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The Republic of Srpska Public Health Institute
The Institute for Public Health of the Federation of Bosnia and Herzegovina
THE BOSNIA AND HERZEGOVINA
THE REPUBLIC OF SRPSKA
THE FEDERATION OF BOSNIA AND HERZEGOVINA
POTENTIAL CLIENTS OF VOLUNTARY CONFIDENTIAL
HIV/AIDS COUNSELLING AND TESTING CENTRES (HIV/AIDS
VCCTCS) AMONG STUDENT POPULATION IN BOSNIA AND
HERZEGOVINA
REPORT OF SURVEY RESULTS
Banja Luka/Sarajevo, 2012.
LIST OF ABBREVIATIONS
HIV - Humani virus imunodeficijencije
AIDS - Stečeni sindrom imunodeficijencije
DPST centri – Centri za Dobrovoljno Povjerljivo Savjetovanje i Testiranje
BiH - Bosna i Hercegovina
RS - Republika Srpska
FBiH - Federacija Bosne i Hercegovine
ISCED - Međunarodna standardna klasifikacija obrazovanja
JZU - Javna zdravstvena ustanova
SPI - Seksualno prenosive infekcije
SZO (WHO) - Svjetska zdravstvena organizacija
UNAIDS - Program Ujedinjenih naroda za borbu protiv HIV/AIDS-a
UNDP - Program Ujedinjenih naroda za razvoj
UNESCO - Organizacija Ujedinjenih naroda za obrazovanje, nauku i kulturu
The Republic of Srpska Public Health Institute
The Institute for Public Health of the Federation of Bosnia and Herzegovina
Potential Clients of Voluntary Confidential HIV/AIDS Counselling and Testing Centres (HIV/AIDS VCCTCs) Among Student Population in Bosnia and Herzegovina
Authors
Dušanka Danojević, MD, M.Sc.Med. Dragana Stojisavljević, MD, M.Sc.Med. Slađana Šiljak, MD, M.Sc.Med. Ljiljana Stanivuk, MD, M.Sc.Med. M.Sc. Jelena Niškanović Dr. Mladen Šukalo, MD, Primarius Radmila Ubović, MD, M.Sc.Med. Vesna Korda-Vidić, M.Sc.Med. Aida Filipović-Hadžiomeragić, M.Sc.Med. Aida Vilić-Švraka, M.Sc.Med. Jelena Ravlija, MD, PhD
Research team of the Republic of Srpska
Dušanka Danojević, MD, M.Sc.Med. Dragana Stojisavljević, MD, M.Sc.Med. Slađana Šiljak, MD, M.Sc.Med. Ljiljana Stanivuk, MD, M.Sc.Med. M.Sc. Jelena Niškanović Mladen Šukalo, MD, Primarius Radmila Ubović, MD, M.Sc.Med. Verica Petrović, MD, M.Sc.Med. Davorka Blagojević, MD, PhD Danijela Babić Sanela Vidović Dea Dimitrijević Mladen Lakić Igor Sliško
Research team of the Federation of Bosnia and Herzegovina
Jelena Ravlija, MD, PhD Aida Ramić-Čatak, MD, PhD Aida Filipović-Hadžiomeragić, MD, M.Sc.Med. Aida Vilić-Švraka, M.Sc.Med. Vesna Korda-Vidić, MD, M.Sc.Med. Sanjin Musa, MD Marija Zeljko, MD
Coordinators of Faculties in Republic of Srpska
Sanja Radetić Lovrić Nataša Đokanović
Saša Petković Slađana Radević
Tatjana Vučić Rogić Mladenka Govedarica
Igor Sladojević Radislav Lale
Dimitrije Marković Vera Vujević
Duška Milanović Mile Milekić
Stojana Kopanja Vlado Medaković
Maja Manojlović Grujica Vico
Duško Pevulja Danijel Miljić
Kristina Pantelić Lazar Radovanović
Biljana Milošević Miodrag Peranović
Darko Drakulić Daliborka Škipina
Coordinators of Faculties in Federation of BiH
Emir Kurtić Danijela Petrović
Adnan Imamović Slavica Pavlović
Meliha Zejnilagić-Hajrić Vesna Varunek
Merisa Osmanović Zoran Perić
Dragana Ognjenović Karmela Miletić
Semra Čavaljuga Viktorija Haubrich
Adis Skejić Mirela Mabić
Zinka Grbo Aida Brkan
Ismail Durmić Merima Mahinić
Sandira Eljšan Senada Pobrić
Senija Nuhanović Lejla Manjgo
Edin Mutapčić Rebeka Kotlo
Sabina Nuhbegović Damir Đedović
Rifet Terzić
Steering Committee for the Survey Implementation in the Republic of Srpska:
Jelena Đaković-Dević, Sanela Dojčinović, Snežana Stanić-Rukavina, Zorica Mihajlović
Steering Committee for the Survey Implementation in the Federation of BiH:
Zlatko Čardaklija, M.Sc.Med; Željko Ler, MD, Primarius; Zlatko Vučina, MD, Primarius
Consulting reviewer
Prof. Miroslava Kristoforović-Ilić, PhD
Graphic Design
Vladimir Stojisavljević
Bojan Milinović, B.Sc.E.E.
Publisher
The Republic of Srpska Public Health Institute
Printed by
Vilux d.o.o. Banja Luka
Circulation
300 copies
Potencijalni korisnici Centara za dobrovoljno i povjerljivo savjetovanje i testiranje (DPST) na HIV/AIDS u studentskoj populaciji u Bosni i Hercegovini
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REVIEW OF REPORT ON SURVEY RESULTS
The publication Potential Clients of Voluntary Confidential HIV/AIDS Counselling and
Testing Centres (HIV/AIDS VCCTCs) Among Student Population in Bosnia and Herzegovina is
the report on the results of the epidemiological survey concerning the HIV/AIDS – a significant
worldwide health problem of the present day – that was conducted among the BiH student
population. Survey was completed in Bosnia and Herzegovina, the Republic of Srpska, Brčko
District and the Federation of Bosnia and Herzegovina. Implementation of survey activities was
entrusted to the Republic of Srpska's Public Health Institute and the Institute for Public Health
of the Federation of Bosnia and Herzegovina that jointly submitted this Report (Banja
Luka/Sarajevo, 2012).
About authors
This manuscript was developed by the group of authors, with participation of the RS
research team as well as the research team of the FBiH. Each team had its own Steering
Committee for the Survey Implementation. The authors and the members of the research are
experts with years of working experience in the field of health.
About the Publication
The manuscript of the Report on Potential Clients of Voluntary Confidential HIV/AIDS
Counselling and Testing Centres (HIV/AIDS VCCTCs) Among Student Population in Bosnia and
Herzegovina consists of 61 pages, comprising 9 chapters. It also contains well designed tables
and charts (4 tables and 37 charts), which significantly increases its usefulness and quality.
Literature is listed at the end of the document. Total number of cited bibliographic units is 23.
The Vancouver style of referencing was applied. Greatest number of cited sources was
published after year 2000.
The following are titles of publication chapters:
Introduction, Survey goal and objectives, Methodology, Survey results, Discussion,
Conclusion, Recommendations, Literature, and Appendix.
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First chapter Introduction comprises two sub-sections: “HIV/AIDS in Bosnia and
Herzegovina – epidemiological situation” and “The role of the voluntary confidential HIV/AIDS
counselling centres among the student population of BiH”. The emphasis has been made of the
facts that HIV/AIDS is a disease primarily affecting stigmatized groups, and that the greatest
danger in spread of HIV infection is the presence of highly risky behaviour or absence of
knowledge and risk awareness of HIV or sexually transmitted diseases (STD). It is believed that,
concerning the HIV surveillance, BiH as a country with a low degree of epidemics, has a duty to
abide by the recommendations of the World Health Organisation (WHO) to implement
surveillance activities among populations whose behaviour exposes them to a risk of HIV
infection. The role and significance of VCCT centres are irreplaceable (Voluntary Confidential
Counselling and Testing) or VCT (Voluntary Counselling and Testing). Concept of their
operational organisation was first mentioned in mid-eighties. There are in total 19 of these
centres in BiH. Since students are particularly vulnerable and of great importance in sense of its
size and the future of population, they are the group given a priority role in this type of surveys.
Second chapter Survey goal and objectives describes in detail the general goal and specific
objectives of this survey. It also defines proposals and recommendations concerning
development of the guidebook for promotion of utilisation of services provided by VCCT
centres among the student population.
Third chapter Methodology comprises 6 sub-sections. In its introductory part it describes
the survey design, the survey sample and the survey instrument. Indicators, organisation of the
survey and its ethical component are explained in detail. Target population of the survey
comprises the students of the first and the final year of full-time study, at 5 public universities
in Bosnia and Herzegovina. The Republic of Srpska was represented by two universities;
University of Banja Luka and University of Istočno Sarajevo, which administratively also covers
faculties in Brčko District, Doboj, Bijeljina and Foča, while FBiH was represented by four
universities; from Sarajevo, Tuzla and two from Mostar. In order to ensure a representative
sample, survey covered 7% of the total number of students enrolled in each included
geographic area. Survey covered total number of 3677 students in Bosnia and Herzegovina, of
which 56.8% from FBiH, 41.5% from RS and 1.7% from Brčko District. Students participated in
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the survey on a voluntary basis. Descriptive statistics and statistical conclusion validity were
applied in survey data processing.
Fourth chapter comprises Survey results In its five sub-sections it describes socio-
demographic characteristics of respondents, as well as their knowledge and attitudes on
HIV/AIDS and VCCT, along with students’ sexual behaviour, attitudes and risky behaviours.
Fifth chapter Discussion comprises four sub-sections. Namely, each of it analyses the
established situation with regards to results of similar surveys conducted around the world and
in the home country.
Sixth chapter Conclusions uniquely sets out the final analysis of knowledge, attitudes and
behaviour regarding HIV/AIDS; sexual behaviour and attitudes of the student population;
knowledge, attitudes and behaviour regarding VCCT centres, and students’ risky behaviour.
Seventh chapter comprises Recommendations regarding the established facts as defined
by survey goals and objectives.
Eighth chapter cites the Literature.
Ninth chapter is the Appendix representing the survey questionnaire used in survey data
collection, which will help the readers to clarify survey results and will instruct them on further
applicability on population’s target groups.
Writing style applied in this publication is clear and comprehensible.
Potencijalni korisnici Centara za dobrovoljno i povjerljivo savjetovanje i testiranje (DPST) na HIV/AIDS u studentskoj populaciji u Bosni i Hercegovini
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Conclusion
The manuscript of the Publication Potential Clients of Voluntary Confidential HIV/AIDS
Counselling and Testing Centres (HIV/AIDS VCCTCs) Among Student Population in Bosnia and
Herzegovina appears at a time when today’s continuous medical education has become a legal
obligation for all medical doctors at all levels of health care sector, which will make the
available results of this study applicable. This means that medicine cannot be separated from
its social environment, but it further on permeates the translational medicine.
I sincerely congratulate all the authors and associates that participated in development of
this study, which will enable not only medical doctors but also all parties interested in these
issues to become acquainted with, as well as to apply given recommendations in order to
improve the health of population.
With full appreciation of the hard work and efforts of the authors and all associates, the
independent reviewer believes that they entirely succeeded in their tasks, thus proposes the
publisher to issue this publication as soon as possible.
Novi Sad, 2nd of June 2012
Prof. Miroslava Kristoforović Ilić, MD, PhD
Specialist in hygiene
Sub-specialist in communal hygiene with
pathology of settlements
Associate member of the Academy of Medical
Science of the Serbian Medical Society
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Acknowledgements
The research team would like to thank all of those who participated in this survey, whose
selfless work made sure this survey was conducted in a highly professional manner
(representatives of Quality Assurance Offices operating within faculties, survey coordinators
from public faculties, survey administrators, survey supervisors, database designer, and data-
entry operators).
We wish to thank Dr. Slobodan Stanić, director of the RS Public Health Institute, and Dr.
Željko Ler, director of the Institute for Public Health of the Federation of Bosnia and
Herzegovina, for their wholehearted support to this survey.
We owe a special gratitude to students who dedicated their valuable time in order to
participate in the survey.
Last, but not the least, we thank UNDP as a primary beneficiary of the Global Fund to
Fight AIDS, Tuberculosis and Malaria, without whose financial support this survey would not
have been possible.
