Demographics and a Historical Perspective
1. Basic Sexological Premises
2. Religious and Ethnic Factors Affecting Sexuality
3. Sexual Knowledge and Education
4. Autoerotic Behaviors and Patterns
5. Interpersonal Heterosexual Behaviors
6. Homoerotic, Homosexual, and Ambisexual Behaviors
7. Gender Conflicted Persons
8. Significant Unconventional Sexual Behaviors
9. Contraception, Abortion, and Population Planning
10. Sexually Transmitted Diseases
12. Sexual Dysfunctions, Counseling, and Therapies
13. Research and Advanced Education
A Final Remark
References and Suggested Readings
Dimosthenis Agrafiotis, Ph.D., and Panagiota Mandi, Ph.D.
The Greek peninsula projects into the Mediterranean Sea from south of the Balkans. The mountainous, mostly nonarable land of the Greek peninsula is deeply indented by long sea inlets and surrounded by over 2,000 islands, of which only 169 are inhabited; these include Delos, Lesbos, Samos, Kerika (Corfu), Crete, and Rhodes. Greeces neighbors in south-eastern Europe are Albania, Yugoslavia, and Bulgaria on the north borders and Turkey on the east. With an area of 51,146 square miles, Greece is about the size of the state of Alabama.
Since sexual identity, attitudes, and behavior are in a large part formed in a nations sociocultural environment, it is important to sketch out the general ethnic, racial, and socioeconomic character of Greece.
In the past century, Greece has been a country searching for its national boundaries and identity, as well as its economic survival. Being a backward agrarian society, its economy has oscillated between self-subsistence and dependency on external markets. Since the advent of the twentith century, constant territorial and, consequently, demographic expansion has provided the foundations for a rapid development. Greece finally embarked on the process of industrialization, though considerably later than the rest of Europe, and under rather violent and short-lived stimuli. However, this rapid development has produced an imbalance between its economic and sociocultural level. This lack of correspondence is a common aspect of societies that are in a stage of development that is neither well articulated nor well defined, and of societies where coexisting economic, social, and cultural structures correspond to different modes of production. Thus it can be said that Greek economy is characterized by heterogeneity due to the coexistence of traditional and modern components of technoeconomic activity. The social structure of institutions, groups, and relations is still in a state of inertia imposed by the past. Social groups and/or classes cannot easily and creatively articulate their role in the context of prevailing conditions and available opportunities. The cultural environment is under the pressure of imported models, while the traditional characteristics do not show any signs of endurance. The confusion between the old and the new, the Greek and the foreign, could paralyze the existing forces and resources.
Nearly two thirds of the 10.6 million Greeks live in urban areas, with more than 4 million in the two cities of Athens and Piraeus. Life expectancy at birth in 1995 was 75 for males and 81 for females. Infant mortality decreased from eleven per 1,000 live births in 1991 to eight per 1,000 live births in 1995. The birthrate has fallen appreciably during the last two or three decades and appears to be on a definite downward trend. While remarkable reductions have taken place in most of the European countries, Greece has the highest reduction in fertility among Eastern European countries. Thus the fertility indicator has been reduced from 2.3 children per woman in 1975 to 1.4 children in 1990, which is 30 percent below the lowest limit necessary for the renewal of the Greek population. The 1995 birthrate was 11 per 1,000 population; the death rate nine per 1,000 population, giving a natural annual increase of 0.1 percent. Greece has one hospital bed per 199 persons and one physician per 303 persons. The literacy rate is 96 percent for men and 89 percent for women. The 1993 overall literacy rate was 93 percent. Nine years of schooling are compulsory. The per capita gross domestic product in 1993 was $8,900.
Out of its labor force of nearly 4 million, about 26.6 percent are employed in agriculture, 27.7 percent in industry and construction, and the remaining 46.2 percent in other activities, mainly services. In 1990, the gross national product (GNP) per capita was U.S. $5,990.
B. A Brief Historical Perspective
The achievements of ancient Greece in art, architecture, science, mathematics, drama, literature, philosophy, and democracy are acknowledged by all as the foundation of Western civilization. Classical Greece reached its apex in Athens during the fourth century B.C.E. In 336, the kingdom of Macedonia, which under Philip II dominated the Greek world and Egypt, passed to his son Alexander. Tutored by Aristotle in the Greek ideals, Alexander the Great conquered Egypt, all the Persian domains, and reached India in 13 years. After his death in 323, his empire was divided into three parts: Egypt under the Ptolemaies, Macedon, and the Seleucid Empire. During the ensuing 300 years, the Hellenic Era, a cosmopolitan Greek-oriented culture permeated the ancient world from the borders of India to western Europe. The sciences thrived, especially in Alexandria, where the pharaohs financed a great library and museum. Major advances were made in the fields of medicine, chemistry, hydraulics, geography, astronomy, and Euclidian and non-Euclidean geometry.
Greece fell under the domination of Roman rule in the second and first centuries B.C.E. In the fourth century C.E., Greece became part of the Byzantine Empire, and, after the fall of Constantinople in 1453 to the Turks, a part of the Ottoman Empire. Greece gained its freedom from Turkey between 1821 and 1829, and became a kingdom. A republic was established in 1924, followed by restoration of the monarchy in 1935. In 1940, Greece was occupied by Germans, Italians, and Bulgarians troops. In the late 1940s, the Communists guerrilla warfare ended with restoration of the monarchy; the monarchy was abolished in 1975.
