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work of youth medico-social services is urgently needed. Preventive programs will be effective only when consideration is give to young people’s medico-social needs.
References
1. Resolution. XI pediatrician congress of Russia “Actual problems of pediatrics” — http://www.pediatr-russia.ru/pediatr/ kongressll/resol.html [in Russian]
2. Levina L. I. Adolescent medicine: the guideline. 2nd edition / Levina L. I., Kulikova A. M. — St.Petersburg: Peter, 2006. — P. 544. [in Russian]
3. Ilin A. G. Children’s state of health in the present conditions: problems and ways of negotiation the emergency situation / Ilin A. G. — Terra Medica. 2005. — N 4 — P. 3 - 5. [in Russian]
4. MironovN.E. Mental health of children’s and adolescents in Russia / Mironov N.E. — Information letter. Moscow, 1999. [in Russian]
5. IovchukN. M. The prevalence and clinical presentations of depression in school and teenager populations / Iovchuk N. M., Batygina G. Z. // Journal of Neurology and Psychology. — 1998.— N 9. — P. 33 -36. [in Russian]
6. Krotin P. N. Reproductive behavior and contraceptive selection of teenagers and young people / Krotin P. N.,
Kozhukhovskaya T. U. // Russian Youth Journal. —'2004. —• N
12. — P. 341 -346. [in Russian]
7. The report on children’s state of health in Russian Federation. — Moscow. 2003. [in Russian]
8. Mirskiy V. E. Children’s and Adolescent andrology / Mir-skiy V. E., Mihaylichenko V. V., Zayezjalkin V. V. — Saint-Petersburg: Peter, 2003. [in Russian]
9. Dolbik-Vorobey T. A. Student’s youth about problems of marriage and fertility / Dolbik-Vorobey T. A. // Sociological investigation. — 2003. — N 11. — P. 78 - 83.
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11. Balaklaenko N. G. Current state of reproductive health protection of adolescent / Balaklaenko N. G., Gavrilova L. V. // Public health. — 2000. — N 7. — P. 26 - 33.
12. Kulikov A. M. Social characterization of young people with different grade of risky behaviour / Kulikov A. M., Boyeva V. I. // Region: Politics, Economics, Sociology. — 2003. — N 1- 2. — P.139 - 140.
13. Krotin P. N. The clinics, which are friendly to the teenagers / Krotin P. N., Kulikov A. M., Kozhukhovskaya T. U. // The guideline for physicians and health authorities. — UNICEF, 2006.
EVALUATION OF KNOWLEDGE LEVEL ABOUT THE WAYS OF TRANSMITTING, MEANS OF PROTECTION AND PREVENTION OF STI/HIV AMONG YOUTH CENTERS ATTENDEES IN ST. PETERSBURG
A. Benkovich 1, E. Sokolovskiy 2([email protected]), I. Mahinenko 2,
A. Savicheva 3, E. Shipitsyna 3, M. Domeika 4
1 Dermatovenereology Dispenser of Leningrad Region, St.-Petersburg, Russia;
2 Department of Dermatology and Venereal diseases, St.-Petersburg Pavlov State Medical University, St.-Petersburg, Russia;
3 D.O. Ott Research Institute of Obstetrics and Gynecology, St.-Petersburg, Russia;
4 Department of Medical Science, Uppsala University, Uppsala, Sweden
■ Presented data shows level of knowledge about the ways of transmitting, means of protection and prevention of STIs/HIV among youth center attendees in St.-Petersburg. Research was done by carrying out of questionnaire of 456 patients, in the age group between 15 and 25 years. This was the follow of the study conducted in 2003 during which knowledge of 300 patients has been accessed.
