The Institute for Public Health of the Federation of ... · The Republic of Srpska Public Health Institute . The Institute for Public Health of the Federation of Bosnia and Herzegovina

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 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


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.


8

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


9

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.


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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

http://www.unaids.org/globalreport/Global_report.htm


14

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


15

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)


16

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


19

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


20

• 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.


23

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).


24

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


25

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


26

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


27

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


28

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


29

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


30

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


31

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


32

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



33

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


34

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


35

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).


36

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


37

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%


45,8% 44,2%

3,6% 9,1%

Had sex Had an STD

Heard about a VCCT centre Visited a VCCT centre


38

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


39

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


40

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


41

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


Homosexual partner With condom 47.8 47.1 Homosexual partner


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


42

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


Sex worker With condom 60.7 62.7


Homosexual partner With condom 47.8 47.1


Bisexual partner With condom 50.0 53.3


Promiscuous individual (having 3 and more sexual partners in 12 months)

With condom 65.5 65.5


Person you just met With condom 71.4 73.2


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


43

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


44

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


45

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


46

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


47

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


48

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


49

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


50

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.


51

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.


52

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


53

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.


54

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


55

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


56

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,


57

• 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.


58

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.


59

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http://www.unaids.org/ (accessed January 14 2012)

http://www.unaids.org/


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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)



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



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



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 _______________________



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



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:



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



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: ________________ ___________________________

The Institute for Public Health of the Federation of ... · The Republic of Srpska Public Health Institute . The Institute for Public Health of the Federation of Bosnia and Herzegovina

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