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SADRŽAJ
1. INTRODUCTION ........................................................................................................... 13 1.1. HIV/AIDS in Bosnia and Herzegovina – epidemiological situation ...................... 13 1.2. The role of the Voluntary Confidential HIV/AIDS Counselling Centres among the
student population of BiH ......................................................................................................... 14 2. SURVEY GOAL AND OBJECTIVES ................................................................................. 17
2.1. General Goal ........................................................................................................ 17 2.2. Specific Objectives of Survey ............................................................................... 17
3. METHODOLOGY .......................................................................................................... 18 3.1. Survey Design ...................................................................................................... 18 3.2. Survey Sample ..................................................................................................... 18 3.3. Survey Instrument ............................................................................................... 19 3.4. Indicators and Data Processing ........................................................................... 20 3.5. Ethical Component .............................................................................................. 22 3.6. Organisation of the Survey .................................................................................. 22 3.7. Statistical Data Processing................................................................................... 23
4. SURVEY RESULTS ......................................................................................................... 24 4.1. Socio-demographic characteristics of respondents ............................................ 24 4.2. Knowledge, Attitudes and Behaviour related to HIV/AIDS ................................. 27
4.2.1. Knowledge of fundamental facts about HIV/AIDS, and sources of information ........................................................................................................................ 27
4.2.2. Attitudes towards HIV/AIDS infected individuals ........................................... 30 4.2.3. Testing for HIV/AIDS (behaviour) ................................................................... 31
4.3. Knowledge, Attitudes and Behaviour related to Voluntary Confidential HIV/AIDS Counselling and Testing Centres ............................................................................................... 32
4.3.1. Acquaintance with fundamental principles of HIV/AIDS VCCT centres’ work 33 4.3.2. Attitudes towards Centres for Voluntary Confidential HIV/AIDS Counselling
and testing and utilisation of their services .......................................................................... 34 4.4. Sexual Behaviour and Attitudes of Student Population ...................................... 38 4.5. Risky Behaviour of Students ................................................................................ 43
5. DISCUSSION ................................................................................................................ 48 5.1. Knowledge, Attitudes and Behaviour related to HIV/AIDS ................................. 48 5.2. Sexual Behaviour and Attitudes of Student Population ...................................... 49 5.3. Risky Behaviour among Students ........................................................................ 50 5.4. Knowledge, Attitudes and Behaviour related to Voluntary Confidential HIV/AIDS
Counselling and Testing Centres ............................................................................................... 50 5.5. The Role of VCCT Centres in Continuous Education of Student Population ....... 52
6. CONCLUSIONS ............................................................................................................. 54 7. RECOMMENDATIONS ................................................................................................. 58 8. LITERATURE ................................................................................................................. 59 9. APPENDICES ................................................................................................................ 61
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1. INTRODUCTION
1.1. HIV/AIDS in Bosnia and Herzegovina – epidemiological situation
Current estimates show that there are approximately 33,000,000 people living with
humane immunodeficiency virus (HIV) today in the world. In year 2005, there were 5 million
people who were newly infected by HIV, and approximately some 3 million of sick individuals
who died.1 Approximately 1.7 million people in Europe are infected, and according to the latest
reports, Eastern Europe shows the greatest relative increase in number of newly registered HIV
infections in the world.2 Bosnia and Herzegovina can be placed in the group of countries with
low degree of epidemics, which would entail the HIV infection rate below 1% in general
population, i.e. below 5% in any of the groups exposed to increased risk (i.e. men who have sex
with men, people who inject drugs intravenously, sex workers, etc.).
First case of HIV infection in Bosnia and Herzegovina was registered in 1986, whereas
until the end of year 2011 total number of people diagnosed with HIV infection was 196. Total
of 116 individuals developed symptoms of AIDS: heterosexuals (56.1%), homosexuals (21.9%)
and those injecting drugs intravenously (10.7%). HIV/AIDS is a disease primarily affecting
stigmatized groups, and the greatest danger in spread of HIV infection is the presence of highly
risky behaviour or absence of knowledge and risk awareness of HIV or sexually transmitted
diseases (STD).3
Concerning the HIV surveillance, BiH as a country with a low degree of epidemics, has a
duty to abide by the recommendations of the World Health Organisation (WHO) to implement
surveillance activities among populations whose behaviour exposes them to a risk of HIV
1 UNAIDS; Report on the global AIDS epidemic 2010. Available at (13.05.2012):
http://www.unaids.org/globalreport/Global_report.htm
2 Ibid
3 Report on epidemiological surveillance on HIV/AIDS. Available at
(13.05.2012):http://www.phi.rs.ba/documents/Analiza_HIV_AIDS.pdf
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infection. There are also several specific potential risk factors here: social and economic
changes generated as consequences of transition period and recent war activities
(unemployment, poverty, migrations), relatively large population of asylum seekers and work-
related migrants, as well as the economy based on seasonal labour.
It seems to be very important to examine knowledge and attitudes of the student
population, as two very important factors indicating their behaviour and potential risks. Great
knowledge and positive attitudes of the student population are preconditions in successful
action against HIV/AIDS. Education has significant influence on the extent of knowledge on HIV
infection and utilisation of services of Voluntary Counselling and Testing centres (VCT centres),
as well as on the level of tolerance for HIV/AIDS related problems (Newman et al. 1993; Siegel
et al. 1995). Genuine value of the health education on action against HIV/AIDS in BiH has been
recognised quite early on. Containment and prevention of HIV/AIDS at the state level has
started significantly before the registration of first cases of the disease, through
implementation of the Strategy on prevention and action against HIV/AIDS in BiH 2004-2009,
which was endorsed by the BiH Council of Ministers.4
Students in general represent the highly educated sub-population, especially in regards to
HIV/AIDS (Ferguson et al. 1995). In addition to the level of education, knowledge and attitudes
are also related to many other factors: social-demographic characteristics, gender, age,
ancestry, religion, tradition, cultural context and potential contacts with HIV/AIDS (Bruce et al.,
2001).
1.2. The role of the Voluntary Confidential HIV/AIDS Counselling Centres
among the student population of BiH
Various models of preventive programmes and activities in the field of HIV/AIDS
prevention and control are nowadays in place around the world. One of the applied approaches
is a voluntary counselling and testing in VCCT centres (Voluntary Confidential Counselling and
4 Official Gazette of the BiH , No. 12/03
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Testing) or VCT (Voluntary Counselling and Testing). VCCT centres are seen as an intervention
that entails pre- and post-testing counselling accompanied with testing. Primary role of VCCT
centres is to help people change their sexual behaviour in order to avoid HIV transmission to
their partner, in case that they are HIV positive, or to remain negative, in case that they are HIV
negative.
Concept of HIV counselling and testing (Human Immunodeficiency Virus Counselling and
Testing, HIV-CT) is first mentioned in literature in mid-eighties, at the time when serological
tests for detection of HIV antibodies became available. To date, there is a total number of 19
VCCT centres opened in BiH, of which 12 are in FBiH and 7 are in the Republic of Srpska. These
centres employ health professionals who completed specific education on HIV counselling and
testing, while clients receive the counselling services prior to the testing, testing services, and
counselling services after the testing itself. Working hours of VCCT centres are determined by
the abilities of centres’ host institutions, and are adjusted to needs of clients to the maximum
possible extent.5
Since the commencement of operations of VCCT centres in Bosnia and Herzegovina, the
number of services provided by them is very low: in RS, on 31st of August 2011, pre-testing was
completed for 12,143 individuals, testing was completed for 11,656 individuals, whereas post-
testing counselling services were provided for 10,686 clients, of which number 18 (0.16 %) were
detected as HIV-positive, while in the territory of FBiH, by 31st of October 2011, total number of
17,393 clients were tested, of which 47 (0.27%) were HIV-positive, whereas pre-testing
counselling was provided to 17,370 clients and post-testing counselling was provided to 15,680
clients.
It is presumed that total number of completed tests is greater since testing services are
also provided in other institutions, but unfortunately without counselling either before or after
testing. Official data on number of individuals tested in other institutions are not published
however this number is very low in comparison to the size of BiH population. One of
5 Data on operations of VCCT centres (Global Fund)
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noteworthy factors leading to such low number of tested clients is that many individuals, due to
a pronounced stigma and potential discrimination by the society, do not want to check and to
know about their HIV status.
Student population is particularly vulnerable to HIV and other sexually transmitted
diseases (STD), which can be linked to their knowledge, attitudes and behaviour. According to
the unofficial information received in interviews conducted with students, lack of knowledge is
frequently accompanied with avoidance of visits to VCCT centres, mainly due to the traditional
upbringing, closed communities or apprehension of visit’s outcomes, and also not so rarely due
to the fact that they are not informed of VCCT centres’ existence, manner of their operations
and potential services.
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2. SURVEY GOAL AND OBJECTIVES
2.1. General Goal
General goal of this survey is to determine the level of knowledge, attitudes and
behaviour of student population in relation to the Voluntary Confidential HIV/AIDS Counselling
and Testing centres (VCCT centres), with reflection on motivational factors that can be linked to
potential utilisation of services provided by VCCT centres.
2.2. Specific Objectives of Survey
• Determine knowledge, attitudes and behaviour of student population in relation to VCCT
centres;
• Determine the sources of information on VCCT centres;
• Determine main reasons/motives for (not) using the services provided by VCCT centres;
• Determine correlations between socio-demographic factors and potential
utilisation/avoidance of services provided by VCCT centres;
• Determine knowledge, attitudes and behaviour of student population in relation to
HIV/AIDS and sexually transmitted diseases (STD);
• Examine the presence of risky behaviour among students, with reflection on HIV/AIDS;
• Determine attitudes of student population towards individuals with HIV/AIDS;
• Define proposals and recommendations concerning development of the guidebook for
promotion of utilisation of services provided by VCCT centres among the student
population.
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3. METHODOLOGY
3.1. Survey Design
The survey was conducted as a cross-sectional study on a randomly selected sample of
students attending public faculties, using the self-administered structured questionnaire.
3.2. Survey Sample
Target population of the survey comprises the students of the first and the final year of
full-time study, at 5 public universities in Bosnia and Herzegovina. The Republic of Srpska was
represented by two universities; University of Banja Luka and University of Istočno Sarajevo,
which administratively also covers faculties in Brčko District, Doboj, Bijeljina and Foča, while
FBiH was represented by four universities; from Sarajevo, Tuzla and two from Mostar.
The two-stage stratification was applied in the selection of sample, where first level of
stratum was a year of study, and second stratum was a level of scientific field in universities.
According to the International Standard Classification of Education (ISCED 97)6 scientific fields
were classified in following groups: education, humanities and arts, social sciences, business
and law, science, engineering, manufacturing and construction, agriculture, health and welfare,
and services.
In order to ensure a representative sample, survey covered 7% of the total number of
students enrolled in each included geographic area (FBiH, RS, Brčko District). Survey covered
total number of 3677 students in Bosnia and Herzegovina, of which 56.8% from FBiH, 41.5%
from RS and 1.7% from Brčko District (Chart 1).
6 UNESCO. In International Standards Classification of Education (ISCED). General Assembly of UNESCO.Paris.1997
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Chart 1: Students participating in the survey, from FBiH, RS and Brčko District
The following table shows the number of interviewed students, by public universities
participating in the survey (Table 1).
Tabela 1. Struktura uzorka prema univerzitetima
University N %
University of Banja Luka 827 22.5%
University of Istočno Sarajevo 760 20.7%
University of Tuzla 426 11.6%
University of Sarajevo 1128 30.7%
University of Mostar – 1 343 9.3%
University of Mostar – 2 192 5.2%
Total 36767 100.0%
3.3. Survey Instrument
Instrument used in this survey was a survey questionnaire (Appendix 1), specifically
designed for the purposes of this survey, following the pattern of similar surveys conducted in
the region and around the world, thus adjusted to the local circumstances and needs in BiH.
The Questionnaire is structured and comprises 4 thematic parts with grouped questions:
• Socio-demographic characteristics;
7 One questionnaire was not coded, and the university at which it was completed is not known
2089
1526
62
3677
FBiH Republic of Srpska Brčko District Total
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• Knowledge and attitudes on HIV/AIDS;
• Knowledge, attitudes and behaviour regarding VCCT centres;
• Sexual behaviour and attitudes of young people.