■ Keywords: STI, knowledge, youth consultation
Introduction
According to the WHO, the sexually transmitted infections (STIs), are the one of the most often causes of morbidity in the world causing acute diseases, infertility, stable invalidity and mortality, have serious medical and psychological consequences for millions of men, women and children [8,10]. It is well documented that
patients having STIs have five to ten times higher risk of acquiring HIV. According to WHO data, morbidity caused by STIs in the East Europe is at the level of epidemic that indicates wide spread of unsafe sexual behavior [9]. In St. Petersburg the morbidity due to STIs in 2005 reached 1643.39 per 100.000 inhabitants [3, 4]. Increase of STIs among teenagers and children [1] is noticed. Knowledge of factors affecting transmission of STIs, creates the necessary prerequisites for the elaboration of an adequate system of medico-social prevention of these diseases [2, 7, 11, 12].
The purpose of the presented study was to evaluate the knowledge about the transmission, means of protection and prevention of STIs (including HIV) among attendees of youth clinics, and also comparison of the received data, with data of the previous study done in 2003.
Average age of the sexual debut was 16.5 ± 1 years. Among people who addressed youth clinics in 2006, 117 had previous history STIs. Of them 43 had been infected once, 73 — more than once.
Patients have answered the questions concerning their knowledge about the transmission and prevention of STIs/HIV. The result is presented in Tables 1 and 2.
The analysis of knowledge regarding transmission, means of protection and prevention of STIs/HIV has shown, that the majority of questions were answered correctly by more than half of participants, both in 2003, and in 2006. However only a minor part of respondents (32 % in 2006, and 25.1 0% in 2003) were aware, that even persons with the negative HIV test result can pass virus to others. It was noted increased number of persons who: (a) think that if his/her partner tells that he/she is HIV-negative, it is enough proof that no protection means are necessary (3 % in 2003 and 11,2 % in 2006); willing to risk of getting infected by STIs/HIV for the sake of pleasure from sex (1,3 % in 2003 and 1,8 % in 2006); disagreeing that use of public toilets increases risk of infection (36,3 % in 2003, and 40,5 % in 2006); doubting if he/she would refuse of having sexual contact in alcoholic or narcotic intoxication (26,3 % in 2003, and 31,4 % in 2006). During the follow up study it
Table 1
Knowledge regarding the transmission and prevention of STI/HIV among 756 attendees of the youth clinics in St Petersburg during the studies conducted in 2003 and 2006
Statement Agree with the statement
2003 2006
N % N %
Use of the common needles (syringes) for injections of the drug creates the high risk of HIV infection 287/299 96,0 429/456 94
By the appearance of the person it is possible to determine whether he is HIV-infected 21/300 7,0 30/456 6,5
If the person had any STI in the past he will not catch the same infection any more 28/300 9,3 53/456 12
Even with the negative result of the analysis on HIV the person can pass the virus to other people 75/299 25,1 145/456 32
Careful washing of genitals after the sexual act can protect from infection STIs/HIV 21/300 7,0 24/456 5
For destruction of HIV it is enough to wash syringe needle with water 2/298 0,7 12/456 2,6
Only having a big number of sexual partners the person risks to catch STI/HIV 39/299 13,0 83/456 18,2
Trusting the partner and being confident of him - the best way to reduce risk of infection STIs/HIV 112/300 37,3 179/456 39,3
The STIs can sometimes have no external symptoms 262/300 87,3 361/456 79,1
If the partner tells you, that he is not HIV-infected, you can not care about safe sex 9/299 3,0 51/456 11,2
I shall refuse sexual contact if I shall be in alcoholic intoxication or under influence of drugs 164/297 55,2 241/456 52,8
Using public toilets increases risk of infection STI/HIV 90/300 30,0 128/456 28,1
For the sake of getting pleasure from sex I agree to undergo the risk of infection STIs/HIV 4/299 1,3 8/456 1,8
The present work was done within the framework of the Russian-Swedish STI project in St. Petersburg.
Material and methods
In 2003 and 2006 attendees (n = 300 and n = 456, respectively) of youth clinics of St Petersburg have been questioned. All attendees who have addressed youth clinics were offered to complete the questionnaire, concerning knowledge on prevention of STIs/AIDS. Statistical analysis of the results was made using of software package JMP 4.0.2 (SAS-Institute).
