's no medecine which can treat HIV/AIDS completely  Right answers  Wrong answers I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%) Possibility of HIV/AIDS therapy and vertical transmission prevention Majority of Crimeans know that HIV/AIDS can’t be cured completely . Though it’s not a death sentence – but only half of respondents know this last fact Total N=1243
  • 19. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 19 21 28 29 44 47 33 People living with HIV now get the necessary meds and can live a normal life The majority of PLWH in our country have no access to the quality treatment of the HIV/AIDS Effective meds and therapy for HIV/AIDS are available only to those who can pay for them Right answers  Wrong answers I’ll read some statements regarding HIV/AIDS to you. Please, for each of them, tell whether this is true or false statement. (%) Level of availability of ARVT and possibility for the PLWH to live a normal life Relative majority aren’t aware about the level of availability of ARVT and possibility for the PLWH to live a normal life Total N=1243
  • 20. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 20 67 68 71 73 74 76 86 93 7 11 11 14 15 5 2 3 26 21 18 13 11 19 13 3 Oral sex without condom Piercing, tattoo, permanent makeup Razors, toothbrushes Syringes or needles Any "blood-blood" contact Anal sex without condom Vaginal sex without condom Blood transfusion Right Wrong Not sure Total N=1243 Which ways of HIV transition among following do you consider possible, and which not? True ways (%) Only 67% know that you can get infection through oral sex, also very worrying is the fact that 14-15% consider “blood-blood” contacts, including contacts through syringes as not dangerous – this needs strong informational response
  • 21. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 21 The level of knowledge about sexual ways of HIV transmission rose among youth from 2007 till now, meanwhile level of knowledge about danger of transmission through syringes and needles fall from 94% to 75% 81 95 71 75 94 77 56 83 5 2 7 6 3 12 13 7 13 2 21 18 2 10 31 10 GfK Ukraine (2011) KIIS (2007) GfK Ukraine (2011) KIIS (2007) GfK Ukraine (2011) KIIS (2007) GfK Ukraine (2011) KIIS (2007) GfK Ukraine (2011) KIIS (2007) GfK Ukraine (2011) KIIS (2007) GfK Ukraine (2011) KIIS (2007) GfK Ukraine (2011) KIIS (2007) Which ways of HIV transition among following do you consider possible, and which not? True ways (only population 15–29 y.o., %) GfK Ukraine sample N=310, KIIS sample N=400 95 94 83 82 75 71 70 69 1 3 8 5 14 12 12 15 3 3 10 13 11 17 18 16 Vaginal sex without condom Blood transfusion Anal sex without condom From mother to child during pregnancy Syringes or needles Razors, toothbrushes Oral sex without condom Piercing , tattoo, permanent makeup  Right  Wrong  Not sure
  • 22. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 22 10 12 15 16 16 16 16 17 17 70 65 56 53 53 58 58 53 51 17 21 26 28 26 21 23 28 29 Touch or hug Living in the same place with PLWH Sharing food with PLWH Sneeze or cough Using the same bathroom with PLWH Animal or insects bites Kiss Sharing towels or soap with PLWH Sharing dishes or fork with PLWH Wrong Right Not sure Which ways of HIV transition among following do you consider possible, and which not? False ways (%) The most common fallacy about HIV transmission are that you can get infection though shared dishes, forks, towels, and so on – and this mistake could lead to everyday exclusion and discrimination of HIV Total N=1243
  • 23. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 23 During period from 2007 to 2011 the percent of youth who share false ideas about ways of HIV transmission fall, so here we can only say good about informational efforts and suggest to follow this course of action GfK Ukraine (2011) КМИС (2007) GfK Ukraine (2011) КМИС (2007) GfK Ukraine (2011) КМИС (2007) GfK Ukraine (2011) КМИС (2007) GfK Ukraine (2011) КМИС (2007) GfK Ukraine (2011) КМИС (2007) GfK Ukraine (2011) КМИС (2007) GfK Ukraine (2011) КМИС (2007) GfK Ukraine (2011) КМИС (2007) Which ways of HIV transition among following do you consider possible, and which not? False ways (only population 15–29 y.o., %) 17 16 16 15 15 14 13 10 9 53 55 56 61 55 60 53 73 70 30 29 29 24 31 26 33 18 21  Wrong  Right  Not sure Sharing towels or soap with PLWH Sharing dishes or fork with PLWH Sharing food with PLWH Animal or insects bites Using the same bathroom with PLWH Kiss Sneeze or cough Touch or hug Living in the same place with PLWH 33 27 17 40 30 33 14 6 22 50 50 59 37 48 48 68 87 72 15 23 23 22 21 17 17 6 15 GfK Ukraine sample N=310, KIIS sample N=400
  • 24. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 24 How real is in your opinion the risk for you to get HIV? (only population 15–29 y.o., %) 12 12 11 28 14 24 3 5 18 42 18 9 Real Probable 50/50 Not very probable Absolutely improbable Hard to answer GfK Ukraine (2011) KIIS (2007) In comparison with 2007 among Crimean youth the share of those who consider the risk of infection as probable (from 5% to 12%) or real (from 3% to 12%) GfK Ukraine sample N=310, KIIS sample N=400