3.4. Indicators and Data Processing
Based on the used questionnaire, indicators were derived in order to serve as a basis for
development of the survey report:
Percentage of students who are aware of 4 and more ways of HIV/AIDS transmission
Percentage of students who are aware of 3 and more ways to prevent HIV/AIDS
The most frequent sources of students’ information on HIV/AIDS
Percentage of students with discriminatory attitude towards individuals with HIV/AIDS
Percentage of students who were ever tested for HIV
Percentage of students who were tested for HIV/AIDS in last 12 months
Percentage of students knowing the result of his/her HIV test
Percentage of students who are aware of VCCT centres
Percentage of students who visited a VCCT centre
Percentage of students who are acquainted with fundamental principles VCCT centres’ work
Percentage of students by sexual orientation
Percentage of students engaging in sexual intercourses without condom
Percentage of students who had sex with casual partner without condom
Percentage of students regularly using condom during sexual intercourse
Percentage of students who had a sexually transmitted disease
Percentage of students consuming alcohol, tobacco and psycho-active substances.
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Grouping of particular questions from the survey questionnaire was applied in order to
establish a scale for measurement of attitudes towards VCCT centres, a scale for measurement
of acquaintance with fundamental principles of VCCT centres’ work, and a scale for
measurement of risky behaviour regarding HIV, which all showed a satisfactory level of
confidence and as such will be used in further analysis.
The scale for measurement of attitudes towards VCCT centres was established when
questions HA11.1 to HA11.8 were re-coded (I do not agree = 1, I neither agree nor disagree =
0.5 and I agree = 0), while in question HA11.9 responses were inversed. Adding of the re-coded
responses resulted in a scale of attitudes towards VCCT centres, with range of points between 0
and 9. Higher sum indicates the positive attitude towards VCCT centres/their work and vice
versa. The scale shows an acceptable level of confidence (Cronbach's Alpha = 0.564).
The scale for measurement of risky behaviour was established when the following
questions were re-coded: HA18.2, HA20.1, HA20.2, SP8, SP11, SP12 (yes = 1, no = 0), SP5, SP9.1-
3 (yes = 0, no = 1), SP10.1-5 (with condom = 0, without condom = 1), HA19 (do not have STD =
0, had at least one STD = 1), SP3 ≤16, SP7≥3. Adding of the re-coded responses resulted in a
scale of risky behaviour regarding HIV/AIDS – higher sum indicates riskier behaviour and vice
versa (minimum score is 0 and maximum is 18). Categorisation of values resulted in three
categories of students: those without risk factors, those with 1 to 3 risk factors, and those with
4 and more risk factors. The scale shows a satisfactory level of confidence (Cronbach's Alpha =
0.741).
In statistical data processing, data were presented for the level of Bosnia and
Herzegovina, while separate data for entities (RS, FBiH) were only shown in parts where
statistically significant differences were established. Results of Brčko District were shown at the
level of the Republic of Srpska, since it is administratively a part of this entity (University of
Istočno Sarajevo).
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3.5. Ethical Component
The survey observed the ethical principles of Declaration of Helsinki, adopted by the 18th
World Medical Assembly, held in Helsinki, Finland, in June 1964, and its consequent revisions,
which provide for ethical component of research ensured by informed decisions regarding
participation in research, and protection of respondents’ data without disclosure of any
personal data.
Bearing in mind all the aforesaid, in order to conduct the survey in the observed
population group, the research team obtained the consent from the Ethical Committee of the
RS Public Health Institute and from the Professional Board of the Institute for Public Health of
the Federation of Bosnia and Herzegovina.
3.6. Organisation of the Survey
The survey was organised and conducted by the RS Public Health Institute and (for the
territory of the Republic of Srpska and Brčko District) and by the Institute for Public Health of
the Federation of Bosnia and Herzegovina (for the territory of FBiH). Research teams were
established, comprising the public health professionals with experience in various research
activities.
Following the approvals given by the RS Ministry of Education and Culture and the FBiH
Ministry of Education and Science, responsible individuals were appointed in universities
(faculties’ offices for quality assurance and deaneries) who were introduced with the goal,
objectives and methodology of the survey. Consequently, in cooperation with universities’
representatives, appointment was made of associates from all faculties in order to conduct the
interviews with students participating in the survey. Appointed faculty associates together with
survey administrators defined the appropriate time line of interviews to be held with students.
Prior to the survey implementation, associates and administrators completed a one-day
training programme specifically designed for the implementation of this survey, which was
organised by the core research team.
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Students participated in the survey on a voluntary basis, while the procedure governing
the survey implementation completely guaranteed participants’ anonymity (questionnaires
which did not contain any personal data were self-administered and sealed in envelopes
personally by respondents). The survey was conducted in facilities of participating public
faculties.
Field work was completed within the period of two months, namely in November and
December 2011.
3.7. Statistical Data Processing
Data entry process was completed in data base developed in Microsoft Access
application, in compliance with the defined questionnaire codex. Upon the completion of data
entry, the logical quality control of entered data was conducted and data were processed with
statistics software package (SPSS 16.0). In data processing, each tabulating programme was
correlated with questions from the survey questionnaire and specific survey objectives, in order
to ensure a high quality reporting of results. Descriptive statistics and statistical conclusion
validity were applied (Chi-Square test, T-test for independent samples, ANOVA).
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4. SURVEY RESULTS
4.1. Socio-demographic characteristics of respondents
The survey covered total of 3677 young individuals belonging to the student population,
of which 56.8% were from FBiH, 41.5% from the Republic of Srpska and 1.7% from Brčko
District. Approximately same number of students of age up to 19 (52.9%) and over 20 (47.1%)
was interviewed at the level of Bosnia and Herzegovina, as well as at the level of individual
entities. The highest percentage of students live in urban areas/cities or towns as their
permanent place of residence (67.6%), then in suburban settlements (17.6%) and in rural areas
(14.8%) – Chart 2.
Chart 2: Students’ gender and age structure, and place of permanent residence
Approximately equal percentages of interviewed BiH students are adherents of the
Islamic religion (43.7%) and of Orthodox Christian denomination (41.0%), which is significantly
more than percentage of students of the Catholic (11.5%) and other denominations (3.8%). The
entities show a significant difference, thus the dominating religious denomination in the RS is
Orthodox Christianity (92.1%) whereas in FBiH it is the Islam (74.3%) – Chart 3.
37,6%
62,4%
52,9% 47,1%
67,6%
14,8% 17,6%
Male Female ≤19 20≥ Urban Rural Suburban
Male Female ≤19 20≥ Urban Rural Suburban
Potencijalni korisnici Centara za dobrovoljno i povjerljivo savjetovanje i testiranje (DPST) na HIV/AIDS u studentskoj populaciji u Bosni i Hercegovini
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Chart 3: Distribution of respondents, by religion
Nearly one half of the student population in Bosnia and Herzegovina live with their
parents (48.6%), slightly over one third (38.1%) live in private accommodation, and 8.7% of
them live in students’ dormitories (Chart 4). In FBiH, 52.4% of students live with parents, which
is by 8.7% more than in the RS (43.7%), while percentage of students living in students’
dormitories in the RS is 12.7%, which is by 7.1% more than in FBiH (5.6%).
Chart 4: Type of student accommodation (BiH, RS, FBiH)
Highest percentage of students live independently, i.e. 92.8% are not married, whereas
only 2.2% live in matrimony, 1.9% of them live with a civil partner, and 0.7% are divorced (Chart
5).
18,6%
2,1%
74,3%
5,1% 2,3%
92,1%
3,5% 2,1%
11,5%
41,0% 43,7%
3,8%
Catholic Orthodox Muslim Other
FBiH RS BiH
38,1% 39,2% 37,3%
8,7% 12,7%
5,6% 2,9% 2,7% 3,1%
48,6% 43,7%
52,4%
1,6% 1,6% 1,6%
BiH RS FBiH
Private accommodation Student dormitory
With relatives/friends With parents
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Chart 5: Marital status of BiH students
More than two thirds of students (75.2%) assessed their material wealth as average
(neither better nor worse), approximately one fifth (19.1%) reported that their material wealth
was better than material wealth of majority of their colleagues (4% believe that it is much
better and 15.1% believe that it is slightly better than material wealth of majority of their
faculty colleagues), while 1.7% assessed their material wealth as much worse than the status of
the majority (Chart 6).
Chart 6: Level of self-assessed material wealth of BiH students
More than one half of students reported that their parents are informed about their
social life and customs, where the highest percentage (80.0%) believed that parents knew who
their friends were and where they go when they are out in the evenings (71.7%), (Chart 7).
92,8%
2,2% 1,9% 0,7% 2,4%
Single
Married
Living with a partner but not married
Divorced
Other
4,0%
15,1%
75,2%
4,0% 1,7%
Much better than majority
Slightly better than majority
Neither better nor worse
Slightly worse Much worse
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Chart 7: Percentage of students whose parents are informed about their social life and customs
4.2. Knowledge, Attitudes and Behaviour related to HIV/AIDS
4.2.1. Knowledge of fundamental facts about HIV/AIDS, and sources of information
Students showed the highest level of knowledge about the fact that HIV/AIDS is a sexually
transmitted disease weakening the immune system (91.3%), that HIV/AIDS is not a disease
specific only to homosexuals and prostitutes (90.7%), since even seemingly healthy people can
be infected (89.4%), (Chart 8).
Chart 8: Knowledge of fundamental facts about HIV/AIDS (correct responses)
In BiH 88.5% of students are aware of 4 and more modes of HIV transmission, significantly
more in urban (89.4%) than in rural areas (82.7%) (χ²=23.787; p = 0.000) (Chart 9).
71,7%
63,0%
61,0%
80,0%
Where you go, when you are out in evenings
What you spend your money on
How you spend your free time
Who your friends are
Mainly well informed
91,3%
21,7%
46,2%
89,4%
90,7%
HIV/AIDS is an STD weakening immunity
People with HIV/AIDS live significantly shorter, regardless treatment
Not all people infected with HIV have AIDS
Seemingly healthy people can be infected with HIV
HIV/AIDS is not a disease specific only for homosexuals and prostitutes
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Chart 9: Percentage of students aware of four and more modes of HIV transmission
Merely 7.4% of students in BiH are aware of all modes of HIV transmission described in
the survey questionnaire.
Over 90.0% of students in BiH know that HIV infection can be transmitted by vaginal
sexual intercourse without condom (94.9%) and by shared use of IV kit for drug injection
(90.8%), while slightly less of them know that infection can be transmitted from HIV-positive
mother to a child, during pregnancy and labour (73.3%), and by anal sexual intercourse without
condom (65.4%), (Chart 10). Over two thirds of students know that HIV infection cannot be
transmitted by shared use of bathroom (74.1%), and by shared use of cutlery (67.6%).
Chart 10: The most frequent reported modes of HIV transmission
Knowledge of 3 and more modes of prevention of HIV transmission was reported by 68%
of students in Bosnia and Herzegovina (FBiH 70.5%; RS 64.7%) and there is a statistically
significant difference between two entities (χ² = 17.040; p = 0.000), (Chart 11).
88,5% 89,4%
82,7%
89,7%
Know 4 and more
transmission routes
Urban Rural Suburban
94,9%
90,8%
73,3%
65,4%
Vaginal sexual intercourse without condom
Shared use of drug injecting IV kit
From HIV positive mother to a child, during pregnancy and labour
Anal sexual intercourse without condom
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Chart 11: Percentage of students who gave correct answers concerning the modes of HIV prevention
Low percentage of students (1.2%) reported knowing about all modes of HIV prevention,
without statistical significance between two entities. Significantly more students from urban
areas know about 3 and more modes of HIV prevention (69.6%) as compared to students from
suburban settlements (66.8%) and from rural areas (62.4%) (χ²=13.443; p = 0.009).
The observation of separate modes of prevention of HIV transmission shows that highest
percentage of the student population in BiH knows that transmission of HIV infection can be
prevented exclusively by proper and regular use of condoms during sexual intercourse (91.7%),
by HIV counselling and testing (88.7%), as well as that even one unprotected sexual intercourse
can lead to HIV infection (86.6%). Also, over a half of students know that HIV can be prevented
by mutually faithful relationship of HIV-uninfected sexual partners (65.5%), by sex abstinence
(63.1%), and by using single-use intravenous kits for drug injection (73.0%), (Chart 12).