Results and discussion
In 2003, 300 attendees, at age group between 14 and 25 years, have been examined; the majority of them were girls — 97 % (291). Average age of the attendees in 2003 was 16.7 ± 1 year. Average age of the sexual debut was 16.4 ± 1 years. Among people addressed youth clinics in 2003, 100 patients in the past had history of STIs. Of them 76 had been infected once and 24 — more than once.
In 2006, 456 attendees of youth clinics, at age between 15 and 25 years, have been examined; the majority of them were girls — 70 % (319). Average age of attendees was 20.7 ± 1.0 years.
Table 2
Data of questioning concerning the use of condoms among attendees of youth clinics in 2003 and 2006
Statement Agree with the statement
2003 2006
N % N /
Condoms reduce the pleasure received at the sexual act I35/287 47 259/456 56,8
Condoms are unreliable 98/28I 34,9 II0/456 24,I
Condoms interrupt prelude and destroy “mood” before sexual contact 8I/277 29,2 I59/456 34,9
Not to have sexual contacts at all more safer, than to have sexual contacts with condom 64/274 23,4 I33/456 29,2
I shall necessarily use condom at sexual contact with the unfamiliar partner 267/285 93,7 392/456 86
Putting on a condom, it is necessary to leave free space on its end 227/289 78,5 37I/456 8I,4
It is possible to begin sexual act without a condom and put on it before ejaculation 27/283 9,5 56/456 I2,2
Oil and vaseline are suitable greasing for a condoms 23/279 8,2 37/456 8,I
Use of condoms unnatural 64/279 22,9 94/456 20,6
I forget about necessity of condom use for in alcoholic(narcotic) intoxication 33/277 II,9 48/456 I0,5
I forget about necessity of condom use when I feel strong sexual desire 59/279 2I,I 79/456 I7,3
was also noted a reduction of the number of young people that agree with necessity of condom use at sexual contact with the unknown (casual) partner (93.7 % in 2003 and 86 % in 2006 year). During the survey conducted at 2006 more young people thought that it is possible to begin the sexual contact without a condom and to put it on before ejaculation (9.5 % in 2003 and12.2 % in 2006).
In favor of insufficient knowledge regarding the transmission of STIs/HIV also witnesses increase in number of those considering, that if the person has had any STIs, it will not have the same infection any more (9.3 % in 2003 and 12 % in 2006) and reduction of number of those considering that STIs may sometimes not have any symptoms (87.3 % in 2003 and 79.1 % in 2006).
The number of young adults, considering, that condoms reduce pleasure of sexual act (47 % vs. 56.8 %), interrupt prelude, destroy mood before the sexual act (29.2 % vs. 34.9 %) and that not to have sexual contacts is safer, than to have sexual contacts with use of condoms (23.4 % vs. 29.2 %) has increased in 2006 if compared to the results of survey conducted during 2003. At the same time the decrease the number of the responders (in 2006 as compared to the survey conducted during 2003) forgetting to use a condom in alcoholic or narcotic intoxication (11.9 % vs. 10.5 %), feeling strong sexual desire (21.1 % vs. 17.3 %), considering that, condoms are unreliable (34.9 % vs. 24.1 %) should encourage us. We also noticed an increased acceptance of the condom use in survey conducted during 2006 as compared to, when more responders thought that condom use isn’t something unnatural (60.6 % vs. 64.4 %). Knowledge on how to use the condom has also improved.
Conclusions
• The level of knowledge regarding the transmission and prevention of STIs/HIV among the attendees of the young clinics in St Petersburg is insufficient.
• Changes towards the more risky sexual behavior in 2006 comparison with 2003 were observed.
• High STI/HIV prevalence of the targeted population [4, 5, 6, 13], low level of knowledge and risky sexual behavior creates all the prerequisites for STI to remain prevalent in this population, unless more targeted prevention measures will be implemented.
• To be able to increase efficiency of clinical — diagnostic work and create an adequate system of medico-social prevention for youth population, introduction of regular screening and knowledge monitoring is needed.