Greece has experienced, although with some chronological differences, about the same population growth as most advanced countries have, despite the mass immigration during the two periods from 1900 to 1922 and from 1951 to 1973. Ever since, immigration has given way to repatriation and the entrance of refugees of Greek origins (Pontioi) as well as of foreign refugees and immigrants who came mainly from Asia and Africa.
A. Character of Gender Roles
Greek society was mainly a masculine-based society. With its transformation from a predominantly agricultural to a semi-industrial society, mens work moved out from the home, leaving women isolated from the economic mainstream and utterly dependent on their menfolk for the essentials of life. In this environment, the inferior status of women was widely accepted as an unalterable fact of life. The idea that females could contribute significantly to public life, or even benefit from higher education, was considered preposterous. In fact, women were not allowed to vote, to make contracts, or even to own property.
Much of this has been progressively changed because of three factors: the active participation of women in the ethnic and social movements of modern history, the increasing number of educated women in the last forty years, and the imported Western influences on the equality of the two sexes. In addition, the contribution of the state with its legislative regulations cannot be ignored.
However, despite the fact that gender roles and the law have changed in recent decades, there are distinct gender-role differences in Greece, which are reflected in the personalities, interpersonal relationships, and workplace experiences of men and women. For instance, women have recently made some inroads into occupations defined as mens jobs, but so far only to a limited degree. Women are poorly represented in the electorate of the national government. Women still retain the primary responsibility for care of the home and children.
B. Sociolegal Status of Males and Females
From the legal viewpoint, Greek men and women now enjoy the same rights as children, adolescents, and adults. Men and women have the same right to vote and equal rights for education and employment. However, because the legal equality between the sexes was enacted only in 1983, it remains to be seen when and how far the law will be implemented in reality.
C. General Concepts of Sexuality and Love
In Greek society, the expression of sexuality and romantic love are interdependent. Many people believe that sexual pleasure is realized only in a relationship governed by love (Apostolodis 1992; Ioannidis et al. 1991; Mandi et al. 1993). The ability to love is regarded as something special, and individuals who are indifferent to or unable to feel it are held in contempt. Some believe that although the sexual act is possible with someone else besides the one and only, true passion and completeness become real only when there is mutual care and devotion.
A. Source and Character of Religious Values
In Greece, the majority of the population (98 percent) declares to be Greek Orthodox by religion. There are also some Catholics, a few Jews and Protestants, and a number of Moslems, mainly from Thrace. The Greek Orthodox Church is much more liberal than the Roman Catholic Church in some aspects, allowing divorce (up to three times normally) and remarriage in church. Although archbishops are not allowed to get married, the majority of parish priests are married.
Influenced by the Platonic and Stoic dualism and the Persian Gnostic tradition (Francoeur 1992), Christianity is governed by a dualistic opposition between the soul and the body, with the soul and mind seeking liberation from the prison of the flesh. Christian faith provides a special kind of knowledge, gnosis, which the soul can use to transcend this earth and rise to the divine heavenly sphere. Thus, Christianity has awakened in each person the worry of saving ones soul, with this salvation depending on the value of ones personal actions, particularly in the sexual sphere. If the flesh is somehow the source of evil, all sexual practices that are not procreative in character are condemned.
However, there is no correspondence between the official teachings and daily practices, at least in present-day Greece. Greeks regard love and sex as a main part of their existence, as evidenced by the incidence of extramarital relations and abortion, both of which are condemned by the Church. Greeces abortion rate is among the highest in Europe. In reality, Greeks often indicate that they do not consider themselves particularly religious; however, there are the faithful who follow the Churchs teachings, and the latter does intervene in the sexual life of couples.
B. Source and Character of Ethnic Values
With 98.5 percent of the population ethnic Greek, the country has no influential ethnic minorities. Apart from the Moslems, who comprise about 1 percent of the population, live in a particular area, and follow their own religious and cultural patterns, there is an ethnic homogeneity. It is obvious that the differences in Greece are more of a sociological than of an ethnic nature.
A. Government Policies and Programs for Sex Education
It is not an exaggeration to say that in Greece, sexual education is not the target of any systematic and well-planned governmental program. Even today, sexual education is not included in the school curriculum, although sporadic knowledge is given as part of lessons in such subjects as anthropology. However, this knowledge concerns more elements of physiology and anatomy than references to the external genital organs, the sexual relationship, or the search for and existence of pleasure in connection with the body and sexuality.
Currently, there is an effort and movement to include sexual education in the schools, although two Ministries, that of Health and Social Welfare and that of Education, have not made clear which one will be responsible for these matters. In recognizing the need for sex education, the government has taken some steps, starting in the early 1980s, by bringing Family Planning under the auspices of the Ministry of Health and Social Welfare. Prior to this move, contraceptive education was mainly handled by the Family Planning Association, a nongovernmental organization. The Ministry established forty-six Family Planning Centers all over Greece to provide genetic counseling, sexual education, information about AIDS and sexually transmitted and gynecological diseases, contraceptives, etc.
However, a 1991 evaluation of the efficiency and effectiveness of these centers made by the Family Planning Association has shown that the Family Centers in Greece meet the needs of only a very limited number of people. Their geographic distribution is not sufficient and there does not appear to be any strategy for a systematic operation. A large number of the centers have departed from the initial aim of their operation and now focus their interest more on medical matters, such as Pap-test and gynecological pathology, rather than on sexual education.
