Academic journal article Central European Journal of Public Health

Time-Site Survey of Substance Use, Sexual Behaviours and HIV-Testing Practices among Women Attending Social Venues in Prague

Academic journal article Central European Journal of Public Health

Time-Site Survey of Substance Use, Sexual Behaviours and HIV-Testing Practices among Women Attending Social Venues in Prague

Article excerpt

INTRODUCTION

Since the Czech Republic regained independence, Czech society has undergone substantial change in its experience of alcohol, drug abuse and HIV infection. Prior political restrictions on travel and trade effectively curtailed HIV risk behaviours; consequently, then Czechoslovakia escaped the initial waves of the European HIV/AIDS epidemic. Today, the incidence of HIV infection has increased fourfold from a low baseline. Diagnosis of non-injection, heterosexually transmitted HIV is rising among both women and men (1).

Historically Czech society has been recognized for its high alcohol intake, often coming first among nations for per capita consumption of beer (2, 3); but, it has had rather low exposure to other drugs of abuse, except marijuana and methamphetamine, locally known as pervitin (4). A recent study found that 21.8% of young Czech adults reported use of marijuana within the previous year (5) and methamphetamine use has raised concern that it could become a risk factor for HIV infection as in North America (6,7).

A recent review of Czech substance abuse treatment data documents two dramatic re-characterizations of drug abuse over the last two decades. First, young adult women have drifted towards problematic alcohol consumption that was typically observed among Czech men (8, 9). The gender ratio for substance abuse treatment admissions, once noted as 4:1, men to women, has gradually shifted to 2:1, reflecting increased prevalence and possibly greater severity of substance use disorders among Czech women (10, 11). Second, although alcohol was the primary substance named in 75% of all treatment admissions, recent data indicate that treatment admissions for alcohol have decreased and treatment for pervitin (12) and opiates have increased. Also, among Czech women, treatment admissions for the abuse of sedatives and hypnotics signal a shift in drug use (10).

Prior to 1989, Czechoslovakia had low prevalence of HIV and sexually transmitted infections compared to Western European countries. The introduction of hormonal birth control methods made reliable contraception options available to Czech women. Birth control pills reformed reproductive behaviours, triggering delayed age for first childbearing which eventually came to match the reproductive patterns of Czech women with women in other European countries (13, 14). Hormonal contraception is now the popular choice over barrier protection (13,15-17). However, little is known about condom use as barrier protection against HIV or sexually transmitted infections.

The countrywide prevalence for HIV infections remains low at <0.014% in the Czech general population (1), fewer than 2,000 people are living with HIV in a country of 10.4 million (as of the 2011 census). Public health concerns are mounting with new HIV infections and the increasing number of individuals living with HIV/AIDS. HIV transmission among men who have sex with men (MSM) accounted for 73% of the new HIV infections and heterosexual, non-injection transmission accounted for 13.7% (212) of newly diagnosed cases in 2012. Heterosexual transmitted cases make up 29.7% of cumulative cases (1).

Czech women are being diagnosed with HIV during mandatory prenatal testing, often in the absence of traditional high-risk behavioural factors. Four new cases of HIV were diagnosed from 134,716 prenatally tested women in 2010 and three were identified from 122,709 in 2011 (1). Fortunately, proactive anti-viral treatment of pregnant women has kept HIV transmission from mother to child rare (18). The Czech National Reference Laboratory data has indicated a 12.7% increase of HIV prevalence among women during 2012(19).

During the first HIV epidemic in Europe, the Czech Ministry of Health devoted significant resources for public education campaigns to forestall HIV transmission. HIV antibody testing and needle exchange programmes were made available in public primary care clinics and at a non-governmental agency in Prague (House of Light) (20). …

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