Literature
1. Smirnova T. S. Situation on sexually transmitted infections in St Petersburg / Smirnova T. S. // Z. Akus. Zen. Bolezn. — 2004. — Vol. LIII, N 4. — P. 20 - 21. [in Russian]
2. Savicheva A. M. Research of laboratory of microbiology of the D. I. Ott Institute of Obstetrics and Gynecology during the last
5 years / Savicheva A. M. // Z. Akus. Zen. Bolezn. — 2006. — Vol. LV. — P. 13 - 21. [in Russian]
3. Raznatovskiy K. I. Situation on sexually transmitted infections, infectious skin diseases and dermatosis in St Petersburg / Raznatovskiy K. I. // Materials of 40th conference of dermato-venereology and adjacent specialties of St Petersburg: Actual problems of dermatology. The control and prevention of sexually transmitted infections St Petersburg, 2005. — P. 4 - 5. [in Russian]
4. Risky sexual behavior and a level STD among the students living in a student hostels of St.-Petersburg / Djatlov R. V., Verevo-chkin S. V., Sokolov H. B. [et al.] // Russian Journal of HIV/AIDS and Related Conditions. — Vol. 8, N 2. — 29 - 33. [in Russian]
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S. V. // Russian Journal of HIV/AIDS and Related Conditions. — Vol. 8, N 1. — P. 27 -29. [in Russian]
6. Patterns of risky behavior of the students living in a student hostels of St Petersburg / Granskaja J. V., Djatlov R. V., Verevochkin S. V. [et al.] // Russian Journal of HIV/AIDS and Related Conditions. — Vol. 9, N 2. — 12 - 15. [in Russian]
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9. WHO. Global prevalence and incidence of selected curable Sexually transmitted infections. Overview and estimates. — Geneva: WHO, 2001.
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12. Shimano S. Analysis of the prevalence of bacterial vaginosis and Chlamydia trachomatis infection in 6083 pregnant women at a hospital in Otaru, Japan / Shimano S., Nishikawa A., Sonoda T., Kudo R. // J Obstet Gynaecol Res. — 2004. — Jun; 30 (3). — P. 230 - 236.
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UNICEF ACTIVITY FOR CLINICS FRIENDLY TO TEENAGERS AND YOUNG PEOPLE IN RUSSIA
К. А. Vartanova ([email protected])
The program “Health and young people’s development” UNISEF, Russia.
The question about the necessity of special services for teenagers despite the fact that there are clinics for both adults and children is frequently asked. However, statistics shows that while the mean age of the sexual debut has decreased, the number of sexually transmitted infections (STIs) increased, as has early pregnancies, drug addiction, drug abuse, cigarette smoking, alcoholism, neglect, involvement of teenagers in the sex industry and the AIDS epidemic. In regular clinics teenagers are not very welcome because they are considered unreliable, insolvent, peculiar and overly sensitive. Teenagers tend to ignore such clinics because they are annoyed by the cool reception and bad publicity.
During the past 10 - 15 years, people throughout the world considered the importance of the specific needs of young people in the health field. Since teenagers are less subject to children and adult diseases, they are more vulnerable to other health problems that are connected with growing up as well as behaving in a risky or ignorant way. This is one major reason why teenagers in particular need information on such issues as reproductive and mental health protection, preventive measures for AIDS, STI and unwanted pregnancy, opportunity for free STI treatment, free access to contraception, help from
psychologists and lawyers and prevention in risky behavior in general.
Reorganization of the medical health service for teenagers and measures for reproductive health protection should be considered as two of the main priorities of the Russian government. Administration at different levels attempts to integrate public health activity, education and social protection in order to develop a system that informs and services young people concerning the reproductive health field. At the same time, neither public health service nor education service are prepared to effectively solve specific health problems of this growing generation of young people.
There are numerous methods to help teenagers. One such method, which is used successfully in many countries, including the Russian Federation, involves the creation of special medical and social services or clinics for teenagers. There are three reasons to create such departments: teenager’s health degradation, inadequacy of current basic medical help and the social importance of health in this age group.
So why do we need friendly clinics for teenagers? This is the institution where teenagers and young people can get professional medical, psychological and social help regarding health protection for young