B. Informal Sources of Sexual Knowledge
The inadequacy of formal sexual education programs and the resultant lack of sexual knowledge in the population have been detected in a small number of studies carried out by the Department of Sociology of the Athens School of Public Health (Pantzou et al. 1991). Four different research projects, focusing on the general population and on pupils (a pilot study) using quantitative and qualitative methods, have indicated that: (1) the mass media as a whole and television in particular seem to be the main sources of information for both the general population and young people on matters concerning health and AIDS, (2) high school pupils receive no kind of information on sexuality and AIDS at school, and (3) there is a need both for intensification of information on sexual contraception, sexually transmitted diseases and AIDS, and improvement of the quality and specialization of this information.
The data on autoerotic behaviors in Greece are very limited. The only available information is that which is derived from the K.A.B.P. study in relation to AIDS in the city of Athens (Agrafiotis et al. 1990). A section of this study was devoted to sexual practices, but only one question, in the section on sexual practices that someone follows with his or her sexual partner, referred to autoerotic behaviors. According to the results, men reported twice the percentage of self-pleasuring than that of women (10.6 percent and 5.1 percent respectively) when they were with their partner. Otherwise, the frequency or the attitudes towards self-pleasuring, both of children, adolescents, and adults have not been examined.
Sexual exploration by children in nursery school between ages 3 to 5 has been observed. The first discoveries are connected with gender and take place mainly among peers. Different kinds of games (playing doctor and nurse, mother and father, king and queen) imitate adult roles, sometimes producing specific pleasure connected with stimulation of the genitals.
Later on, at the age of 10 or 11 years, childrens interest is focused on details and confirmation of earlier knowledge on gender differences. At the prepubertal age, they are usually engaged in self-pleasuring activities that occur either in pairs or in groups of peers of the same and other gender, as well as alone.
Puberty Rituals and Adolescent Sexual Activities
In the pubertal period, children are more interested in matters related to emotional/sentimental relations and sexuality. Usually the parent of the same sex assumes the responsibility of preparing the child for its physical maturation. Although there are no particular puberty rituals, the occurrence of the first menstruation and the first nocturnal emission or ejaculation are the signs of sexual maturation. These events, however, are not celebrated in any particular formal way in the family or among relatives.
Premarital sexual activities, especially in large cities, are not any longer socially condemned, and sexual intercourse begins between the ages of 14 to 17. Research showed that the most frequent types of contact are through hugging, deep (open mouth) kissing, petting above and below the waist, sleeping together (without sexual intercourse), and oral and vaginal sex.
Premarital Courtship, Dating, and Relationships
In a society in which major social and cultural transformation are taking place, it would be misleading to present facts and opinions that seem definite and absolute. However, it seems definite that there are great differences concerning premarital relations and courtship among urban and rural settings.
In todays predominantly urban and anonymous setting, young people often have access to automobiles that allow an exceptional degree of privacy in their courting. The practice of dating enables young Greeks to find out about one another, to improve their own interpersonal skills, to experiment sexually if they wish to, and finally to select a marriage partner. The courtship period usually varies between one to about six or seven years, with attendance at a college or university being a factor in longer engagements. Beyond all the economic and financial constraints, it is very difficult for an unmarried couple to find an apartment and live together because of the strong opposition of the majority of Greek society.
In more closed rural communities and small villages, premarital relations and courtship are not yet the norm before marriage. Although freer than in the past, young adults and especially women do not have the opportunity of dating their future spouse. The idea of arranged marriages and matchmaking (proksenio) is still present; the difference is that now women have the right to chose which matchmaking will end in marriage. In some areas a dowry (prika) is still required.
Up until the last two decades or so, a large proportion of Greek men and women found their primary identification in their family, and moral approval was given to those who fulfilled traditional expectations of being good husbands and housewives. The proportion of those who were remaining single was very low, and, as a result, data on their sexual behavior and relationships are limited.
However, certain groups, mainly the younger and more educated people, are adopting more contemporary attitudes towards family and marriage, giving greater priority to their personal rights and self-fulfillment as individuals. Nonetheless, the numbers of children born to unmarried women is the lowest in Europe; between 1926 and 1980, the rate changed from 1.1 percent to 1.5 percent of all births.
Marriage and the Family
According to the 1993 statistical data of a Parliamentary Committee responsible for the study of the demographic problem, the Greek family seems to be going through a period of transformation, following the patterns of all other industrial societies. The number of marriages decreased from 7.78 per 1,000 people in 1953 to 6.41 in 1985 and to 5.77 in 1990. On the other hand, the number of divorces is rising.
The typical Greek family unit is monogamous: Greeks may marry only one person at a time. Second, it is increasingly nuclear, although occasionally a grandparent or other relative may live with a family group. Third, it is increasingly egalitarian, with wives becoming much more assertive and husbands more flexible than they were even a decade ago.
Divorce and Remarriage
The divorce rate, although low compared to other European countries, has been rising steadily in the last decade. In 1978, the courts granted 4,322 divorces; in 1989, this number increased by 47 percent to 6,360 cases. According to the statistical data on the culpability of a divorce, it is evident that there has been a great change in the mentality and structure of the Greek family. In a total of 5,684 divorces reported in 1980, men were held culpable for the breakdown of 2,162 marriages and women for 1,144. In a total of 6,360 divorces reported in 1989, after amendment of the divorce law, culpability numbers were 280 and 294 respectively. In addition, the above numbers indicate that the no-fault divorces are on an upward trend, reaching about 75 percent of all divorces.
The majority of divorces are obtained after five to ten years of marriage. Also, the majority of divorcing couples have no children or only one child. In 1989, 1,730 divorced couples had no children and 1,520 had only one. Although both divorced parties may experience difficult times, ex-wives in particular may face severe economic problems, especially if they have to raise young children. In the past, when most wives were not expected to work outside the home, courts frequently awarded alimony to divorced women. Now, after adoption of a new Family Law in 1983 that considers women capable of earning their own living, they receive alimony only for a period of three years. After this period, the alimony is automatically interrupted, without considering the possibility that a woman may not find a job. Courts award child custody to mothers rather than to fathers in most cases; however, the courts usually require that the fathers provide child support. A mother cannot retain the childrens custody if she is a drug or alcohol addict, mentally or physically disabled, or psychopathic.