  • 25. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 25 Why do you think, that there’s an actual risk of getting infected? (only those, who said that the risk is real, probable or 50/50)? (%) 44 25 21 2 8 38 30 23 3 6 I know how to protect myself from HIV and I take all necessary precautions, but anything could happen still I know how to protect myself from HIV, but sometimes I can't take all precautions I don't know how to protect myself from HIV It's all useless, you can even get an infection in hospital Hard to answer Total (N=354) 15-24 y.o. (N=68) 21% of respondents among those, who consider the probability to get HIV said that they don’t know how to protect themselves. This shows that there still are important gaps in informational preventative policy
  • 26. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 26 ARMED & (NOT)DANGEROUS Behavioral practices Sex is Dangerous 2 by timtak
  • 27. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 27 How often do you use condoms when you have sex? (all respondents excluding those who had no sex, %) 10 3 8 5 48 2 24 16 3 9 4 40 28 Always Almost always From time to time Rarely Don't use, I have sex with only one partner Don't use, for other reasons Refuse to answer Total (N=1080) 15-24 y.o. (N=152) Only 10% of people (and 16% among youth) said that they always use condoms while having sex. 13% - use condoms from time to time or rarely, so the risk group is pretty large.
  • 28. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 28 Why don’t you use the condoms at all times? (only whose, who don’t have stable partner and still don’t use condoms at all times, %) 18 17 14 10 7 7 5 3 1 1 51 17 19 13 7 7 2 2 3 54 Don't use when I trust partner I don't like the feel Don't have them at the time Condoms are not relaible protection (can rip) Condoms are too expensive I use other means of protection Don't think it's necessary My partner refuse to use condoms I feel ashamed to ask partner for this I feel ashamed when I buy condoms Hard to answer Total (N=462) 15-24 y.o. (N=69) The main reasons for not using condoms are trust to partner and decrease of pleasure level. Also they’re too expensive for 7% of respondents, so the real way to increase the condom use would be a massive info campaign with free condoms spread.
  • 29. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 29 Have you been ever tested for HIV/AIDS? If yes, why did you decide to pass this test? (%) 19 20 10 38 13 19 19 8 40 14 I do this regularly Passed several times, but don't do this regularly Passed once Hadn't passed Refuse to answer Total (N=1243) 15-24 y.o. (N=205) 38% of Crimeans have never been tested for HIV, 19% indicated that they do it regularly. At the same time, among those who passed the test for HIV, only 11% did that voluntarily and consciously with clear goal 85 11 4 2 86 13 3 2 It was mandatory to get the document For my own peace of mind During the special promotion in company with somebody Upon the request of my partner Total (N=605) 15-24 y.o. (N=94)
  • 30. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 30 Why you never passed the test? (among those who hadn’t passed HIV testing, %) 65 19 6 4 3 2 1 66 18 6 2 3 I am sure that I could not possibly get the infection Refuse to answer I do not know where it can be done I do not want others to know that I passed the test I'm afraid of possible test results I do not believe in the reliability of the test I do not want to pay for it Total (N=477) 15-24 y.o. (N=81) Would you like to pass a free test for HIV/AIDS if such was offered? (among those who hadn’t passed HIV testing, %) 56 25 19 48 30 22 No Refuse to answer Yes Total (N=638) 15-24 y.o. (N=220) Among those, who have never passed the test, about 65% are sure that the probability for them to get the infection is zero. The study revealed high barriers to HIV testing especially among people aged 24 and over
  • 31. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 31 The main recommendation for HIV spread prevention Popularization of voluntary testing for HIV, testing for partners in pairs, spreading information about organizations which provide VCT and other related info Introduction of mandatory HIV testing for various procedures / medical examinations with restrictions on results disclosure to anybody except tested person Popularization of the basic rules of safe behavior Promotion and distribution of high-quality condoms
  • 32. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 32 | 2011 Erase The Ignorance Life with HIV. Attitude and adoption