Chart 12: Modes of prevention of HIV transmission
68,0% 64,7% 70,5%
29,6% 33,1% 26,9%
2,5% 2,2% 2,6%
BiH RS FBiH
Know up to 3 methods for HIV prevention Know 2 methods for HIV prevention
Do not know neither one metod for HIV prevention
63,1%
65,5%
73,0%
88,7%
91,7%
Sex abstinence
Mutually faithful relationship of HIV-uninfected sexual partners
Single-use intravenous kits for drug injection
HIV counselling and testing
Proper and regular use of condoms during sexual intercourse
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Students are most frequently informed about HIV prevention via TV and radio shows
(89.8%), via internet (81.1%), and via brochures and leaflets (75.9%). Slightly over one half of
students got the information on HIV prevention from health workers (53.4%), (Chart 13).
Chart 13: Sources of information on HIV among BiH students
4.2.2. Attitudes towards HIV/AIDS infected individuals
Attitudes of BiH students towards HIV/AIDS infected individuals were assessed by use of
affirmative responses based on a series of statements examining the sensibility towards HIV
infected individuals. The highest percentage of students (83.6%) believe that individuals with
HIV/AIDS deserve equal living and education conditions as other young people, and that
individuals with HIV/AIDS are entitled to determine who should know about their HIV status
(72.6%). Over one half of the student population would not have any doubts about giving first
aid to individuals with HIV (62.4%), they would be worried to find out that person in their
immediate environment is HIV-infected (60,8%), but would continue living in the environment
of an HIV-positive individual (58.3%), (Chart 14).
89,8%
81,8%
70,6%
75,9%
53,4%
49,9%
63,5%
TV and radio shows
Internet
Newspaper
Brochures and leaflets
Health workers
Peers
Lectures
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Chart 14: Attitudes of young people towards HIV/AIDS infected individuals (affirmative responses)
4.2.3. Testing for HIV/AIDS (behaviour)
Najveći dio studenata (96,2%) u BiH, bez značajnijih razlika na nivou entiteta, se nije
testirao na HIV. Među onima koji su se testirali (3,8%) neznatno više od polovine je to učinilo
tokom proteklih dvanaest mjeseci (53,6%) i gotovo svi (94,1%) su upoznati sa rezultatima.
Među razlozima testiranja navedeni su kod četvrtine studenata (24,4%) nesiguran seks, grafikon
Greatest majority of students in BiH (96.2%), without significant difference between entities,
have never been tested for HIV. Among those tested (3.8%), insignificantly more than one half
did it in last twelve months (53.6%) and nearly all of them (94.1%) received their test results.
One quarter of students (24.4%) reported unprotected sex as a reason for taking an HIV test,
(Chart 15).
Chart 15: BiH students’ reasons for taking an HIV test
The most frequently reported reasons for not taking an HIV test were absence of risky
behaviour (66.1%) and practicing of safe sexual behaviour (28.3%). Significantly low percentage
reported other reasons, such as mistrust in ethics of medical personnel (1.6%), fear of being
seen taking the test (1.1%), mistrust in tests/testing (0.2%) or something else (2.7%).
58,3%
60,8%
62,4%
26,1%
83,6%
72,6%
I would continue my friendship despite finding out that my friend (he/she) is HIV/AIDS positive
I would be worried if I found out that person I share accommodation with is HIV/AIDS positive
I would not have any doubts about giving first aid to an HIV/AIDS positive person, providing personal protection measures are taken
Majority of people infected by HIV or with AIDS are to blame themselves for their situation
Individuals with HIV/AIDS deserve equal living and education conditions as other young people
Individuals with HIV/AIDS are entitled to determine who should know about their status
42,0%
24,4%
13,4%
9,2%
8,4%
2,5%
other
unprotected sex
visa application requirement
condom break/tear during intercourse
employment requirement
shared use of drug injection kit
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4.3. Knowledge, Attitudes and Behaviour related to Voluntary
Confidential HIV/AIDS Counselling and Testing Centres
Nearly one half of BiH students are acquainted with existence of VCCT centres (44.5%),
equally in both entities. Significantly greater student population from urban (46.2%) and
suburban settlements (42.9%) knows about existence of VCCT centres, as compared to students
from rural areas (38.2%) (χ²=12.070, p = 0.002).
In FBiH, there is a statistically significant difference in awareness on existence of VCCT
centres with regards to the place of permanent residence (χ²=10.442, p = 0.005), (Chart 16).
Chart 16: Percentage of students who heard about existence of VCCT centres (BiH, RS, FBiH)
Over 60% of students who heard about VCCT centres reported that they got the
information from media, internet and brochures/leaflets, while approximately one half of
students (50.8%) heard about VCCT centres from health workers. Slightly over one third of
respondents reported that they had heard about VCCT centres from non-governmental
organisations (39.4%) and from friends/peers (35.5%), (Chart 17).
46,5% 45,7% 46,2%
36,8% 40,3%
38,2% 42,9% 42,9% 42,9%
FBiH RS BiH
Urban Rural Suburban
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Chart 17: Sources of information on existence of VCCT centres among the student population in BiH
4.3.1. Acquaintance with fundamental principles of HIV/AIDS VCCT centres’ work
Approximately one third of the BiH student population (32.2%) correctly identified all
principles of work of VCCT centres. Students know that VCCT centres are anonymous and
voluntary (68.2%), public and available to everyone (66.3%), and that counselling and testing
services are provided with prior consent of clients (57.6%). Approximately 10% of students
reported that VCCT centres were available only to groups at risk, with doctor’s referral letter,
and that they were anonymous and voluntary, but only for young people (Chart 18).
Chart 18: Percentage of responses to questions concerning fundamental principles of work of VCCT centres
50,8%
67,7%
67,1%
64,1%
35,5%
39,4%
Health workers
Internet
Other media
Brochures, leaflets
Friends and peers
Non-governmental organisations
66,3%
10,5%
68,2%
9,4%
7,4%
57,6%
33,7%
89,5%
31,8%
90,6%
92,6%
42,4%
Public and available to everyone
Available only to groups at risk
Anonymous and voluntary
Anonymous and voluntary, but only for young people
Available only with doctor's referral letter
Testing and counselling services provided with prior consent of the client
Yes No
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4.3.2. Attitudes towards Centres for Voluntary Confidential HIV/AIDS Counselling and
testing and utilisation of their services
Among the students who heard about existence of VCCT centres, only 2.5% visited one of
centres. Out of few students who visited a VCCT centre, one third (29.0%) reported
unprotected sex with unknown partner as a main reason for the visit to a VCCT centre, while
9.7% reported paid sex, and 6.5% reported shared use of a drug injection kit. Large percentage
of the student population reported other reasons for visiting a VCCT centre without specifying
them (Chart 19).
Chart 19: Main reasons for visiting VCCT centres
The main reason reported by the highest percentage of students for not visiting any of
VCCT centres is absence of risky behaviour (82.8%), but it is indicative that nearly one third of
students (22.6%) believed that VCCT centres are meant only for infected (sick) individuals and
those who engage in risky behaviour. On the other hand, leading reasons for a potential visit to
a VCCT centre reported by students were curiosity and wish to learn more about HIV and other
sexually transmitted diseases (approximately 70% of students), while merely 10.7% of
respondents would visit a VCCT centre in case that they had engaged in risky behaviour (Table
2).
2,5%
29,0%
6,5%
3,2%
9,7%
51,6%
Visited a VCCT centre
Unprotected sex with unknown partner
Shared use of drug injection kit
Sex with a same-gender partner
Paid sex
Other
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Table 2: Reasons for not visiting and reasons for potential visits to VCCT centres
% Reasons for not visiting VCCT centres Reasons for potential visits %
6.8 Fear that someone will see me going to a
VCCT centre Curiosity 75.7
5.8 Fear of the testing (finding out about the
potential status) I want to learn more about HIV and other
sexually transmitted diseases 74.9
5.0 I cannot learn anything new there I want to get tested and find out about my
status 42.0
22.6 It is meant only for infected (sick) and
those engaging in risky behaviour I want to learn about work of a VCCT centre 61.7
82.8 I have never engaged in risky behaviour,
thus there is no need for me to visit them I fear that my previous behaviour was risky 10.7
In order to determine attitudes towards VCCT centres, the scale for measurement of
attitudes towards VCCT centres was established, with higher values of the scale indicating more
positive attitude towards VCCT centres (their work), and lower values indicating a negative
attitude towards VCCT centres.
The following charts show the value of T-test for independent samples at level of BiH and
two entities (FBiH, RS) for the compared groups of students. Higher average value on the scale
for measurement of attitudes towards VCCT centres indicates a more positive attitude (readier
to get tested, to visit a VCCT centre) and vice versa, and if p<0.05 there is a significant
difference between compared groups in their attitudes towards VCCT centres.
Female students reached higher values on the scale for measurement of attitudes
towards VCCT centres, and they expressed more positive attitude towards VCCT centres than
men. The aforesaid difference is statistically significant at the level of BiH (t=-16.771, p=0.000)
and at the level of each individual entity (RS: t=-10.969, p=0.000, FBiH: t=-12.562, p=0.000),
(Chart 20).
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Chart 20: Levels achieved on the scale for measurement of attitudes towards VCCT centres, by gender (BIH, FBiH, RS)
Comparison of two age categories, i.e. students under 19 and over 20 years of age,
showed that older students have a more positive attitude towards VCCT centres than younger
categories of students (19-year-old and younger). The observed difference is statistically
significant at the level of BiH (t=-4.193, p=0.000) and at the level of each individual entity (FBiH:
t=-3.277, p=0.000, RS: t=-2.227, p=0.026), (Chart 21).
Chart 21: Levels achieved on the scale for measurement of attitudes towards VCCT centres, by gender (BIH, FBiH, RS), by two age categories of the student population
Application of Univariate Analysis of Variance (ANOVA) showed the statistically significant
difference between students living in urban, rural and suburban settlements in respect to their
attitudes towards VCCT centres (F=4.626, p=0.010). Application of LSD post hoc test showed
that students from urban areas have significantly more positive attitude towards VCCT centres
(readier to get tested, i.e. to visit a VCCT centre) than students from rural areas (p=0.003),
(Chart 22).
6,1% 6,2%
6,0%
6,9% 7,0%
6,8%
BiH RS FBiH
Male Female
6,5%
6,7% 6,6%
6,8%
6,4%
6,6%
≤19 20≥ ≤19 20≥ ≤19 20≥
BiH RS FBiH
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Chart 22: Attitudes of BiH students towards VCCT centres, by permanent place of residence
Concerning the clients of VCCT centres, the conclusion can be made that nearly one half
of students who did have sex are aware of the existence of VCCT centres (45.8%), while the
same was visited by only 3.6% of the sexually active student population. Also, nearly one half of
students who sometimes had (at least one) sexually transmitted disease heard about VCCT
centres (44.2%), but it was visited by only 9.1%, (Chart 23).
Chart 23: Level of awareness and visits to VCCT centres by students who had sex and who had STD
Level of students’ risky behaviour was estimated on the “0 to 18” scale, based on drug
abuse, body piercing, risky sexual behaviour and use of condoms, unprotected sex with a casual
partner, existence of a steady sexual partner, engagement in sexual behaviour below the age of
16, and having of more than 3 sexual partners over the period of one year.
If we observe the level of students’ risky behaviour, i.e. the level of present risk factors
regarding HIV and visits to VCCT centres, the following chart shows that students with riskier
behaviour patterns regarding HIV (4 and more risks) visited VCCT centres more frequently than
those who do not show risk regarding HIV(χ²=21.578, p=0.000), (Chart 24).
6,6%
6,4%
6,6%
Urban Rural Suburban
45,8% 44,2%
3,6% 9,1%
Had sex Had an STD
Heard about a VCCT centre Visited a VCCT centre
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Chart 24: Level of risk regarding HIV and visits to VCCT centres
4.4. Sexual Behaviour and Attitudes of Student Population
Sexual behaviour represents a significant aspect in protection of reproductive health, as
well as in protection of youth health in general. In Bosnia and Herzegovina, the highest
percentage of student population (over 90.0%) is heterosexual, with almost equal frequency in
both entities and at the level of the state. If we observe other types of sexual orientation, it can
be noted that a very small percentage of students are in bisexual or homosexual relationships,
with higher frequency of bisexual than homosexual relationships (Chart 25).