The Greek Orthodox Church allows a person to get married up to three times in his/her lifespan. Although there are no statistical data, it is estimated that 90 percent of those who obtain divorce will marry again - especially now that divorces are easier to get and provoke less social disapproval than ever before.
Marital and Extramarital Sexual Behaviors
Although some scientific studies have been undertaken in relation to sexual practices and behaviors of Greeks, no study was concerned with married couples in particular. According to some opinion polls however, both men and women, although satisfied with their sexual life, express their desire for even greater sexual activity. In addition, men in higher percentages than women report extramarital relationships at least with one partner. In addition, it can be said that there is a kind of tolerance on this matter. For instance, the extramarital relationships of important political persons do not constitute a cause for political disgrace or resignation, as is common in other European countries.
Incidence of Oral and Anal Sex
The survey conducted by the Department of Sociology of the Athens School of Public Health (Agrafiotis et al. 1990) has revealed some interesting results in relation to the sexual practices of the general population. The representative sample drawn from the general population of Athens, which really covers one third of the total Greek population, consisted of 1,200 people aged 16 to 65. Generally, for all practices, men reported higher percentages than women. This included vaginal sex (97.3 percent of men versus 94.5 percent of women), oral sex (36.3 percent versus 19.3 percent), and oral sex with body fluids transmission (8.2 percent versus 3.5 percent). Anal sex was also reported at double the rate to that of women (10.8 percent versus 5.1 percent).
Women were less likely to respond to questions concerning sexual practices, (37 percent versus 9 percent). Age groups also showed a considerable variation in sexual practices, with younger groups mentioning a wider variety of practices and a higher rate of them. Those who were 16 to 22 years old were less likely to practice vaginal sex (92.6 percent versus 96 percent) and more likely to practice anal sex (14.9 percent versus 8 percent). Oral sex was over 40 percent for the age groups 16 to 30, but declined to 5.3 percent in age groups 51 to 64. Of course, whether this difference is related to age, to religious and moral objections, or simply to an unwillingness by the older generation to admit to such practices is open to debate.
The above results were more or less confirmed by another research study (Malliori et al. 1991) with a representative sample of 1,980 Athenians of both sexes, 15 to 49 years old. According to these results, 95.5 percent of the females and 96.5 percent of the males employ ordinary intercourse, 35.6 percent of the females and 45.5 percent of the males use additional fellatio practices, 32 percent of the females and 40.5 percent of the males employ cunnilingus, and 10 percent of the females and 17 percent of the males use anal intercourse. Greek law contains no legal restrictions on fellatio, cunnilingus, or anal sex.
According to the first scientific research conducted by the Athens Medical School (Hantzakis 1992) in an unrepresentative sample of homosexual men, about half of the sample of 213 men were single without ever being married, and either lived alone or with a parent or relative. The majority of these gay mens sexual activity is taken up in the three behaviors of self-pleasuring, fellatio, and anal intercourse. In addition, the majority claimed to have heterosexual contacts as well. This can be partly attributed to the fact that in Greek society there are different kinds of homosexuals (i.e., gays and bisexuals), and a mixture of tolerance and taboos coexist. As a result, many gay men are forced to get married and pass as heterosexuals, whereas in reality, they are ambisexual or psychologically and emotionally exclusively homosexual although engaging in some heterosexual relations.
The legal age of consent for homosexual men is 17 years. The legislation of 1981 can force STD testing of homosexual men. The gay community is visible in the Greek social scene, principally in Athens, Mykonos, and Thessaloniki, and has formed a small political action organization.
There is no official data on this matter. According to the opinion of Dr. D. Papoutsakis, who works at the Ministry of Health and Social Welfare, there are forty to fifty transsexuals who had their surgery abroad, mainly at Casablanca and Morocco, who work among the female registered prostitutes.
Greek law does not allow for the change of gender, nor does Greek society provide for any special gender roles, such as the hijra of India or the berdache among Native Americans.
A. Coercive Sex
Child Sexual Abuse and Incest
The phenomenon of child sexual abuse has only recently been surfacing in Greece as an issue of concern among professionals, researchers, and the public, following a long period of denial that continues to exist in many settings. This change can be partly attributed to changes in societys general attitudes towards sexuality as well as to the appearance of AIDS. The term child sexual abuse does not exist in Greek criminal law; there are, however, many provisions that specify offenses that infringe upon a childs purity. These offenses are rape, seduction of a minor, indecent assault, incest, and pimping. When the person culpable of such an offense is a parent, a teacher, or a minors guardian, the punishment is particularly severe. In the seduction of a minor, the younger the child, the harsher the punishment. If the child is less than 10 years old, the penalty can be at least ten years imprisonment; if the child is between 10 to 13 years, the penalty can be between five to ten years; the penalty is five years imprisonment for children 13 to 15 years of age. For the offenses of rape, incest, and pimping the prosecution is automatic, ex officio, while for the rest of the offenses, the prosecution continues only if the sufferer or his/her legal representative brings a charge against the perpetrator.
In cases of child sexual abuse, it is not possible to ascertain the incidence of pedophilia, since this category is not included as such in the offenses that infringe upon a childs purity.
