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A Comparison of Comprehensive 
HIV/AIDS Knowledge Among 
Women Across Seven Post-Soviet 
Countries 

 
Hakim Zainiddinov1, Nazim 
Habibov2 
 
1Rutgers University, United States; 
2University of Windsor, Canada  
 
 
 
 
 
 

 
Vol. 7, No. 1 (2018)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2018.295 |   http://cajgh.pitt.edu 

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Central Asian Journal of Global Health 
Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.295|http://cajgh.pitt.edu 

 
 

Abstract 

Introduction: Post-Soviet countries of Eastern Europe and Central Asia have witnessed a recent growth of HIV infection through 
heterosexual transmission. Women’s low levels of knowledge about HIV prevention and transmission methods have been found to 
account for the higher female-to-male ratio among cases infected through the heterosexual route. This cross national comparison 
study assessed comprehensive HIV/AIDS knowledge and its key determinants among women of seven post-Soviet countries and 
identified which countries face the highest levels of risk due to the low levels of HIV/AIDS awareness.  
Methods: Study data were obtained from the third wave of the Multiple Indicator Cluster Surveys (MICS3) (conducted in 2005 
and 2006), nationally representative samples of women aged 15-49 years. Data on HIV/AIDS knowledge were analyzed for women 
in Kazakhstan (N=14,310), Kyrgyzstan (N=6,493), Tajikistan (N=4,676), Uzbekistan (N=13,376), Belarus (N=5,884), Ukraine 
(N=6,066), and Georgia (N=7,727) using descriptive statistics and ordinary least squares (OLS) regressions.  
Results: We found that the percentage of women who could correctly identify all five modes of HIV/AIDS transmission and 
prevention was highest in Eastern European countries of Belarus (34.98%) and Ukraine (31.67%). Across all countries, the 
strongest predictors of comprehensive HIV/AIDS knowledge were age, education, and region of residence. Marital status, area of 
residence (urban vs. rural), and household wealth were significant predictors for several countries.  
Conclusion: High rates of comprehensive HIV/AIDS knowledge were found among women of Belarus and Ukraine. To reduce 
the spread of HIV in the region, programs promoting comprehensive HIV/AIDS knowledge for women of younger ages and with 
lower education are recommended. 

Keywords: HIV infection; comprehensive HIV/AIDS knowledge; women; heterosexual transmission; post-Soviet countries 

A Comparison of Comprehensive 
HIV/AIDS Knowledge Among Women 
Across Seven Post-Soviet Countries 

 
Hakim Zainiddinov1, Nazim Habibov2 
 
1Rutgers University, United States; 
2University of Windsor, Canada  
 

 
 

Research 

In the past fifteen years many countries around 
the world witnessed dramatic decline in HIV incidence 
and mortality.1 Between 2001 and 2011, the number of 
people acquiring HIV declined by 50% in 25 low and 
middle-income countries.1 Nepal was at the top of the list 
with a drop of 91%, followed by Ethiopia at 90%, 
Cambodia at 88%, Suriname at 86%, Myanmar at 74%, 
Dominican Republic at 73%, Malawi at 72%, and 
Botswana at 71%.1 Yet, these encouraging national 
trends in a dramatic reduction in the rate of new HIV 
infections in many parts of the world were not observed 
in Eastern Europe and Central Asia.1,2 For example, 
Georgia, Kazakhstan, and Kyrgyzstan reported a 25% 
increase in the rate of new HIV infections between 2001 
and 2011.1 According to recent WHO report, between 
2006 and 2012, rates of HIV diagnoses per 100 000 
population increased more than threefold in Tajikistan, 

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twofold in Kyrgyzstan, and by 72% and 92% in Belarus 
and Georgia, respectively.3 Among 52 countries of the 
WHO European Region, Ukraine reported the highest 
rate (37.1%) of newly diagnosed HIV infections in 2012.3 
Several other countries of Eastern Europe and Central 
Asia, including Belarus (13.1%), Kyrgyzstan (12.8%), 
and Kazakhstan (12.4%) were among the countries with 
the highest rates of newly diagnosed HIV infections.3 
Political and economic instability, as well as the collapse 
of highly structured public health system contribute to 
growing rates of HIV/AIDS epidemic throughout Central 
Asia and Eastern Europe.2,4 Other factors leading to the 
high HIV prevalence rates in post-Soviet countries 
include low levels of preventive practices and punitive 
measures taken against HIV infected people.5 Among 
low and middle-income countries, the treatment gap 
remains one of the highest for countries of Eastern 
Europe and Central Asia. In 2011, there was a 75% gap 
between the number of people receiving antiretroviral 
therapy (130,000) and the number of people eligible for 
treatment (510,000).1  

In the past decades, the leading mode of HIV 
transmission in Eastern Europe and Central Asia changed 
from injection drug route to heterosexual transmission.2,3 
Between 2006 and 2012, the number of HIV infections 
acquired through heterosexual transmission increased 
more than three times in Kazakhstan and Kyrgyzstan, and 
around six times in Tajikistan.3 In 2012, the majority 
(60%) of new HIV infections were acquired through 
heterosexual contact in 13 of the 15 countries in the 
Eastern part of the WHO European Region.3 
Heterosexual mode of transmission affects women more 
than men.3  

One of the main factors contributing to the 
higher female-to-male ratio among cases infected 
through heterosexual transmission is a low level of 
knowledge on HIV prevention and transmission methods 
among women. Recent nationally representative surveys 
conducted in 26 of 31 countries with generalized 
epidemics revealed that less than 50% of women have 

comprehensive HIV knowledge.1 Similarly, empirical 
studies demonstrate that although women’s awareness 
about HIV/AIDS has increased, their levels of 
comprehensive knowledge, as defined by UNICEF, 
either remain low,6,7 or have not reached the 90% 
targeted threshold set by the United Nations General 
Assembly Special Session (UNGASS).8  