  • 33. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 33 Level of social tolerance towards PLWH and groups of high risk in comparison with different ethnic and racial groups (Bogardus scale, means) 1.4 1.6 3.0 4.1 5.4 5.4 5.6 5.7 5.8 5.9 6.0 6.1 Ukrainians Russain Crimean Tartars Jews Americans Asians Africans People living with HIV Homosexuals Chechens Sex workers Drug users Socially close Neutral Acceptable Xenophobic attitude The problem in perception of people living with HIV in society is still quite significant, especially in comparative perspective with the level of "social tolerance" towards PLWH and groups of high risk
  • 34. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 34 Are there PLWH among your acquaintances? (%) Yes 10% No 90% 56 42 2 79 21 I treat them as all other people I don't show it, but I try to avoid contact Hard to answer Total (N=122) 15-24 y.o. (N=25) How you feel about them? (only those who have acquaintances among PLWH, %) At the same time, most of those who have friends among PLWH indicated that they treat them as ordinary people. Experts also believe that the mere fact of the disease does not necessarily lead to social exclusion in Crimea
  • 35. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 35 22 21 19 12 6 20 26 23 28 11 18 16 19 17 23 9 14 16 12 25 32 23 23 31 35 Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree HTA Total N=1243 The share of those, who thinks that PLWH have a right to preserve their status confidential, and those, who thinks, that they must warn other are almost equal in Crimea – 42% and 40% respectively Indicate, please, for each of the following statements regarding PLWH to which measure do you agree with it, (%) People living with HIV/AIDS have the right to keep this in secret Rights of people living with HIV AIDS violated in Crimea Most people with HIV AIDS are to blame for the fact that infected People with HIV AIDS must warn others about the disease HIV AIDS - a punishment from God
  • 36. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 36 •Quite often, after the discovery of HIV-positive status, people alienate themselves from the world, from society, even from close friends, lock themselves in the problem. This behaviour can be provoked also by the desire to protect one’s family from him/herself Self-isolation Self stigmatization •The physical consequences of HIV infection can be severe enough to deprive a person of the opportunity for active employment and self-realization in some professional fields. On the other hand, the opportunities for retraining and employment are quite small Disability •PLHIV often suffer from concurrent disorders such as drug addiction and contagious co-infections. The degree of social tolerance to such problems is significantly lower than even to HIV itself, which affects the perception of PLHIV with such problems in the first place as a drug addicts (the image of which is strongly associated with delinquent behaviour), tuberculosis-infected (TB is contagious by droplet contact). A similar mechanism applies to the CSW, whom people also often associate with delinquent behaviour. HIV-related medical and social problems such as drug addiction, tuberculosis coinfection Изменения в жизненном мире ЛЖВ после сообщения о статусе очень велики, и для полноценной адаптации нужна активная психологическая и социальная помощь для принятия своего положения и предупреждения самоизоляции
  • 37. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 37 Changing attitudes toward people living with HIV status Assistance in rehabilitation, self-realization Overcoming negative institutional background Improving the overall situation with perception of PLWH and HIV AIDS by the general population Authors of photos (left to right): Romainguy, Walt Stoneburner, Keith Allison, Julie McLeod All photos are used under Creative Commons license conditions Our response to epidemic should cover all stages - from the psychology and behaviour of people living with HIV to the broad understanding of problem by society. Very important step would be overcoming the negative institutional background.
  • 38. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 38 Recommendations for improving tolerance to PLHIV. To improve the tolerance towards PLHIV it’s recommended to spread in the media, as well as through the civil organizations the following information: The epidemic has moved beyond the groups of drug users and promiscuous people – so people are often not to blame for the infection; Life stories of adults and children living with HIV, who can (with the necessary treatment ) live a normal life (in particular, in popular programs, movies, TV series); information about human rights and violations of the rights of PLHIV. According to the research, people who have friends among PLHIV better treat them than those who doesn’t; Intolerance towards PLHIV promotes the spread of HIV / AIDS epidemic; Stories about healthy children which can be born to PLHIV thanks to effective treatment; Communication with adults and children living with HIV is absolutely safe, HIV can be only transmitted through blood and sex.