All types of sexual offenses are socially condemned. Although there is no statistical evidence, a study of child sexual abuse among an unrepresentative sample of Greek college students conducted by the Department of Family Relations of the Institute of Child Health (Agathonos et al. 1992) has shown that the phenomenon in Greece is unexplored and its magnitude very likely underestimated. Among the 743 respondents, 96 students (13 men and 83 women), or 13 percent, had experiences of sexual victimization, while 230, or 31 percent, had sexual experiences that did not contain the element of victimization. In one third of the group with the sexual victimization cases, the abuse has been intrafamilial; in one third of the cases, the perpetrator was known to the child. The remaining perpetrators were strangers. In men, perpetrators were on average 12 years older, while women were abused by offenders who were on average 22 years older than them.
Although Greek legislation does not distinguish this category of behavior, sexual harassment, especially by males in the workplace, is not uncommon.
Although Greece, according to the statistical data of the United Nations Report, had the lowest number of rapes per 100,000 women in 1992 (only 2 rapes compared to New Zealand with 254 rapes), scientific studies have shown that only 15 percent of rapes are reported to the authorities. Greek society shows an inexcusable tolerance to a criminal behavior that insults human beings. It is not accidental that ten years ago, rape was the only felony for which prosecution was not automatic, ex officio. The public regards the victims of this form of sexual assault as being responsible for their own rapes: they asked for it, flaunted their sexuality, enjoyed it although they pretended not to, started something they could not stop, were out alone at night, or dressed provocatively. According to the new legislation, the penalty for rape is between five and twenty years imprisonment. However, this new legislation still leaves out the concept of marital rape.
Prostitution has for many years been a socially accepted practice, especially for young Greek men. Given traditional rules of virginity for women and the expectation of masculine behavior including sexual prowess for men, prostitutes were both an outlet and a schooling for many men. Nowadays, particularly in the urban centers, young men are more likely to have a girl friend with whom they have sex. In the rest of the country, the situation has not changed dramatically.
In Greece, professional prostitutes, who are officially estimated to be around 200 to 270, are registered with the local police, have a health book, and are obliged to report twice a week for health inspection at a special clinic of the Ministry of Health and Welfare. In order to monitor and control the further spread of HIV infection among registered prostitutes, an intense educational program was implemented in December 1985 (Papaevangelou et al. 1988). As a result, there was a considerable reduction of the incidence of HIV infection and other STDS among prostitutes.
In addition to officially registered prostitutes, there are an estimated ten times as many unregistered prostitutes for whom there is no adequate information about their practices. The number and extent of unregistered prostitutes can only be roughly estimated, because many prostitutes are now being imported from former communist countries and the Philippines to work the market unofficially. Alongside the unregistered female prostitutes, there is also an unknown number of male and adolescent prostitutes, mainly in Athens and Thessaloniki.
C. Pornography and Erotica
Despite legislation that prohibits the production and distribution of pornography and erotica, both hard- and soft-core pornography are easily accessible in Greece. In addition, during the last three or four years, there have been a few telephone hot lines which, however, are based abroad and their charge is extremely expensive. Many kiosks sell pornographic magazines, and pornographic videotapes are unofficially available to anyone over age 18. However, these tapes are not openly displayed and there is an unwritten code of communications between the customer and the shop owner.
Unlike other countries where a considerable amount of social research has been carried out on attitudes of the population towards contraceptive methods, in Greece, until the appearance of AIDS, there were only a few studies on such issues.
In a statistical survey conducted in the context of the Family Planning Center in Thessaloniki, it was found that, among the women visiting the Center, 6.5 percent used the pill, 15 percent the IUD, and most had had some experience with condoms. However, 90 percent of the women never bought condoms, leaving this to their male partners. The latest research concerning the attitudes toward and the use of contraceptive methods by the population of Athens have shown that 46.7 percent of the population use condoms (although it was not clear whether this use was systematic and consistent), 6.6 percent of the women use the pill, and 4 percent the IUD. The preferences of different contraceptive methods depended on age, knowledge of AIDS, educational level, and religiosity. Women did not perceive the condom as their responsibility and were hesitant to propose or promote its use. Young people, on the other hand, were less negative in their attitudes towards condom use, and many have adopted it both as a contraceptive method and a prophylactic against AIDS. The same findings were evident in the pretest study of the K.A.B.P. survey on young people in Athens (Agrafiotis et al. 1990). Sixty-one percent of the pupils did not consider condom use to be against their religion and 84 percent did not consider it contrary to their traditional beliefs.
What is evident in comparison with other European countries is two particularities of the Greek situation in regard to the attitudes towards contraceptive methods. First, Greek society has not fully adopted the use of modern methods of contraception. According to the statistical data provided by the pharmaceutical companies (Margaritidou et al. 1991), such methods are not easily available and their use is relatively low (i.e., IUD sales are 20,000 annually). Thus, the condom, which is available through pharmacies, supermarkets, and kiosks, is still the most widely used method of contraception. Second, there is a tendency for many Greek couples to prove their fertility by not using contraception and resorting to frequent abortion. It is worth noting that while many countries reported that abortion concerns a very small percentage of women and is considered marginal behavior from a psychosocial point of view, in Greece repeated abortion and withdrawal are the most widespread methods of birth control (Agrafiotis et al. 1990).
As for education in the contraceptive methods, it can be said that little systematic information was provided by the state or medical practitioners until the founding of the Family Planning Centers after 1982. Some of these centers provide contraceptive methods free of charge to persons who are not insured, while the National Health Insurance organization does not cover the costs of contraception.
