December 1, 1997 - AIDS Prevention in Bulgaria:
Preliminary findings of a dissertation project
Since early 1996, the Bulgarian student Michail A. Okoliyski has been doing research on his doctoral dissertation, mostly at the RKI - Archiv für Sexualwissenschaft - and on location in Bulgaria. The subject is "AIDS Prevention in Bulgaria" (dissertation committee: Prof. Dr. Ernst von Kardorff (HU) and Prof. E. J. Haeberle (RKI)). As the dissertation is nearing completion, some preliminary findings can be reported here:
General Situation
The dramatic political changes of recent years have created a difficult situation with regard to AIDS prevention in Bulgaria. On the one hand, rapid modernization and the opening to the West have created an overabundance of new sexual options (pornography, prostitution, the self-identification of sexual minorities etc.), but on the other hand, there is no public education on the dangers of the new sexual freedom, no sex counseling, no educational literature, no outreach to persons at risk, no concerted prevention effort. Under these circumstances, the dissertation project has tried to find promising starting points for future Bulgarian STD and AIDS prevention campaigns.
Target Groups
It was extremely difficult to find cooperative persons at risk for HIV infection in Bulgaria. Nevertheless, after many futile attempts it proved possible to motivate a total of 61 persons from the following target groups to fill out questionnaires:
-Intravenous drug users: 12 (of these, 1 had worked as prostitute),
-persons with bisexual behavior: 15 (of these, 1 had worked as a prostitute),
-persons with homosexual behavior: 20 (of these, 10 had worked as prostitutes),
-persons with exclusively heterosexual behavior: 14.
Goals of the Investigation
It was hoped that an analysis of the data provided by these 61 persons, in combination with findings from other sources, would help answer to following questions:
- What kind of person can be considered a member of what target group in Bulgaria?
- What do Bulgarians know about HIV/AIDS?
- What are the sexual attitudes in Bulgaria, and how do people feel about using condoms?
- Which factors influence the acceptance of prevention programs?
- Are HIV-infected persons being stigmatized in Bulgaria, and if so, how does this manifest itself?
- How do Bulgarians feel about those AIDS prevention efforts they have heard about?
Some Preliminary Findings
A. Sexual Knowledge and HIV/AIDS Education
Of those answering the questionnaire, 84,7% received their sexual knowledge from friends, and 20,3% through the media. Only 15,3% received sex education from their parents. This confirms the claim of many Bulgarian educators that sex is still a taboo subject in most Bulgarian families. (Our finding is, by the way, almost identical to an early study conducted by the Bulgarian ministry of health in 1995. It found that only 14,8% of the student talked about sexual concerns with their parents.) The fact that only 13,6% learned anything about sex from their teachers, reflects the general absence of sex education from Bulgarian schools, where students are taught a total of only two hours on the biological differences between the sexes. There is a total lack of formal education with regard to the psychological and social aspects of sex. As a result, Bulgarian adolescents feel abandoned by their elders as far as their own sexual problems are concerned. Their sexual knowledge is still obtained "in the streets".
Fig. 1: Sources of Sexual Knowledge
Knowledge about HIV/AIDS is obtained in a quite different way. Most Bulgarians learn about it from the media, since friends and peer groups are largely uninformed due to a lack of intensive government campaigns. Again, parents and schools play a very modest role, illustrating once again the inadequacy of formal sex education. There is one relative difference between our target groups, however: Persons with bisexual and homosexual behavior receive more AIDS information from their friends and peer groups.
Fig. 2: Sources of Information about HIV Infection and AIDS
B. AIDS Prevention in Bulgaria and Public Perception
The general public in Bulgaria has been repeatedly irritated by confusing messages about AIDS: Modest government efforts have been undermined by contradictory reports in the mass media and by various journalistic horror scenarios that failed to become true. In spite of all that, only a small minority in our sample (6,6%) felt underinformed about AIDS. Nevertheless, it seems that, in actual fact, the majority is hardly as well informed as it believes. Thus, it is striking to note that few actually change their risky behavior. For example, 66,7% of the iv drug users believe themselves to be well informed, but only a few practice "safe sex" or "safe use". Moreover, fewer persons with exclusively heterosexual behavior consider themselves well informed (50%) in comparison with the other target groups (drug use: 66,7%, homosexual behavior: 60%, bisexual behavior: 60%). This can only mean that the latter groups get their information not from public campaigns, which are still mostly directed at the heterosexual majority, but from friends and peers. Finally, although a majority feels sufficiently informed, 66,5% maintain nevertheless that there is not enough AIDS information and AIDS counseling in Bulgaria.
Fig. 3: Self-assessed Level of Information about AIDS
Conclusion
The contradiction between feeling well informed on the one hand and, on the other, believing the information to be inadequate, suggests that Bulgarians, inside or outside of any particular target group, have a different concept of AIDS prevention and expect future prevention campaigns to be different from what has been offered so far. In particular, it seems that AIDS prevention in Bulgaria should be more specifically tailored to specific groups.
Fig. 4: How do you rate the quality of the now available AIDS information and counseling services?
