Understanding women's HIV risk perception in postsocialist Georgia : role of knowledge, behavioral, and contextual factors

Substantial empirical research has documented that HIV prevention and decision-making are heavily influenced by the knowledge and practice of values and beliefs regarding infection and behavior. Most HIV research is still concentrated among high-risk populations (IDU and FSW), leaving out women in long-term heterosexual marriage who have been considered “safe” and less at risk of infection. In addition, researchers have called for more comparative and cross-cultural studies focused on the interplay of health education, behaviors, context, and HIV risk perception. The objective of this dissertation is to advance understanding of the factors sexually experienced women in Postsocialist Georgia consider important when they assess HIV perceived risk of which they are made aware by messages emanating from the social environment. A conceptual framework that integrates concepts from traditional social psychological theory and the constructs of context-specific factors to guide research intervention is applied. Combined quantitative and qualitative approaches are used to achieve a better understanding of perceived HIV risk and its association with different factors. The testing of relationships from two national Reproductive Health Survey samples (1999 and 2005) demonstrate strong positive associations among increased HIV transmission knowledge, belief in accidental transmission, HIV testing practice, and HIV perceived risk, while controlling for sociodemographic factors. Characteristics associated with social norms and economic factors (including stigmatizing attitudes about the rights of PWAs, constrained attitudes concerning sexual control, and experienced migration) demonstrate a strong significant link with assessment of HIV risk perception. Qualitative research with women strengthens the argument of superficial health education and helps to explain variations in perceived risk assessment. Through the interviews, HIV prevention practice is examined in relation to a myriad of cognitive components. This study finds health knowledge, misconceptions, stigmatizing attitudes, and beliefs in sexual and gender norms among the major factors constraining successful HIV/AIDS prevention practices. An effective strategy for HIV/AIDS prevention will require enhancement of research, more emphasis on an integrated approach to target education efforts, training providers in information diffusion approaches, and promoting a general communication campaign.