  • 39. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 39 | 2011 Keep fighting HIV-service and prevention
  • 40. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 40 All respondents are satisfied with the services for PLHIV in the AIDS centres in Simferopol and Sevastopol. Stated the following suggestions: Increase numbers of full-time medical stuff; Enlarge the list of available medical services – there is high demand for treatment of cardiovascular, services of dentists, gastroenterologists, neurologists, other specialized doctors; Provide free analysis on the immune status and viral load, as well as opportunistic infections; Provide free medicines for the treatment of opportunistic infections; Divide the flows of patients (testing, issuing of ART for patients with opportunistic diseases, etc.); Improve facilities (larger premises in Simferopol, separate room in Sevastopol); (only for Sevastopol) Create own laboratory for analysis on the immune status and viral load.
  • 41. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 41 Most PLHIV are satisfied with the services provided by public organizations. Made the following suggestions regarding social services: The main need of all respondents - to increase the volume of humanitarian aid (medicines, rations); Expand the services in area of the care of seriously ill patients (transportation of patients to the hospital or visits by doctors at home, presence of social workers in hospitals); Organize assistance in employment search; Provide the services of professional lawyers; Organize recreational programs for children; Organize creative workshops; Provide services like haircuts, manicures;
  • 42. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 42 The shortage of qualified doctors (especially those, specializing in infectious diseases and dentists) and the unavailability of drugs for the treatment of opportunistic infections are the main challenges in the area of medical services Problems with medical services for PLWH Infrastructural Problem with access in distant areas Lack of qualified doctors-specialists Lack of premises, insufficiency of equipment and facilities Availability and quality of the meds Lack of ARVT meds, only several combinations available Outdated drugs with negative side effects Unavailability of drugs for opportunistic infections treatment Availability of special services Unavailability of artificial insemination for discordant couples Main problems with medical services for PLWH
  • 43. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 43 Opinions PLHIV and experts agree that at present NGO’s operate more effectively than government in the fields of prevention of infection and care & support for people living with HIV The main problems in the area of HIV / AIDS prevention and non-medical services for people living with HIV NGO Governmental agencies Scope Relatively small, mainly in big cities Relatively large Resources Better equipment and resources, but lack the premises Worse equipment and resources, enough premises Finances Relatively bigger project-based finance from multilateral sources Relatively smaller budget-based Work Organization Project-based organization of work, more flexible, but not always successive Planned work, relatively inert and less effective, though more permanent Monitoring & Evaluation Effective and established No systematic M&E Motivation High Low PLHIV involvement Large % of workers are PLHIV No systematic involvement Trust PLHIV and people from risk groups access NGO more often. The high level of confidence is caused by the previous experience in referent groups and activity in the provision of services Rarely apply to state non-medical organizations. Many bureaucratic procedures, delays. IDUs and CSWs often had in the past experience of the arrests and generally do not trust the state authorities
  • 44. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 44 Achievements of the HIV-service organizations in Crimea Raising awareness about the threat of HIV / AIDS and safe behaviour practices among young people under 30 years old in 2007. At the moment, the most informed and cautious group of Crimean population are people aged 15-24, which apparently is the target audience of many prevention programs; Advances in prevention work among IDUs, to a lesser extent – among CSW, and least of all - MSM; Increasing the number of HIV tests performed in 2007 (16% compared to 2006) and in 2009 (9% compared to 2008) in the ARC (in Sevastopol in 2008-2009, the number of tests is stable). Overall, at the end of 2010, 47% of Crimean aged 15-29 were tested for HIV, compared with 37% in 2007 .; Expansion of the branch network of AIDS centers and offices for ART provision Provision of ART for the absolute majority of those in need; Satisfaction of respondents with the work of HIV / AIDS centres and NGO’s, which is a key indicator of the effectiveness of their work.
  • 45. HIV/AIDS IN CRIMEA: SOCIAL PERCEPTION AND AUTHORITIES’ ACTIONS | 2011 45 Priorities for the future The relatively low level of awareness about the threat of HIV / AIDS and safe behaviour practices among the sexually active age group of 25-49 years, which receives the relevant information less often; Lack of preventive work among CSWs and MSM; The low popularity of regular voluntary HIV testing (of all respondents who are tested for HIV, 85% have done it because they needed a certificate for some purpose and only 11% were tested deliberately for their own peace of mind). The low level of tolerance towards people living with HIV in the general population (40% of them wouldn’t allow PLHIV into the territory of the peninsula, 42% believe that they are to blame for their fate) and, in particular, among health care workers and employees of state organizations, including law enforcement services. In 2010 compared to 2007 tolerance to PLHIV decreased, even among young people 15-29 years old, which is the most tolerant group: in 2007, 52% claimed that their attitude towards somebody whom they know, would not change if such person will get infected, or they will try to help him, in 2010 only 37% claimed the same.