Hungary has low but slowly growing levels of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). In a population of 10.2 million, a total of 297 Hungarian residents had developed AIDS and 729 had reported infections with HIV as of June 1998 (HIV/AIDS – Magyarország, 1998
; Hungary and her inhabitants, 2000
). Although the rates of HIV infection are low at this time, unsafe sexual practices may be common, especially among teenagers. Data on sexual behaviour in Hungary are not readily available, but other Eastern European countries have recently witnessed increases in the incidence of sexually transmitted diseases (STDs) and risky behaviours, and teenagers are especially at high risk of becoming infected (Hegyi et al., 1997
; Tichonova et al., 1997
; Mikl et al., 1998
). For example, three-quarters of heterosexual patients at an STD clinic in Prague, Czech Republic, had had unprotected sex, about 11% of heterosexual men had had sex with prostitutes, and the same percentage of women had engaged in prostitution. One per cent of the patients injected drugs. Adolescents exhibited higher rates of high-risk behaviours: they were ten times more likely than adults to inject drugs, twice as likely to work as prostitutes, and about twice as likely to be diagnosed with an STD (Mikl et al., 1998
). Since the late 1980s, Slovakia, too, has experienced an increase in sexual freedom, sexual promiscuity and prostitution (Hegyi et al., 1997
). Also, an increase of about 40-fold in the incidence of syphilis in Russia between 1988 and 1996 has been attributed to changes in sexual behavior and rapid increases in injecting drug use (Tichonova et al., 1997
). Clearly, AIDS prevention activities are urgently needed in Eastern Europe.
In Hungary, many high-level government officials recognize the need for AIDS education and prevention (Nemzeti AIDS Bizottság). In a country faced with many pressing health problems and scarce resources, however, government funding for AIDS education and prevention is limited. Unable to support a comprehensive nationwide campaign, the government sponsors smaller programmes instead. The National AIDS Committee (NAC), an organization run by the Ministry of Health Care (formerly the Ministry of Welfare), has been the main financial support of both governmental and non-governmental organizations.
Supplementing governmental efforts, over 20 non-profit and profit-oriented organizations in Hungary offer AIDS prevention programmes as part of their diverse agendas (Bressollette and Pioker, 1997
). About half of these organizations deal exclusively with AIDS education. Most are run by gay groups or by health-care workers and target their programmes to gay men, high school students, prison inmates, prostitutes, and intravenous drug users. Apart from visiting institutions or social hangouts where members of the target groups can be found, these organizations may train educators, provide money for treatment of HIV infection and related diseases, offer financial support to other organizations in the country, produce educational materials, or conduct behavioural research projects. A lack of well-trained behavioural scientists and health educators is another constraint in providing comprehensive high-quality AIDS education in Hungary. First, educators are not well trained in disease prevention. Second, no adequate evaluation of AIDS education and prevention programmes has been performed. Currently, only one organization has attempted to evaluate its AIDS programme (Bressollette and Pioker, 1997
). This project translated an AIDS education curriculum of the American Red Cross from English to Hungarian. The evaluators stated that the curriculum had been tested and found effective, but because there was no systematic data collection and analysis, the basis for this evaluation is unclear.
No co-ordinated AIDS education programme for schools exists in Hungary, and none is required by law or regulation. In addition, several barriers hinder school-based programmes. First, some school administrators do not perceive a need for AIDS education. Quoting the low prevalence of HIV infections in Hungary, they consider AIDS a problem only of “foreign countries”. Second, some secondary school administrators are convinced that their students are sexually abstinent, as they “come from good families”. Third, the full curriculum at Hungarian schools leaves little room for added modules, so additions must pass rugged scrutiny.
When AIDS education is presented in schools, it is primarily provided by guest lecturers from external organizations. If the headmaster (principal) of the school does decide that AIDS education is needed, or is willing to accommodate organizations providing AIDS prevention sessions, presentations are usually made during the “form master class”. This class, which is similar to the “home room” session in the United States, is dedicated once a week to the discussion of administrative and academic matters not covered in regular classes. As the academic load of Hungarian schools is very heavy, non-academic extracurricular activities, such as health education, are frequently limited to “form master classes”. In addition to hosting guest lecturers, some teachers may incorporate AIDS education into their classes (Simon and Morava, 1993
), such as mathematics, foreign languages or biology, but these classes may be more likely to provide information about the disease than to help students gain skills for preventing it.
Providing effective AIDS education and prevention programmes to individuals embarking on sexual activity is an important step in preventing the spread of HIV and other STDs. A cost-effective strategy in countries just beginning the fight against AIDS is to adopt programmes with demonstrated effectiveness in other settings. The purpose of this study was to determine the effectiveness of several AIDS prevention methods in modifying AIDS-related attitudes among secondary school students in Hungary.
We used certain elements of the Health Belief Model (Becker, 1974
; Strecher and Rosenstock, 1997
) to assess the effectiveness of the education project. We hypothesized that perceived severity of AIDS and perceived susceptibility to infection may have an important role in AIDS prevention, and that the devaluation of monogamy that has followed changes in sexual behaviour may be a perceived barrier to preventive behaviour. Furthermore, although knowledge about AIDS does not seem to be associated with preventive behaviour (Brown et al., 1992
; DiClemente et al., 1996
), lack of basic knowledge about AIDS and condom use may be a barrier to protective, contraceptive behaviour.