Chart 25: Sexual orientation of the student population
No risk 1 to 3 risk
factors 4 and more risk factors
Never visited a VCCT centre 99,0% 97,3% 94,0%
Visited a VCCT centre 1,0% 2,7% 6,0%
0,0%
20,0%
40,0%
60,0%
80,0%
100,0%
120,0%
90,5% 90,3% 90,7%
5,8% 5,9% 5,7% 3,7% 3,7% 3,6%
BiH RS FBiH
Homosexual
Bisexual
Heterosexual
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More than one half (53.1%) of BiH students are sexually active. The highest percentage of
affirmative responses were recorded in the Republic of Srpska (67.60%), more by young males
(81.3%) than young females (59.9%), which is also recorded in FBiH (66.3% : 27.0%) and at the
level of BiH (72.5% : 41.5%). Statistically significant difference was found between two genders
(χ²= 328.511, p=0.000), (Chart 26).
Chart 26: Percentage of BiH students who had sexual intercourse
BiH students over the age of 20 in significantly higher percentage engage in sexual
intercourses than those in a younger category (66.3% : 41.4%), which is also statistically
significant (χ²= 224.327, p=0.000). The highest frequency of engagement in sexual intercourses
by students over the age of 20 is recorded in the RS (79.9%), where high statistically significant
difference was also recorded between age categories (χ² = 110.913, p=0.000), (Chart 27).
Chart 27: Distribution of students who had sex, by age category
42,2%
67,6% 53,1%
57,8%
32,4% 46,9%
FBiH RS BiH
No
Yes
32,3% 67,7%
54,5% 45,5%
55,0% 45,0%
79,9% 20,1%
41,4% 58,6% 66,3% 33,7%
Yes No Yes No
≤19 years of age ≥20 years of age
BiH
RS
FBiH
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Average age of first sexual intercourse among BiH students was 17.73. Condom was used
in first sexual intercourse by slightly more than two thirds of the student population in BiH
(70.0%), as well as in both entities, with lowest frequency in FBiH (66.7%). It is observed that,
following the first sexual intercourse, attitudes towards safe sex and awareness of important
use of condom change, i.e. show decreasing trend among student population in RS and BiH, but
increasing trend in FBiH (Chart 28). Awareness of important use of condom during sexual
intercourse is in higher percentage recorded among young males, both in two entities and at
the state level, with high statistically significant difference between genders (χ²= 42.104,
p=0.000).
Chart 28: Use of condom during first sexual intercourse, and in general
BiH students’ awareness of important use of condom during sex significantly decreases
with age (χ² = 63.799, p=0,000), (Chart 29).
42,2% 57,8% 58,1% 41,9%
72,8% 27,2% 52,0% 48,0%
53,1% 46,9% 54,7% 45,3%
Yes No Yes No
Use of condom during first sexual intercourse
Use of condom always during sex
BiH
RS
FBiH
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Chart 29: Regular use of condom – always during sex, by age categories
On average, the highest number of sexual partners in last 12 months was recorded among
students in FBiH (2.58). 64.4% of BiH students have a steady sexual partner, more in RS (68.2%)
than in FBiH (59.9%).
One fifth of the BiH student population practice sex without condom with casual partners,
with the highest frequency recorded in FBiH (22.4%). Correct behaviour regarding use of
condom during vaginal sex is in the highest percentage recorded among students in FBiH
(61.8%), while correct behaviour regarding use of condom during oral (23.4%) and anal (42.4%)
sexual intercourse was in the highest percentage recorded among students in RS (Table 3).
Also, worrying is the fact that over 3/4 of the student population engaged in risky behaviour
and did not use condom during oral sex, and more than one half did not use condom during
anal sex.
Table 3: Frequency of condom use regarding the type of sexual intercourse
Sexual intercourses with: FBiH
%
RS BiH Sexual intercourses with:
% %
Drug injecting addict With condom 53.7 55.0 Drug injecting addict
Without condom 46.3 45.0
Sex worker With condom 60.7 62.7 Sex worker
Without condom 39.3 37.3
Homosexual partner With condom 47.8 47.1 Homosexual partner
Without condom 52.2 52.9
70,8% 29,2% 49,4% 50,6%
61,7% 38,3% 45,9% 54,1%
65,9% 34,1% 47,4% 52,6%
Yes No Yes No
≤19 years of age ≥20 years of age
BiH
RS
FBiH
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Use of condom when engaging in sexual intercourses with individuals of known risky
behaviour is shown in Table 4. Students most frequently use condom when engaging in sexual
intercourse with a person they just met (72.3%), with a promiscuous individual (65.5%) and
with sex workers (61.5%). Also, worrying is the fact that approximately one half of students had
sex without condom in contact with drug injecting addicts (45.7%), homosexuals (52.5%), and
bisexuals (48.4%).
Table 4: Frequency of condom use in sexual intercourses with individuals of risky behaviour
Sexual intercourses with: FBiH RS BiH
% % %
Drug injecting addict With condom 53.7 55.0
Without condom 46.3 45.0
Sex worker With condom 60.7 62.7
Without condom 39.3 37.3
Homosexual partner With condom 47.8 47.1
Without condom 52.2 52.9
Bisexual partner With condom 50.0 53.3
Without condom 50.0 46.7
Promiscuous individual (having 3 and more sexual partners in 12 months)
With condom 65.5 65.5
Without condom 34.5 34.5
Person you just met With condom 71.4 73.2
Without condom 28.6 26.8
Asked if they have ever received or given money, gifts or services in exchange for sex, the
highest percentage of the student population responded negatively, more than 90.0% (Chart
30).
Chart 30: Use of sex for personal gain
7,8% 92,2% 8,4%
91,6%
3,9% 96,1% 2,9%
97,1%
5,7% 94,3% 5,3% 94,7%
Yes No Yes No
Have you ever received money, gifts or services in exchange for
sex?
Have you ever given money, gifts or services in exchange for sex?
BiH
RS
FBiH
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Highest percentage of BiH students has appropriate attitudes towards the risk of
irresponsible sexual behaviour. Over one half of the student population believes that it is not
desirable to have as much sexual experience as possible or is not sure about it, more than two
thirds believe that it is not normal to end a first date with sex, while 90.0% believe that it is
required to have and use condom always during sex in order to protect themselves from
sexually transmitted diseases, even though practically all respondents who made this
statement failed to do it in practice (Chart 31).
Chart 31: Attitudes towards risky sexual behaviour
4.5. Risky Behaviour of Students
Slightly more than one third of the BiH student population consume alcohol (38.0%),
while tobacco products are consumed in lower percentage (25.8%), significantly more in the
Federation of Bosnia and Herzegovina (30.9%) than in the Republic of Srpska (19.1%)
(χ²=63.013; p=0.000), (Chart 32). Only 4.5% of the BiH student population used psycho-active
substances, 2.6% more in the Federation of BiH than in the Republic of Srpska (3.0%)
(χ²=13.853; p=0.000).
40,8% 38,7% 42,4%
8,8% 9,0% 8,6%
89,8% 89,4% 90,2% 31,1% 31,9% 30,5%
15,9% 18,5% 13,9%
6,5% 7,3% 5,9% 28,1% 29,4% 27,2%
75,4% 72,6% 77,4%
3,7% 3,3% 3,9%
BiH RS FBiH BiH RS FBiH BiH RS FBiH
Majority of my friends believe that it is desirable to have as much sexual
experience as possible
It is normal to end a first date with sex
In order to protect yourself from sexually transmitted diseases you
should always have and use a condom during sex
Yes I am not sure No
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Chart 32: Use of alcohol, tobacco and psycho-stimulating substances among the BiH student population
Low percentage of students (2.8%) used drugs by sniffing, 0.6% by intravenous injections,
while 6.4% of students took drugs in other ways.
Highest percentage of youth in Bosnia and Herzegovina never had any sexually
transmitted disease (97.9%). Among those who have had one or more sexually transmitted
diseases (2.1%), significantly more are from the Republic of Srpska (2.7%) than from the
Federation of BiH (1.6%) (χ²=5.135; p=0.023), (Chart 33). The most frequent sexually
transmitted diseases are Genital Herpes (0.7%), Chlamydia (0.6%) and Hepatitis B (0.6%).
Chart 33: Experience with sexually transmitted diseases among the student population in BiH
Students who have at some point had one or more sexually transmitted diseases have
been in higher percentage tested for HIV (20.8%) and have visited VCCT centres more than
those who have never had any sexually transmitted disease (Chart 34).
37,1%
30,9%
5,6%
39,2%
19,1%
3,0%
38,0%
25,8%
4,5%
Alcohol Tobacco Psycho-stimulative substances
FBiH RS BiH
98,4%
1,6%
97,3%
2,7%
97,9%
2,1%
Never had an STD Had one or more STDs
FBiH RS BiH
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Chart 34: Testing for HIV and visits to VCCT centres, by experience with sexually transmitted diseases among the student population in Bosnia and Herzegovina
Students who used condoms have had sexually transmitted diseases in lower percentage
(1.6%) than those who did not use condoms (5.1%) (χ²=18.459, p=0.000).
Only 3.6% of young people have permanent tattoos, and 6.3% have body piercing, slightly
more in the Federation of Bosnia and Herzegovina (7.3%) than in the Republic of Srpska (5.1%).
Level of students’ risky behaviour was estimated on the “0 to 18” scale, based on drug
abuse, body piercing, risky sexual behaviour and use of condoms, unprotected sex with a casual
partner, existence of a steady sexual partner, engagement in sexual behaviour below the age of
16, and having of more than 3 sexual partners in one year.
More than one half of the BiH students do not engage in risky behaviour leading to
HIV/AIDS and other sexually transmitted diseases, significantly more in the Federation of Bosnia
and Herzegovina (58.0%) than in the Republic of Srpska (39.6%) (χ²=129.784, p=0.000), (Chart
36). Nearly one third of the student population (32.0%) had 1 to 3 risk factors, significantly
more in the Republic of Srpska (40.6%) than in the Federation of BiH (25.6%), while one in 6
students has 4 and more risk factors (17.9%), (Chart 35).
3,9% 2,8%
38,2%
18,8%
2,9% 1,8%
7,0%
0 3,5% 2,3%
20,8%
9,1%
Tested for HiV Visited an VCCT centre Tested for HiV Visited an VCCT centre
Never had an STD Had one or more STDs
FBiH RS BiH
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Chart 35: Risky behaviour of BiH students, by level of risk
Female students in Bosnia and Herzegovina are in significantly higher percentage without
risk (77.4%) than male students (22.6%) (χ²=400.168, p=0.000), which is also the case with the
age category under 19 (63.6%) as compared to the older group (36.4%) (χ²=169.289, p=0.000).
Students in the first year of study are in significantly higher percentage without risk (72.1%)
than students in the final year of study (27.9%), where risk increases with the years of study
(χ²=81.045, p=0.000), (Chart 36).
Chart 36: Level of risky behaviour among BiH students, by gender, age, and year of study
Students who got tested for HIV/AIDS have significantly higher number of risk factors that
can cause this infection/disease (χ²=74.807, p=0.000), (Chart 37).
58,0%
25,6%
16,5%
39,6% 40,6%
19,8%
50,0%
32,0%
17,9%
No risk 1-3 risk factors 4 and more risk factors
FBIH RS BiH
77,4%
22,6%
63,6%
36,4%
72,1%
27,9%
53,4%
46,6%
41,3%
58,7%
56,2%
43,8%
36,8%
63,2%
43,7%
56,3%
63,5%
36,5%
Female
Male
19 years of age and younger
20 years of age and over
First year
Final year
4 and more risk factors 1-3 risk factors No risk
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Chart 37: Testing for HIV/AIDS among BiH students, by risky behaviour
Students living in urban areas have significantly higher number of risk factors that can be
related to HIV/AIDS and other sexually transmitted diseases than those living in suburban
settlements and rural areas (χ²=45.663, p=0.000).
1,6% 4,3% 9,1%
98,4% 95,7% 90,9%
No risk 1-3 risk factors 4 and more risk factors
Tested for HIV/AIDS Not tested for HIV/AIDS
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5. DISCUSSION
5.1. Knowledge, Attitudes and Behaviour related to HIV/AIDS
Survey findings showed that BiH youth have high level of knowledge regarding sources of
HIV infection and transmission routes, which can be explained by multiple sources of
information at their disposal.