B. Teenage Unmarried Pregnancies
The latest epidemiological figures indicate a marked increase in the incidence of teenage pregnancies. In 1974, teenagers accounted for 5.3 percent of the pregnancies in Greece; in 1988, they accounted for 10.3 percent of the total number of pregnancies. According to the statistical data of the Adolescent Gynecology Department of the Alexandras Hospital (Creatsas et al. 1991), during 1987 and 1988, the ratio of adolescent childbirths, compared to the overall number of childbirths of the clinic, was 10.65 percent, with 88.7 percent of these teenagers 17 to 19 years of age. Half of the pregnant teenagers (49.8 percent) were of low socioeconomic status. Unmarried pregnancies were higher among teenagers than in older age groups. (Greek law allows marriage at the age of 18; girls or boys who wish to marry before that age must obtain a special license with the consent of their parents.)
The doubling of the teenage pregnancy rate and its continued increase can be mainly attributed to several reasons. First, the lack of information on ways to avoid an undesirable pregnancy. It has been estimated that in countries where adolescent sexual education is put into practice, the percentage of undesirable pregnancies is kept relatively low. Second, biological maturation of girls now comes earlier than in the past. And third, premarital sexual activities start at a younger age now than they did in the 1940s and 1950s. Many of the expectant teenage mothers, however, decide to terminate their pregnancies, being fearful of both the medical and social consequences. Thus, parallel to the teenage pregnancies, teenage abortions are increasing.
Greece possesses the highest percentage of abortions among the European countries. Although the data from the National Statistical Service indicate that only 200 legal abortions are registered every year, the actual number of abortions is estimated to be around 150,000 per year. In research carried out by The National Center for Social Research (E.K.K.E.) in 1988, it was found that the ratio between abortions and live births was nearly one to three. Forty-three percent of all Greek women in the sample reported at least one abortion or miscarriage. In the study conducted by the Family Center in Thessaloniki (Anapliods 1985), it was found that a large number of women, around 64 percent aged 16 to 46 (and over), had an abortion with the ratio between abortion and live births being 1:8 to 1:3 per woman respectively. Thus, it can be said that repeated abortion is a norm, a traditional form of birth control, especially for Greek women who have already acquired the desirable number of children.
The above evidence indicates that abortion in Greece is not considered a moral issue of any dimension, and there is a general lack of guilt about the subject. One explanation provided for this behavior is that the traditional importance of the mother role and the constraints concerning the expression of female sexuality come into conflict with the symbolic and real meaning of modern contraceptives (Naziri 1988). The unwanted pregnancy that usually ends up in abortion is used as evidence by both men and women of their continuing fertility, whereas modern contraception would create doubts about this.
Abortion was legalized in 1986, although no prosecutions were ever brought against those performing or having abortions under prior laws.
The law allows for abortion until twelve weeks of pregnancy. The National Health System covers the expenses and provides the right of three days full-pay leave. Despite this, only a few women use the National Health System and their insurance fund for abortion, while there is still a substantive use of private gynecologists for unreported abortions. This can be partly attributed to the fact that private abortions are usually performed immediately, in contrast to the state system that requires some bureaucratic procedures and therefore involves delays. Finally, it must be stressed that only a vocal minority associated with the Orthodox Church was against the legalization of abortion, though in general the Orthodox Church, unlike the Catholic, is not so absolute in its teachings and is more tolerant in its attitudes towards peoples practices such as birth control, abortion, and so on.
D. Population Control Efforts
In the last decade, Greeces population growth rate was 1 percent annually compared to the rate of 12 to 13 percent before the World War II. Thus, the governments aim is to promote population growth. However, the birthrate still remains very low, because the government so far has employed only financial incentives, such as allowances, houses, and reduced military service. It seems that the government is content to rely on Greek immigrants who show a tendency of repatriation as the main way of increasing the nations population.
A. Incidence, Patterns, and Trends of STDs
The data do not provide reliable indications, or even close estimates, of the actual incidence of STDs in Greece, because the requested notifications are not always made to the authorities. Also, many cases treated by doctors in private practice are not reported. However, a study made by using data from the National Statistical Service, the University Hospital for STDs, and the special clinic for STDs of the Ministry of Health (Kaklamani et al. 1981) has shown that between 1962 and 1976, the frequency of both syphilis and gonorrhea declined among men as well as among women, with the decline more evident among women and among the older age groups. Among men, the highest incidence was in the age group 20 to 29 years, whereas among women the peak incidence was a little earlier. The rates for both syphilis and gonorrhea were higher in men than in women, higher in the greater Athens area than in the rest of Greece, and higher in single persons than in married ones. There was also a marked seasonal variation of STDs with peak incidence at late summer.
From the latest figures, it is evident that there has been a stabilization in the incidence of STDs infection at a relatively low rate. A possible explanation lies in the preventive measures against AIDS and the greater usage of condoms, particularly by prostitutes.
B. Availability of Treatment and Prevention Efforts
In Greece, there are two public dermatological hospitals for the treatment of STDs, with 200 beds in Athens and 60 beds in Salonica.
The considerable reduction in STDs should be attributed to the increasing use of condoms, especially by prostitutes. This was the result of an educational campaign implemented by the Ministry of Health in order to control the spread of HIV infection among registered prostitutes. Indeed, the use of condoms has been considerably increased, from 66 percent in 1985 to 98.5 percent in 1989. As a result, the incidence of syphilis and gonococcal infections has been substantially reduced: for syphilis from 17.1 percent in 1985 to 2 percent in 1989 and for gonococcal infection from 14 percent in 1985 to 1.2 percent in 1989 (Roumeliotou et al. 1990).
