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AIDS awareness among German resettlers from the former Soviet Union: it is time for an immigrant-specific HIV prevention
Sir,German resettlers are German offspring, who immigrated in the 18–19th century to the Russian Empire following the invitation of Empress Catherine the Great.1 During 1991–2006, 2 092 865 resettlers and their relatives returned to Germany, and this process is still going on.2 Since 2001, an increasing of number of HIV infections has been reported in the resettlers' countries of origin, the former Soviet Union (FSU), which is comparable to an epidemic.3,4 There is no current data available on how many HIV-positive resettlers or immigrants from the FSU are registered in Germany, but an increasing number of HIV diagnoses in resettlers newly arrived from the FSU regions with a high prevalence of HIV is to be expected in the next years.
This pilot survey of HIV/AIDS awareness and misconceptions was conducted with 927 resettlers from the FSU (308 in resettlers' hostels and 619 in randomly chosen private households), age 16–65, through an anonymous mail-in questionnaire in February-July of 2005 in Germany's second biggest federal state of Bavaria. 346 questionnaires were received back, and 340 (36.7%) of them were evaluated (table 1).
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Sufficient knowledge was detected in questions about HIV/AIDS transmission by a needle sharing (97.0%, n = 328), vaginal sexual intercourse (82.5%, n = 279), and from an HIV-positive mother to her child (78.7%, n = 266). Only 65.1% (n = 220) of the respondents knew of HIV/AIDS transmission by anal sex, and only 50.0% (n = 169) by oral sex. Some misconceptions about HIV transmission were revealed: hairdressing and manicure (32.5%, n = 111), insect bites (19.5%, n = 66), kissing (18.3%, n = 62), sharing kitchen utensils (7.1%, n = 24), and sharing a swimming pool or a restroom (5.3%, n = 18).
Most of the respondents knew of HIV prevention by condom use (91.6%; n = 306), and by using single syringes and needles (79.9%; n = 267). More than half of the resettlers (54.8%; n = 183) mentioned that blood transfusion should be avoided to prevent HIV infection. Misconceptions about HIV prevention include: HIV vaccination (17.1%; n = 57), and oral contraceptives or intrauterine devices (1.5%; n = 5). 68.6% (n = 229) of the respondents cited ‘being faithful to the sexual partner’ as an HIV protection.
HIV/AIDS awareness has not been sufficiently investigated in the FSU countries. In the first survey on AIDS awareness in the Russian population (1993–1994), 99.1% of the respondents gave correct answers about HIV transmission by a needle sharing and sexual intercourse,5 compared to our study: 97.0% and 82.5%, respectively. The misconception about HIV transmission by insect bites (55.8%) and kissing (47.9%)5 was significantly higher in the Russians at that time than in the resettlers today, but it still remains relatively high.
Recently published studies show a high risk sexual behaviour6 with stigmatisation and isolation of HIV-infected people in Russia,7 and difficulties of HIV prevention in FSU immigrants in Germany due to tabooing of the HIV/AIDS topic and differences in the social, cultural and public health systems.8 That all together, with the described here knowledge gap about HIV/AIDS risk by unprotected anal and oral sexual intercourse, and the HIV/AIDS misconceptions, urgently calls for a new HIV/AIDS education and prevention program targeting the German resettlers in Germany.
Laura Kouznetsov1, Alexander V. Kuznetsov2, Ralf Wienecke2 and Stefan A. Zippel1
1 AIDS Psychosocial Division, Department of Dermatology and Allergology, Ludwig-Maximilians University Munich, Germany
2 Department of Dermatology and Allergology, Ludwig-Maximilians University Munich, Germany
Correspondence: Alexander V. Kuznetsov, MD (Hons), Department of Dermatology and Allergology, Ludwig-Maximilians University, Munich, Frauenlobstr. 9–11, 80337 Munich, Germany, tel: +49 0 89 5160 6010, fax: + 49 0 89 5160 6312, e-mail: alexander.kuznetsov{at}med.uni-muenchen.de
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Acknowledgments |
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The survey is a part of the PhD thesis of Mrs. Laura Kouznetsov MA, performed at the Medical Faculty of the Ludwig-Maximilians University, Munich, Germany. Mrs. L. Kouznetsov, MA, was supported by the Bavarian Elite Research Scholarship from the Association of University of Bavaria (‘Universität Bayern e.V.’), Germany.
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1 Dietz B. Russlanddeutsche: Unbekannte im Osten; Geschichte, Situation, Zukunftsperspektiven [Russian Germans: strangers in the East; history, situation, perspectives of the future]. (1993) München: Olzog.
2 Bayerisches Staatsministerium für Arbeit und Sozialordnung, Familie und Frauen: Statistik Spätaussiedler und deren Angehörige 2006. [Bavarian State Ministry for Work, Social Order, Family, and Women: Statistic of the Late German Resettlers and their relatives]: http://www.arbeitsministerium.bayern.de/migration/aussiedler/ausss06.pdf. Accessed April 24, 2007.
3 Kelly JA, Amirkhanian YA. The newest epidemic: a review of HIV/AIDS in Central and Eastern Europe. Int J STD AIDS (2003) 14:361–71.
4 UNAIDS. Eastern Europe and Central Asia Fact sheet 2006. Available at URL: http://data.unaids.org/pub/EpiReport/2006/20061121_EPI_FS_EECA_en.pdf. Accessed April 24, 2007.
5 Amirkhanian YA, Kelly JA, Issayev DD. AIDS knowledge, attitudes, and behaviour in Russia: results of a population-based, random-digit telephone survey in St Petersburg. Int J STD AIDS (2001) 12:50–7.[CrossRef][Web of Science][Medline]
6 Wall M, Tkatchenko-Schmidt E, Renton A. Sexual behaviour in Russia: who exhibits a higher risk? Evidence from longitudinal data. Int J STD AIDS (2006) 17:759–63.
7 Balabanova Y, Coker R, Atun RA, Drobniewski F. Stigma and HIV infection in Russia. AIDS Care (2006) 18:846–52.[CrossRef][Web of Science][Medline]
8 Kouznetsov L, Kouznetsov AV, Wienecke R, Zippel SA. Social and cultural problems of HIV prevention in emigrants from the former USSR to Germany. Caplinskas S, ed. Sept 16–18. Vilnius: Publishing House of the Lithuanian AIDS Centre, 2004. Europe and HIV/AIDS: new challenges, new opportunities. Proceedings of the Second Open Europe AIDS Conference; 2004.
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  L Kouznetsov, A V Kuznetsov, and S A Zippel Risky sexual behaviour, taboo of HIV/AIDS and HIV-prevention topics: interviews with HIV-positive immigrants from the former Soviet Union Int J STD AIDS, January 1, 2008; 19(1): 71 - 72. [Full Text] [PDF]
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