Majority of young people in Bosnia and Herzegovina have proper understanding of
HIV/AIDS and related health consequences, more those living in urban and suburban
settlements. Student population has proper knowledge on potentially infected individuals and
infection transmission routes. Results showed that approximately 70% of students are aware of
3 and more methods for prevention of infection transmission. It can be observed that youth’s
knowledge on HIV/AIDS transmission and protection is relatively good, but not completely
satisfactory, since 7.4% of students are aware of all transmission routes, and 1.2% of students
are aware of all HIV/AIDS prevention methods. High awareness on HIV/AIDS was established,
whether originating from internet, mass-media or lectures and peer talk. Despite the efforts
made for infected individuals to be bestowed with equal rights, tolerance to HIV infected does
not exist in practice, thus only approximately 60% of students would continue friendship with
or give aid to an infected individual. The aforesaid confirms the still existing presence of fear,
stigma and many misapprehensions related to HIV, routes of its transmission, and wrong
practices.
Regardless the aforesaid, the survey results showed that one quarter of students (24.4%)
were tested for HIV because of unprotected sex, even though their number is negligibly low
(3.8%). Other real reasons for HIV testing that were not specified by 42% of students are
intriguing, and it could be rightfully guessed that these include risky sexual behaviour and
sexual experiments.
AIDS-phobia and stigma against infected and ill are significantly more pronounced and
accompanied with assessments of moral dimensions and behaviour of affected individuals than
in case of other infectious diseases. Fear and prejudices can be diminished by better
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information, whereas students’ moderately liberal attitudes regarding provision of aid to an
infected individual can be changed into much more positive.
The aforementioned implies that youth are sporadically informed and educated about
this topic, and that focus is exclusively on young people in big cities. Educations are primarily
linked to activities of the non-governmental sector, thus systematic programme
implementation does not exist within or beyond the framework of the education system.
5.2. Sexual Behaviour and Attitudes of Student Population
Research studies conducted around the world imply that sexual activities of young people
are gradually but constantly increasing, as well as that the age of sexual initiation is lowering.
Mainly, the age of first sexual intercourse ranges between the age of 15 (Sedlecki, 1999) and 20
(Tonkin, 1994) depending on the culture and tradition of the region in which survey is
conducted. Earlier onset of coital activity is registered in highest percentages in countries of the
Balkan and in the USA. Comparison of our survey results with other countries showed quite
many similarities, namely more than one half of young people in BiH had sexual intercourses,
male students in higher percentage than female (72.5% : 41.5%), which is also recorded in
other surveys (Cucic et al., 2000; Radovanović, S et al. 2010). If we observe the age of sexual
initiation / onset of sexual activity, we notice that it is very similar to that established in other
countries of the European region (Sedlecki, 1999), as well as other in countries in our
immediate surroundings (Cucic et al., 2000). Condom was used during a first sexual intercourse
by slightly more than two thirds of BiH youth, which matches the picture established by surveys
on youth sexual behaviour in Balkans, as well as surveys conducted by our colleagues in Serbia.
Unfortunately, awareness of important use of condoms decreases by age, and is significantly
lower among the students in the category over 20 years of age. Insufficient degree of
responsibility mainly implies the insufficient knowledge, even tough the comparison of youth
attitudes towards risky sexual behaviour indicates that highest percentage of those who
reported proper knowledge on condom use (over 90%) do not apply that knowledge in
practice. Condom is mainly used by students in heterosexual relationships, while significantly
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lower percentage of youth use condoms in bisexual and homosexual relationships, or in
contacts with drug injecting addicts.
5.3. Risky Behaviour among Students
Level of tobacco products consumption among the student population in the Federation
of Bosnia and Herzegovina (30.9%) and the Republic of Srpska (19.1%) represents an important
preventable factor that shows an increase in comparisons to prevalence among the BiH
secondary school population (18.2% in the RS and 15.0% in the FBiH), while associated with
consumption of alcohol and drugs, and their easy availability, it increases the level of youth
risky behaviour that can directly lead to other public health problems such as blood-borne and
sexually transmitted diseases (Šiljak S, Niškanović J, Stojisavljević D, Pilav A, 2008). Health
promotion measures directed towards reduction of use of the aforesaid psycho-active
substances represent first steps in decreasing the level of youth risky behaviour, while
associated with continuous education on prevention of HIV and other sexually transmitted
diseases they ensure long term access to improvement of youth health, both in Bosnia and
Herzegovina and around the world (Anderson, 2012). Results of the European research studies
(Currie C et al. 2012) point out to the complex approach to the prevention of socially risky
behaviour, starting from the family support (Curry SJ, 2009), (Thomas RE, 2007), full policy
implementation (Hublet A, 2009), to continuous education as a basic mean in provision of
health promotion measures (WHO 2007, Harden 2006), thus enabling creation of the youth
health support environment throughout all developmental periods of psycho-physical and
social maturation.
5.4. Knowledge, Attitudes and Behaviour related to Voluntary
Confidential HIV/AIDS Counselling and Testing Centres
Since similar surveys have never before been conducted in Bosnia and Herzegovina, this
discussion represents some key considerations on their role among students, from the aspect
of basic survey results, and in order to reconsider their effectiveness in relation to their
geographic distribution and period of operation.
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Survey results indicate a low percentage of utilisation of services provided by VCCT
centres among the student population in Bosnia and Herzegovina, despite their geographic and
financial availability (free of charge).
55.5% of the total number of students have never heard of such centres, thereby never
heard of the possibility of voluntary and confidential testing. Out of the remaining students,
who heard about existence of VCCT centres, only 2.5% visited one of them, slightly more in the
FBiH. Main reason reported by students for visits to a VCCT centre and for testing is
“unprotected sex with casual partner” (29%).
Even though those who heard about VCCT centres demonstrated relatively good
awareness of fundamental principles regarding their work, i.e. 2/3 knew that counselling and
HIV testing services are available to everyone, this survey showed that barriers to utilisation of
VCCT centres’ services include a lack of knowledge regarding the principles of centres’ work and
lack of youth’s awareness on possible risks related to HIV and other STDs, as well as absence of
knowledge regarding the advantages of early detection and prevention. Survey results point
out that young people are not sufficiently acquainted with goals and objectives of VCCT
centres, that they are not aware of HIV exposure risks, as well as that probability that they will
utilise VCCT centres’ services is very low. This situation is supported by deficient knowledge on
HIV/AIDS, transmission routes and methods for prevention, since only 10.3% of respondents
had correct answers on HIV/AIDS.
Important barriers to potential utilisation of services provided by VCCT centres among the
student population are based on the perception of individual risk in their current or past sexual
relationships, as well as on insufficient awareness of advantages brought by services of VCCT
centres. It is evident that even those who know about existence of centres have not used and
would never use their services, partly due to the fear of stigma and the fear of jeopardising the
exisiting social relations. 64% of students show a certain stigmatising attitude, i.e. believe that
tests for HIV and Hepatitis C should be required prior to asigning the slots in student
dormitories. Students noticeably differ in their discriminatory attitudes towards individuals with
HIV/AIDS depending on place of their permanent residence. Students from rural areas showed
significantly more discriminatory attitude towards HIV/AIDS than students from urban areas.
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Improvement in utilisation of services provided to youth by VCCT centres requires various
innovative approaches that are based on better knowledge on HIV, self-perception of risk,
motivation to use VCCT centres, along with clear messages of the health education services that
are focused on barriers. The latest discussions also focus on HIV testing as a routine practice
that will be occurring within the existing facilities of the health care system. This would ensure
that more individuals, especially those exposed to higher risks, find out about their HIV status,
and become more motivated to change their risky behaviour patterns, while those living with
HIV would sooner begin their treatment.
5.5. The Role of VCCT Centres in Continuous Education of Student
Population
Since VCCT centres are a backbone in HIV detection, treatment, provision of psycho-social
support, and in general, serve as a point of entry into the health care system, greater
promotion of their work and of importance of HIV testing is a basis for health protection and
prevention of inadvertent transmission of HIV infection. Methods of disseminating information
concerning VCCT centres should move from the concept of printed and written materials, and
focus on more interactive means of communication, since the survey results show that young
people in high percentage receive information via internet, which nowadays represents an
important communication method directed towards social networks, especially for younger
categories of the population. Various surveys showed that, owing to the new media and
technical gadgets (internet, mobile phones), young people exchange information faster and
more than any other target group (Haramija, 2007).
Diverse metaphors related to AIDS have contributed to the perception of HIV/AIDS as a
disease that affects other people, especially groups stigmatised for their sexual orientation or a
risky behaviour (men who have sex with men, sexual workers, drug injecting addicts). Our
society, that increasingly emphasises individualism, influences a perception of HIV/AIDS as a
disease caused by personal irresponsibility, in which way individuals living with HIV are
themselves blamed for their condition (Stojanovski, Stojanović, Prvulović, 2007). This can
explain the basic motivational barriers to visits to VCCT centres, since majority of students
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believe that VCCT centres are intended only for infected individuals, while neglecting the
possibility to become infected due to their personal behaviour. Negation of the possibility of
personal risky behaviour and potential risk of HIV infection (highest percentage of students who
visited VCCT centres did not specify the reasons for the visit) minimises the risk and creates the
imaginary protection.
For the purposes of the greater promotion and stimulation of visits to VCCT centres
among the sexually active student population, it is necessary to carry out more extensive
promotion of fundamental principles governing their operations (anonymity, clients’ consent,
etc.) in order to overcome the prejudices that VCCT centres are intended only for “infected”
individuals and those who engage in risky behaviour. Educational and promotional activities
should be directed towards both, younger and older students, and should bespeak sensibility in
regards to specific differences concerning sexual characteristics and a place of residence.
The impression is made that young people are still not ready to become aware of
potential risky behaviours or to realise the benefits they have regarding testing and greater
care of their sexual and reproductive health (only 2.5% have paid a visit to a VCCT centre).
Faced with a new environment, and with standards directed towards experimenting, i.e.
greater risks, young people need to acquire confidence and trust in anonymity and voluntary
aspect of the testing as a basis for health protection and improvement.
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6. CONCLUSIONS
Knowledge of fundamental facts about HIV/AIDS
• Majority of BiH students (88.5%) are aware of 4 and more modes of HIV transmission;
• Students from urban areas have significantly more knowledge about modes of transmission
and HIV prevention than students from rural and suburban settlements;
• Over two thirds of BiH students (68%) reported knowing about three and more modes of
prevention of the HIV transmission;
• All modes of HIV transmission are correctly identified by only 7.4% students, and 1.2%
correctly identified all ways of HIV/AIDS prevention;
• Dominant sources of information on HIV/AIDS reported by students are: TV and radio shows
(89.8%), internet (81.1%), newspapers (70.6%), brochures and leaflets (75.9%), lectures
(63.5%), health workers (53.4%), or peers (49.9%);
• Knowledge of HIV/AIDS as an sexually transmitted disease weakening immune system is
reported by 91.3% students, while one third of them think that people with HIV/AIDS live
significantly shorter regardless the treatment;
• Greatest portion of students (94.9%) believe that HIV infection is most frequently
transmitted by vaginal sexual intercourse without condom, by shared use of IV kit for drug
injection (90.8%), by HIV-positive mother during pregnancy and labour (73.3%), or anal
sexual intercourse without condom (65.4%);
• Majority of students (91.7%) know that transmission of HIV infection can be prevented by
proper and regular use of condoms during sexual intercourses.
Attitudes towards individuals with HIV/AIDS (discrimination)
• Over two thirds of students (83.6%) believe that individuals with HIV/AIDS deserve equal
rights and living conditions as other people, while 72.6% of students believe that individuals
with HIV/AIDS are entitled to determine who should know about their status,
• Slightly over one half of students (60%) reported that they would give first aid to an
HIV/AIDS infected person providing precautionary personal protection measures were
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taken, and somewhat lower percentage (58.3%) reported that they would continue their
friendship with an infected person.