Greece continues to remain among the European countries with the lowest rates of AIDS. Of the 721 cases of HIV infection detected by December 1992, 366 were homosexual or bisexual males, 153 were heterosexuals, 49 had multiple plasma transfusions, 44 had blood transfusion, 30 were drug addicts, and 5 homosexual drug addicts. The remaining 74 could not be categorized. The overall number of pediatric cases, ages 0 to 12 years, was 12. From the above data, it is evident that, although homosexuals comprise the greatest percentage of people with AIDS, the rate of heterosexual cases is relatively high. This rate may be fictitious due to the fact that homosexual men sometimes hide their sexual identity and pass as heterosexuals.
According to Agrafiotis et al. (1990), the Greek Ministry of Health has used three strategies of preventative intervention: information, laboratory infrastructure, and control measures for the disease. The information campaign, begun in February 1983, was focused primarily at health services and hospitals. The campaign continued through 1985 with special emphasis on high risk groups, while at the same time providing information pamphlets for health personnel, dentists, the general public, and travelers. In 1988, pamphlets were also produced for certain professions, e.g., hairdressers and earring sellers. At the same time, there were television and radio discussions and public debates all over the country. At that time, six national reference centers for AIDS were operating and approximately ten hospitals offered HIV testing and treatment of AIDS patients. In addition to the Blood Donation Centers where HIV-antibody screening was performed on a routine basis, prevention efforts were supplemented by control measures implemented by the Ministry of Health, such as the HIV-antibody blood screening for transfusions and use of heat-sterilized products for blood testing.
In September 1992, two new services began to operate in Greece, an Open Phone Line and an Information Center for AIDS. These services aimed both at reducing the spread of HIV infection and at solving the various psychological problems deriving from the increasing incidence of the disease. These services resulted mainly from a proposal to the Ministry of Health made by the Psychological Problems Subcommittee of the National Committee of AIDS. Responsibility for running these services rests with the Department of Psychology at the Psychiatric Clinic of the University of Athens. In addition, a Hostel for psychological support was established to provide support for those who face difficulties with their close family and social environment.
At the level of prevention, the Ministry of Health created a video concerning issues related to the spread of HIV, sexual behavior, and psychosocial problems as a basis for launching an education campaign in the schools. Finally, the Ministry of Health, working with the Greek General Trade Union and the Greek Army, decided to broaden its educational campaign in two specific populations, workers and those in the military.
However, the information campaign that began in the mid-1980s appears to have been curtailed, and television campaigns or public discussions have decreased. In 1993, public debate focused on numerous issues. The import of blood products from Europe has raised concern among hospitals and other healthcare organizations about mechanisms of quality control. Due to the fact that some hospitals refused to accept and treat AIDS patients, there has been a controversy as to whether there should be special units for the treatment of AIDS patients and to the precautions that should be taken.
The situation in Greece, at the beginning at least, can be characterized as AIDS information epidemic, that is to say, before the virus had arrived in Greece, the media had already created a situation of panic. On the other hand, the mass media has played an important role in the exchange of views. In most cases, AIDS patients are treated in the Department of Infectious Diseases. However, because Greek journalists are not expert on AIDS issues, discourse is often reduced to journalistic rhetoric. More recently, the Ministry of Education has initiated a number of interventions, by preparing a program for prevention and health promotion in schools, as well as initiating a special project on AIDS and drug use. However, prevention programs have no kind of continuity and the policies are not very well established. One explanation for this is that the epidemic is very limited, in comparison with other European countries, and there is an absence of nongovernmental organizations that could push for cooperation. In addition, Greek bureaucracy has no long-term views.
A/B. Concepts of Sexual Dysfunction and the Availability of Treatment
Even at the end of the twentieth century, the sexual act in Greece seems to be shrouded by myths and antiscientific attitudes and approaches that lead to the superficial management of sexual dysfunctions.
It was only at the end of the last decade that some private institutions, both in Athens and Salonica, began to deal with sexual therapy. Having a better mechanism for preserving a patients privacy, they brought the problem up for open discussion, recognized it, and helped in its demystification. The acceptable methodology for the diagnosis and therapy of sexual dysfunctions is based on the protocol I.S.I.R (International Society of Impotence Research). Impotence is regarded as a symptom of both psychological and organic problems. According to the statistical data of the Andrological Institute, which specializes in male impotence, from a sample of 5,000 patients treated, 25.1 percent of impotence was due to psychogenic causes, 24.6 percent to organic causes, and 50.3 percent resulted from combined causes. The distribution of cases according to age has shown that problems exist in all age groups, with more cases between the ages of 40 and 50. In addition, the analysis of cases according to profession and social class has shown that the problem is present in all social classes with more or less the same frequency. From the same data, it is evident that one in four men in Greece has some kind of sexual dysfunction. (The name Andrological reveals the distinction of science into two specialities related to sex. From a sociological and cultural point of view, it is interesting to see how this will operate in Greece.)
The need for sexual research in Greece was pointed out in the early 1980s by D. Agrafiotis. But it was the advent of AIDS that forced these matters to emerge somewhat into the public consciousness and policy. In Greece, there are no institutions engaged in sexological research on a regular basis. Research on sexual matters is conducted occasionally and by different research teams without any national coordination. Among the teams engaged in various kinds of sexological research are:
University of Athens, Department of Psychiatry. Director: C. Stefanis. Address: 74 Vas. Sophias Avenue, Athens, Greece
Athens School of Public Health, Department of Sociology. Director: Demosthenis Agrafiotis. Address: 196 Alexandras Avenue, Athens, Greece
Athens School of Public Health, Department of Epidemiology. Director: G. Papaevangelou. Address: 196 Alexandras Avenue, Athens, Greece
A Syngros Hospital. Director: G. Stratigos. Address: 6 Dragoumi, Athens, Greece
Family Planning Association (FPA). Address: 121 Solonos, Athens, Greece
Athens Medical School. Department of Epidemiology and Hygiene, Director: D. Trixopoulos, Address: Athens, Greece
Hellenic Society of Paediatric and Adolescent Gyaecology (HSPAG). Director: C. Kreatsas. Address: 9 Kanarie str, Athens, Greece
The Department of Psychiatry, the FPA, and the HSPAG offer sex education programs for parents.