Knowledge, attitudes and behaviour regarding VCCT centres
• Over one half of students (55.5%) have never heard about existence of VCCT centres;
• Students from urban and suburban settlements are significantly better informed about
existence of VCCT centres than their peers from rural areas (χ²=12.070, p=0.002);
• Over three quarters of students reported media and promotional materials as dominant
sources of information on VCCT centres, while one half of students received such
information from health workers, and one third from non-governmental organisations;
• Approximately one third of the student population in Bosnia and Herzegovina (32.2%) is
aware of all fundamental principles of work of VCCT centres;
• Nearly 90% of young people recognise VCCT centres as places available to all people,
without doctor’s referral letter, but slightly over one half of students (57.6%) know that
testing and counselling services are provided upon consent received from a client;
• Merely 2.5% of students who heard about VCCT centres paid a visit to one of them, and one
third (29%) reported unprotected sex with a casual partner as a main reason of the visit to a
VCCT centre. It is important to emphasise that young people in 50% of cases reported
another reason for visiting a VCCT centre, however without specifying it. Reported data are
indicative, since they imply low level of openness and readiness of young people to visit
VCCT centres, as well as to talk about it openly and to become aware of the potential risks;
• Approximately 89% of students reported that they did not engage in any risky behaviours,
thus did not have a need to visit a VCCT centre, but worrying fact is that 22.6% think that
VCCT centres serve only infected individuals and those who engaged in risky behaviour.
Merely 10.7% of students report that they would visit a VCCT centre had they engaged in
risky behaviours, but report curiosity and a wish to get informed as main reasons for a
possible visit. The aforesaid implies a low level of knowledge regarding VCCT centres, but
also a fact that young people see centres as places intended only for “infected individuals”
or individuals who engage in risky behaviour, and they mainly consider them out of curiosity
Potencijalni korisnici Centara za dobrovoljno i povjerljivo savjetovanje i testiranje (DPST) na HIV/AIDS u studentskoj populaciji u Bosni i Hercegovini
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or a wish to get informed rather than a whish to find out about their status or to define
risky behaviour;
• More positive attitude towards VCCT centres, i.e. their work and testing services, is
reported by female students (t=-16.771, p=0.000), by older students (20-year-old and over,
t= -4.193, p=0.000), as well as by young people from urban areas (F=4.626, p=.010);
• Considering the main motives for visiting/not visiting VCCT centres, which come down to
curiosity but not a wish to get tested or to assess the level of risky behaviour, as described
in the preceding conclusion, we can observe consistency in behaviour related to low level of
visits to VCCT centres among young people who had sexual intercourse (3.6%) and a
sexually transmitted disease (9.1%);
• Increased level of risky behaviour related to HIV leads to an increased percentage of young
people who visited a VCCT centre, i.e. from 1% of those without risk factors to 6% of those
who have 4 and more risk factors (χ²=21.578, p=0.000). However, the reported percentages
are extremely low and imply the need for a greater promotion of services provided by VCCT
centres among the student population.
Sexual behaviour and attitudes of the student population towards sexual intercourses
• Highest percentage of students, over 90.0%, report that they are heterosexual;
• More than one half of the students in BiH had a sexual intercourse, more young men
(72.5%) than young girls (41.5%);
• Students in BiH report age of 17 or 18 as the age of first sexual intercourse;
• Somewhat more than two thirds of BiH students report use of condom during first sexual
intercourse;
• Attitude towards safe sex and awareness of important use of condom decreases after the
first sexual intercourse among students in the RS, but increases among students in the FBiH;
• Awareness of the important use of condom during sex is in higher percentage recorded
among young males, both at the entity and the state levels;
• Awareness of condom use during sex significantly decreases by age,
Potencijalni korisnici Centara za dobrovoljno i povjerljivo savjetovanje i testiranje (DPST) na HIV/AIDS u studentskoj populaciji u Bosni i Hercegovini
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• On average, highest numbečr of sexual partners in last 12 months is reported by students in
the Federation of BiH;
• Sexual intercourse without condom with a casual partner is reported by 1/5 of students in
BiH;
• Over 3/4 of students engage in risky behaviour and do not use condom during oral sex, and
over 1/2 do not use condom during anal sex;
• Approximately two thirds of students report that they most frequently use condom when
they have sex with a partner they just met;
• Approximately one half of students have sex without condom in contacts with drug injecting
addicts, homosexuals and bisexuals;
• Over 90.0% of students do not give nor receive sex services for personal gain.
Risky behaviour among the student population
• Slightly over one third of the BiH students consume alcohol (38.0%), 25.8% consume
tobacco products, and 4.5% use psycho-active substances;
• Highest percentage of the BiH student population has never had any sexually transmitted
disease (97.9%);
• Only 3.6% of BiH students have permanent tattoos, and 6.3% have body piercing;
• Half of the student population in Bosnia and Herzegovina does not have risk factors that can
be related to HIV/AIDS and other sexually transmitted diseases;
• Nearly one third of students (32.0%) have 1 to 3 risk factors related to HIV/AIDS and other
sexually transmitted diseases, and one in six students has 4 and more risk factors (17.9%);
• Female students in age category below 19 years are significantly less exposed to risky
behaviour related to HIV/AIDS and other sexually transmitted diseases than students in final
year of study.
Potencijalni korisnici Centara za dobrovoljno i povjerljivo savjetovanje i testiranje (DPST) na HIV/AIDS u studentskoj populaciji u Bosni i Hercegovini
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7. RECOMMENDATIONS
• It is essential to engage in health education activities with students and via VCCT centres in
order to improve the level of knowledge and attitudes of the student population regarding
the basic information on HIV/AIDS, sources of infection, transmission routes and prevention
measures;
• It is important to develop anti-stigma campaigns that will, in addition to provision of basic
information, help build positive attitudes towards infected individuals by direct contact with
a professional and with an infected individual;
• It is necessary to carry out a greater promotion of VCCT centres, their roles and working
principles among the student population, while taking into consideration the specificities of
their accommodation circumstances, i.e. life in urban, suburban and rural settlements
(living with family /in student dormitory);
• Methods of disseminating information concerning VCCT centres should move from the
concept of printed and written materials, and focus on more interactive means of
communication, since the survey results show that young people in high percentage receive
information via internet, which nowadays represents an important communication method
directed towards social networks, especially for younger categories of the population;
• Greater education is required along with encouragements for health workers and non-
governmental organisations to engage in more extensive promotion of services provided by
VCCT centres. The aforesaid is fundamental for health workers as leading specialist in field
of health education;
• Bearing in mind youth’s curiosity and wish to gain information on sexually transmitted
diseases as main reasons for visits to VCCT centres, it is necessary to expand work on
education concerning the need to get tested and becoming aware of the potential risks;
• Continuous education of the student population on habits and behaviour leading to
HIV/AIDS and other STD-related risks represents an imperative in work of the public health
institutions in their cooperation with the education sector. There is also a need for
development of detailed and local community-based youth health awareness programmes
concerning the HIV/AIDS prevention.
Potencijalni korisnici Centara za dobrovoljno i povjerljivo savjetovanje i testiranje (DPST) na HIV/AIDS u studentskoj populaciji u Bosni i Hercegovini
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8. LITERATURE
Anderson M. (2012). The Impact of HIV Education on Behavior among Youths: A Propensity Score Matching Approach. Montana State University. Bozeman.
Bernays, S. , Rouds T., Prodanović, A. (2006): Accessibility, services providing and uncertainty in HIV treatment, Faculty for Hygiene and Tropical Medicine of London University, UK, DFID, HIV Prevention among Vulnerable Groups Initiative, United Nations Development Programme, Beograd/Podgorica
Bruce KE, Walker LJ. College students attitudes about AIDS: 1986 to 2000. AIDS Educ Prev 2001;13: 428-437
Cucic,V. i dr. (2000). Zdravstveno ponašanje studentske i srednjoškolske omladine, (Beograd: Zavod za zdravstvenu zaštitu studenata). Istraživanje zdravlja stanovnika Republike Srbije. Beograd: Ministarstvo zdravlja Republike Srbije; 2007.
Currie C, Zanotti C, Morgan A, et all. (2012). Health behaviour in school aged children (HBSC) Study: international Report from 2009/2010 Survey. Denmark: World Health Organization.
Curry SJ, Mermelstein RJ, Sporer AK. (2009). Therapy for specific problems: youth tobacco cessation. Annual Review of Psychology, 60:229–255.
Ferguson E, Cox T, Irving K, Leiter M, Farnswort B. A measure of knowledge and confidence in relation to HIV and AIDS – realibility and validity. AIDS Care 1995; 7:534-543
Harden A et al. (2006). Young people, pregnancy and social exclusion: a systematic synthesis of research evidence to identify effective, appropriate and promising approaches for prevention and support. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London
Harmija, P. (2007). Marketing usmenom predajom: fenomen i mogućnosti. Zagreb.
Hublet A et al. (2009). Association between tobacco control policies and smoking behaviour among adolescents in 29 European countries. Addiction, 104 (11):1918–1926.
Institut za javno zdravstvo Republike Srpske i Zavod za javno zdravstvo Federacije BiH. Izvještaj istraživanja o HIV stigmi i diskriminaciji među zdravstvenim radnicima u javnom i privatnom zdravstvenom sektoru u BiH, 2011.
Newman C, Durant RH, Ashworth CS, Gaillard G. An Evaluation of school-based AIDS HIV education program for young adolescents. AIDS Educ Prev 1993;5:327-339
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Pilav A. (2008). Evropski projekat istraživanja o pušenju, alkoholu i drogama u srednjim školama. Završni Izvještaj. Sarajevo: Zavod za javno zdravstvo Federacije Bosne i Hercegovine. Ministarstvo zdravstva Federacije BiH.
Radovanović, S i dr. (2010). Stavovi i ponašanje studenata u vezi sa reproduktivnim zdravljem, Med Pregl 2010; LXIII (11-12): 859-862. Novi Sad: novembar-decembar.
Sedlecki, K. (1999). Znacaj ispitivanja cervicisa ciji je uzrocnik Chlamydia tracomatis kod seksualno aktivnih adolescentkinja, doktorska disertacija (Beograd: Medicinski fakultet)
Siegel D, Diclemente R, Durbin M, Krasnovsky F, Saliba P. Change in junior high school students AIDS-related knowledge, misconceptions, attitudes, and HIV-preventive behaviours – effects of school-based intervention. AIDS Educ Prev 1995; 7:5345-543
Stojanovski, J., Stojanović, M., Prvulović, M. (2007). Stigma i diskriminacija ljudi koji žive sa HIV-om. GIP ekspertski centar za mentalno zdravlje i HIV/AIDS u Srbiji.
Šiljak S, Niškanović J, Stojisavljević D (2008). Evropsko istraživanje upotrebe duvana, droga i alkohola među srednjoškolcima. Izvještaj za Republiku Srpsku. Banja Luka: Institut za javno zdravstvo.
Thomas RE, Baker PRA, Lorenzetti D. (2007). Family-based programmes for preventing smoking by children and adolescents. Cochrane Database of SystematicReviews, 1(1):CD004493.
Tonkin, R. (ed.) (1994). "Current Issues in the Adolescent Patient", Bailliere's Clinical Paediatrics, Vol. 2/ No. 2.
Global strategy for the prevention and control of sexually transmitted infections, 2006−2015. (2007). Breaking the chain of transmission. World Health Organization: (http://www.who.int/reproductivehealth/publications/rtis/9789241563475/en, pristupljeno 29. februara, 2012).
UNESCO. In International Standards Clasification of Education (ISCED). General Assembly of UNESCO. Paris.1997.
UNICEF (2001). Teenage Births in Rich Nations, Innocenti Report Card, No. 3, (Florence: Unicef Innocenti Research Centre).
http://www.unaids.org/ (accessed January 14 2012)
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9. APPENDICES
Survey questionnaire.
Survey on potential clients of Voluntary Confidential HIV/AIDS Counselling and Testing Centres (HIV/AIDS VCCTCs) conducted among student population in Bosnia and Herzegovina
The RS Public Health Institute, The Institute for Public Health FB&H 1
QUESTIONNAIRE
Dear Participant, The Public Health Institute of the Republic of Srpska and the Institute for Public Health of the Federation of Bosnia and Herzegovina are conducting the survey on availability of Centres for Voluntary Confidential Counselling and Testing (VCCT). This is an attempt to gather data on knowledge, attitudes and behaviour of student population on the subject of HIV/AIDS and VCCT centres. You have been randomly selected to participate in the survey. Anonymity of your responses is guaranteed and they will be exclusively used for the purpose of this survey. Would you please complete the questionnaire sincerely and with due care, without stating your name, and making sure that you responded to all questions, either by marking the proposed answer of your choice or by specifying it on the appropriate lines. Thank You for your cooperation!
Questionnaire code (entered by supervisors)
Survey on potential clients of Voluntary Confidential HIV/AIDS Counselling and Testing Centres (HIV/AIDS VCCTCs) conducted among student population in Bosnia and Herzegovina
The RS Public Health Institute, The Institute for Public Health FB&H 2
I / Socio-Demographic Characteristics
SC 1. Age _________ years.
SC 2. Gender
1. Male 2. Female
SC 3. Religion
1. Catholic 2. Orthodox 3. Islam 4. Other, specify __________________
SC 4. Place of permanent residence (as stated in your personal ID)
1. Urban (city, town) 2. Rural 3. Suburban settlement
SC 5. Faculty and department, Town/municipality (please specify)
_______________________________ _______________________________
SC 6. Year of study _____________
SC 7. Current place of residence
1. Urban (city, town) 2. Rural 3. Suburban settlement
SC 8. Type of accommodation
1. Private accommodation 2. Student dormitory 3. With relatives and friends 4. With parents 5. Other, specify ____________________
SC 9. What is your marital status?
1. Single 2. Married 3. Civil partnership, living together but not married 4. Divorced 5. Other (specify): _________________
SC 10.
In comparison to your faculty colleagues, your material wealth/status is:
1. Much better than material wealth of majority of my colleagues 2. Slightly better than material wealth of majority of my colleagues 3. Neither better nor worse 4. Slightly worse 5. Much worse
SC 11. How well are your parents (guardians) informed about
Not informed at all Partly informed Mainly well informed
1. Where you go, when you are out in evenings 1 2 3
2. What you spend your money on 1 2 3
3. How you spend your free time 1 2 3
4. Who your friends are 1 2 3
Survey on potential clients of Voluntary Confidential HIV/AIDS Counselling and Testing Centres (HIV/AIDS VCCTCs) conducted among student population in Bosnia and Herzegovina
The RS Public Health Institute, The Institute for Public Health FB&H 3
II / Knowledge and attitudes on HIV/AIDS
Yes No I do not
know
HA 1. Is HIV/AIDS sexually transmitted disease weakening immune system? 1 2 3
HA 2. People who have HIV/AIDS live significantly shorter, regardless the treatment
1 2 3
HA 3. All people infected with HIV have AIDS 1 2 3
HA 4. Seemingly healthy people can be infected with HIV 1 2 3
HA 5. Only homosexuals and prostitutes have HIV/AIDS 1 2 3
HA 6. HIV infection is transmitted by (which of given statements are correct?)
Yes No I do not
know 1. Vaginal sexual intercourse without condom 1 2 3
2. Anal sexual intercourse without condom 1 2 3
3. Oral sex 1 2 3
4. Shared use of bathroom 1 2 3
5. Shared use of cutlery 1 2 3
6. HIV positive mother during pregnancy and labour 1 2 3
7. Shared use of shaving kit, toothbrush 1 2 3
8. Shared use of IV kit for drug injection 1 2 3
HA 7. Transmission of HIV can be prevented by
Yes No I do not
know
1. Sex abstinence 1 2 3
2. Mutually faithful relationship of HIV-uninfected sexual partners 1 2 3
3. Proper and regular use of condoms during sexual intercourse 1 2 3
4. Single-use intravenous kits for drug injection 1 2 3
5. HIV counselling and testing 1 2 3
HA 8. Even one single unprotected sexual intercourse can lead to HIV infection. 1 2 3
HA 9. Have you been taught about sexually transmitted diseases and sexuality in highschool?
1 2
HA 10. From which sources did you receive information on HIV/AIDS
Yes No 1. TV and radio shows 1 2 2. Newspapers 1 2
Survey on potential clients of Voluntary Confidential HIV/AIDS Counselling and Testing Centres (HIV/AIDS VCCTCs) conducted among student population in Bosnia and Herzegovina
The RS Public Health Institute, The Institute for Public Health FB&H 4
3. Brochures, leaflets 1 2 4. Health workers 1 2 5. Peers 1 2
6. Internet 1 2 7. Lectures 1 2
HA 11.
Evaluate following statements:
I do not agree
I neither agree nor disagree
I agree
1. HIV-infected individual cannot change anything, thus should not be tested.
1 2 3
2. Only individuals engaging in risky behaviour need counselling.
1 2 3
3. Only promiscuous people get HIV. 1 2 3
4. I know enough about HIV, thus I do not need additional information.
1 2 3
5. I do not engage in risky behaviour and therefore I do not need to be HIV tested.
1 2 3
6. If someone sees me going to the VCCT centre, he/she will think that I am infected.
1 2 3
7. There is no need for VCCT centres to exist, since we have opportunity to get informed by literature.
1 2 3
8. I have more confidence in colleagues, with whom I will exchange information and resolve all dilemmas.
1 2 3
9. I would participate in activities of VCCT centre as a volunteer.
1 2 3
HA 12. Have you ever been tested for HIV? 1. Yes
2. No
HA 13. If you have been tested for HIV, has it happened in past 12 months?
1. Yes 2. No
HA 14. Have you received results of HIV test? 1. Yes 2. No
HA 15.
If your answer to the previous question is YES, specify the reason (only one proposed answer); if you answered NO, move to the next question
1. Unprotected sex (without condom) 2. Shared use of drug injection kit 3. Condom break/tear during intercourse 4. Employment requirement 5. Visa application requirement 6. Other, specify _____________________
HA 16.
If you have never been tested for HIV, specify the reason
1. I do not engage in risky behaviour 2. I practice safe sex 3. Fear of being seen 4. I mistrust testing 5. Mistrust of ethics of medical personnel 6. Other, specify _______________________
Survey on potential clients of Voluntary Confidential HIV/AIDS Counselling and Testing Centres (HIV/AIDS VCCTCs) conducted among student population in Bosnia and Herzegovina
The RS Public Health Institute, The Institute for Public Health FB&H 5
HA 17. Are you currently using any of the following substances causing dependence?
Yes No
1. Alcohol 1 2
2. Tobacco 1 2 3. Psycho-stimulating substances 1 2
HA 18. Have you ever taken drugs
Yes No
1. By sniffing 1 2
2. By intravenous injection 1 2
3. Other, specify ______________________ 1 2
HA 19. Have you ever had any of the following sexually transmitted diseases?
Yes No 1. Hepatitis B 1 2 2. Hepatitis C 1 2 3. Human Papilloma Virus 1 2 4. Genital Herpes 1 2 5. Trichomoniasis 1 2
6. Syphilis 1 2
7. Gonorrhea 1 2 8. Chlamydia 1 2
HA 20. Do you have any
1. Permanent tattoo 1. Yes 2. No
2. Body piercing 1. Yes 2. No
III/ Knowledge, attitudes and behaviour regarding VCCT centres
DP 1.
Have you ever heard of centres for Voluntary Confidential Counselling and Testing (VCCT) / Voluntary counselling testing (VCT) If your answer is NO go to section IV “Sexual behaviour and attitudes of young people“
1. Yes
2. No
DP 2. If you have heard of VCCT centres, please state from whom and how (several answers are possible):
Yes No
1. From health workers 1 2
2. Via Internet 1 2
3. From other media 1 2 4. From brochures, leaflets 1 2 5. From friends and peers 1 2
6. From non-governmental organisations 1 2
7. Other, (specify)_______________________ 1 2
DP 3. Are you acquainted with fundamental principles of VCCT centres’ work?
Yes No
1. Public and available to everyone 1 2 2. Available only to groups at risk (drug addicts, sex workers, etc.) 1 2
Survey on potential clients of Voluntary Confidential HIV/AIDS Counselling and Testing Centres (HIV/AIDS VCCTCs) conducted among student population in Bosnia and Herzegovina
The RS Public Health Institute, The Institute for Public Health FB&H 6
3. Anonymous and voluntary 1 2 4. Anonymous and voluntary, but only for young people 1 2 5. Available only with doctor's referral letter 1 2 6. Testing and counselling services are provided with prior consent of the client 1 2
DP 4. Have you ever visited a VCCT centre? 1. Yes
2. No
DP 5.
If you have visited a VCCT centre, please state the main reason of your visit (only one answer) 1. Unprotected sex with unknown partner 2. Shared use of drug injection kit 3. Sex with a same-gender partner 4. Paid sex 5. Other (specify) ________________________________________
DP 6.
If you have never visited a VCCT centre, what were your reasons: Yes No
1. Fear that someone will see me going to a VCCT centre 1 2
2. Fear of the testing (finding out about the potential status) 1 2
3. I cannot learn anything new there 1 2
4. It is meant only for infected (sick) and those who engage in risky behaviour 1 2
5. I have never engaged in risky behaviour, thus there is no need for me to visit them 1 2
DP 7.
If you have not visit a VCCT centre so far, please mark the reasons that would make you visit it (several responses are possible)? Yes No
1. Curiosity 1 2
2. I want to learn more about HIV and other sexually transmitted diseases 1 2
3. I want to get tested and find out about my status 1 2
4. I want to learn about work of a VCCT centre 1 2
5. I fear that my previous behaviour was risky 1 2
IV Sexual behaviour and attitudes of young people SP 1. Your sexual orientation is: 1. Heterosexual
2. Homosexual 3. Bisexual
SP 2. Have you ever had sexual intercourse? 1. Yes 2. No
If answer to the previous question is YES, please answer the following questions; if NO, go to question No. 13
SP 3. How old were you the first time you had sexual intercourse? ____________________
SP 4. Did you use a condom during your first sexual intercourse?
1. Yes 2. No
SP 5. Do you have a steady sexual partner? 1. Yes 2. No
SP 6. Do you always use a condom during sexual intercourses?
1. Yes 2. No
SP 7. Please state the number of your sexual partners in last 12 months ___________
SP 8. Have you ever had unprotected sex/without condom with a casual partner?
1. Yes
2. No
SP 9. Do you always use condom during:
Survey on potential clients of Voluntary Confidential HIV/AIDS Counselling and Testing Centres (HIV/AIDS VCCTCs) conducted among student population in Bosnia and Herzegovina
The RS Public Health Institute, The Institute for Public Health FB&H 7
Yes No 1. Vaginal sexual intercourse 1 2 2. Oral sex 1 2 3. Anal sex 1 2
SP10. If you have ever had sex with any of the following partners, please mark if you used condom or not: With condom Without condom
1. Drug injecting addict 1 2 2. Sex worker 1 2 3. Homosexual 1 2 4. Bisexual 1 2 5. Promiscuous individual (individual who had more than
3 sexual partners in 12 months) 1 2
6. Person you just meet 1 2
SP 11. Have you ever received money, gifts or services in exchange for sex?
1. Yes 2. No
SP 12. Have you ever given money, gifts or services in exchange for sex?
1. Yes 2. No
SP 13. Evaluate the following statements:
Yes I am not
sure No
1. Majority of my friend believe that it is desirable to have as much sexual experience as possible.
1 2 3
2. It is normal to end a first date with sex. 1 2 3
3. In order to protect yourself from sexually transmitted diseases you should always have and use a condom during sex
1 2 3
4. I would continue my friendship despite finding out that my friend (he/she) is HIV/AIDS positive
1 2 3
5. I would be worried if I found out that person I share accommodation with is HIV/AIDS positive
1 2 3
6. I would not have any doubts about giving first aid to an HIV/AIDS positive person, providing personal protection measures are taken
1 2 3
7. Majority of people infected by HIV or with AIDS are to blame themselves for their situation
1 2 3
8. Individuals with HIV/AIDS deserve equal living and education conditions as other young people
1 2 3
9. Students need to be tested for HIV and Hepatitis C at medical examination prior to being granted accommodation in student dormitory
1 2 3
10. Individuals with HIV/AIDS are entitled to determine who should know about their status.
1 2 3
SP 14. If you were HIV positive, would you say that to your
Yes I am not sure No 1. Father 1 2 3 2. Mother 1 2 3 3. Brother/sister 1 2 3 4. Girlfriend/boyfriend 1 2 3
5. Friend 1 2 3
6. Family doctor 1 2 3
7. Other, specify ___________________ 1 2 3
Survey on potential clients of Voluntary Confidential HIV/AIDS Counselling and Testing Centres (HIV/AIDS VCCTCs) conducted among student population in Bosnia and Herzegovina
The RS Public Health Institute, The Institute for Public Health FB&H 8
TO BE COMPLETED BY INTERVIEWER
Date of interview
2 0 1 1
Interviewer's code:
Interviewer's signature Place of interview ___________________ _______________________ Field work supervisor's signature Date: ________________ ___________________________