Undergraduate courses are provided to doctors by the Medical School but only as part of the general curriculum (knowledge of organic systems), and are not intended to be a study of human sexuality as such. There is no medical specialization in sexology, and the psychiatrists or gynecologists who wish to specialize in this field should go abroad. The question of sexology as a scientific field is not fully recognized and there is always a controversy on this matter. As a result, psychologists, sexologists, psychiatrists, and psychoanalysts try to determine their domains of competence. On the other hand, the Department of Sociology of the Athens School of Public Health explores various issues related to sexuality, and in general, the social sciences includes sexuality and sexual issues in their area of research.
There are no Greek journals or periodicals on sexuality.
The issues of sexuality in Greece have yet to be adequately studied. Over all, there is an urgent need for a more systematic investigation of the coexistence of traditional and modern values due to the social particularities of the Greek society and their influence on current sexual attitudes and behaviors.
Agathonos, H., et al. 1992. Retrospective Study of Child Sexual Abuse. Experiences Among Greek College Students. Paper presented at the ISPCAN Conference Chicago, USA. August 30 to September 2, 1992.
Agrafiotis, D. 1981. Social and Cultural Development in Greece. Scientific Report Ministry of Health. Athens.
Agrafiotis, D., et al. 1990. Knowledge, Attitudes, Beliefs and Practices of Young People. Pre-Test WHO/GPA/SBR (World Health Organization; Global Programme on AIDS; Social and Behavioural Research). Research Monograph No. 26. Sociology of Health and Illness.
Agrafiotis, D., et al. 1991. Knowledge, Attitudes, Beliefs and Practices in Relation to HIV Infection and AIDS. The Case of the City of Athens. Department of Sociology. Athens School of Public Health.
Apostolodis, T. 1992. A Cross-Cultural Investigation of Socio-Cultural Models on Sexuality and Love, Between Students in France and in Greece. Unpublished Thesis. University of Paris, France.
Creatsas, O., et al. 1991. Teenage Pregnacy: Comparison with Two Groups of Older Women. Journal of Adolescent Health Care, 15-17:77-81.
Francoeur, Robert T. 1992. The Religious Supression of Eros. In: The Erotic Impulse. David Steinberg, ed. New York: Tarcher/Perigee.
Hantzakis, A. 1992. Homosexuality in Greece. In: Homosexual Response Studies. International Report. Anthony P.M. Coxon, ed. World Health Organization.
Ioannidis, E., et al. 1991. Sexual Behavior in the Years of AIDS in Greece. Lisbon Workshop. ECCA.
Kaklamani, E., et al. 1981. Syphilis and Gonorrhea: Epidemiology Update. Paediatrician, 10:207-215.
Malliori, M., et al. 1991. Sexual Behavior and Knowledge about AIDS in a Representative Sample of Athens Area. Department of Psychiatry, University of Athens.
Madianos, M., et al. 1988. Health and Greek Society. Athens: EKKE.
Mandi, P., et al. 1993. Sexual Patterns in Contemporary Greece A Pilot Study. Research Monograph No.9. Athens School of Public Health/Andrological Institute.
Naziri, D. 1988. Greek Women and Abortion. Clinical Study of Repeated Abortion. Unpublished Thesis. University of Paris.
Pantzou, P., et al. 1991. The Demand for Health Education on Sexuality and AIDS Based on Sociopsychological Research. Second European Conference on Effectiveness of Health Promotion and Education.
Papaevangelou, G., et al. 1988. Education in Preventing HIV Infection in Greek Registered Prostitutes. Journal of Aquired Immune Deficiency Syndromes, 1:386-89.
Primpas Welts, Eve. 1982. Greek Families. In M. McGoldrick, J.K. Pearce, and J. Giordano, eds. Ethnicity and Family Therapy. New York: Guilford Press.
Roumeliotou, A., et al. 1990. Prevention of HIV Infection in Greek Registered Prostitutes. A Five-Year Study. 6th International Conference on AIDS, San Francisco, USA. June 20-24, 1990.
Recipient of the 1997 Citation of Excellence for an outstanding reference work in the field of sexology, awarded by the American Foundation for Gender and Genital Medicine and Science at the Thirteenth World Congress of Sexology, Valencia, Spain.
The World Association of Sexology, an international society of leading scholars and eighty professional organizations devoted to the study of human sexual behavior, has endorsed The International Encyclopedia of Sexuality as an important and unique contribution to our understanding and appreciation of the rich variety of human sexual attitudes, values, and behavior in cultures around the world.
- Eli Coleman, Ph.D.,
Secretary General, WAS
The International Encyclopedia of Sexuality is a landmark effort to cross-reference vast amounts of information about human sexual behaviors, customs, and cultural attitudes existing in the world. Never before has such a comprehensive undertaking been even remotely available to researchers, scholars, educators, and clinicians active in the field of human sexuality.
- Sandra Cole, Professor of Physical Medicine and Rehabilitation, University of Michigan Medical Center