Since injection drug use was the primary 
method of HIV transmission in the early days of the 
epidemic, it is not surprising that most published studies 
of HIV infections in Eastern Europe and Central Asia 
were focused on injection drug users.9,20,11,12 Given the 
recent rise of new HIV infections acquired through 
heterosexual contact, this study examined women’s 
comprehensive HIV knowledge in post-Soviet countries 
to determine regional differences and identify key 
determinants that could serve in guiding future policies 
aimed at reducing discrepancies across countries and 
regions. We focused this investigation on seven post-
Soviet countries, including four Central Asian 
(Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan), 
two Eastern European (Belarus and Ukraine), and one 
Caucasian (Georgia). The selection of these countries 
was determined by 1) data availability; and 2) 
representativeness of the former Soviet Union.  

The HIV/AIDS trends vary in each of these 
countries. In 2012 the percentage of newly diagnosed 
HIV infections ranged from the lowest 10.2% in 
Tajikistan to the highest 37.1% in Ukraine.3 The levels of 
public health expenditure differ substantially across these 
countries. In 2006, the levels of public health expenditure 
were lower in the countries of the Caucasus and Central 
Asia (less than 3% of GDP and even below 1% in 
Georgia and Tajikistan) and higher in the Western  
Commonwealth of Independent Countries (CIS) 
countries (4% and 5% of GDP), which includes Belarus 
and Ukraine.13  

Given the level of socio-economic development 
of Central Asian countries (except for Kazakhstan, the 
other three countries are low middle income countries13) 

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and their low levels of public health expenditure, it is 
expected that women of this region will report lower 
levels of comprehensive HIV knowledge compared to 
women from Eastern Europe.  

 

Methods 

Data sources 

Study data were obtained from the third wave of 
the Multiple Indicator Cluster Surveys (MICS3) 
(conducted in 2005 and 2006), nationally representative 
samples of women aged 15-49 years. Eligible women 
were interviewed from the list of households chosen for 
participation in the surveys.14,15,16,17,18,19 The survey 
samples were selected using a multi-stage stratified 
cluster sampling approach.14,15,16,17,18,19 The data were 
collected in more than 50 countries around the 
world.14,15,16,17,18,19 MICS3 datasets provide information 
about basic household socio-demographic 
characteristics, nutrition, and health indicators for 
women and children, and women’s general knowledge 
about HIV/AIDS, as well as its prevention and 
transmission methods. The data are publicly available 
and can be accessed at MICS website.20 MICS3 surveys 
included a large number of post-Soviet countries: four 
Central Asian countries (Kazakhstan, Kyrgyzstan, 
Tajikistan, and Uzbekistan), two Eastern European 
countries (Belarus and Ukraine), and one country from 
the Caucasus region (Georgia). The data for other MICS 
waves were available for a limited number of post-Soviet 
countries, thus our study focused on the wave with the 
most complete data available. The total sample for all 
seven countries is 58,532, out of which 4,676 come from 
Tajikistan, 5,884 from Belarus, 6,066 from Ukraine, 
6,493 from Kyrgyzstan, 7,727 from Georgia, 13,376 
from Uzbekistan, and 14,310 from Kazakhstan. 
Women’s response rates in the surveys were very high, 
with 90.3% for Georgia, 96% for Tajikistan, 98% for 
Uzbekistan, 99% for Kazakhstan and Kyrgyzstan, and 
99.8% for Belarus and Ukraine. Statistical Agencies of 

the analyzed countries conducted MICS3 with the 
financial and technical support of the United Nations 
Children’s Fund (UNICEF).  

Measures 

Using the UNICEF definition of comprehensive 
knowledge of HIV/AIDS that includes an accurate 
identification of two primary methods of HIV prevention 
(using condoms and having one uninfected partner) and 
rejection of three common misconceptions about HIV 
transmission (HIV can be transmitted by sharing food 
and by mosquito bites, and a healthy-looking person 
cannot be infected),14,15,16,17,18,19 we created a scale, 
labeled “comprehensive HIV/AIDS knowledge.” The 
scale ranged from 0 to 5, with higher scores indicating 
high comprehensive HIV/AIDS knowledge, and lower 
scores indicating low comprehensive knowledge about 
the disease. We estimated Cronbach’s alphas to show the 
degree of consistency in our scale. Cronbach’s alphas 
ranging from the lowest to highest were as follows: 0.34 
for Belarus, 0.43 for Ukraine, 0.48 for Kyrgyzstan and 
Kazakhstan, 0.50 for Georgia, 0.52 for Uzbekistan, and 
0.56 for Tajikistan. Except for Belarus, alpha coefficients 
for other countries were within the range of previous 
studies.21,22  

Independent variables included several 
sociodemographic measures that were potentially 
correlated with AIDS knowledge.23 Demographic 
measures include: age (between 15-49), marital status 
(currently married vs. not married), region of residence 
(capital city vs. other), and area of residence (rural vs. 
urban). Education was classified as (higher degree 
(university graduate) vs. other), and level household 
income (recoded as tertiles: lower income, middle 
income, upper income).   

Statistical analysis 

Univariate analyses were used to identify 
associations between the variables across seven post-
Soviet countries. To evaluate comprehensive HIV/AIDS 
knowledge and its key determinants among women, we 

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Figure 1. Distribution of scores for HIV/AIDS knowledge across seven compared countries.  

ran ordinary least squares (OLS) regression on the 
weighted data. To accurately assess the effect of age, 
which might not have a linear relationship with the 
outcome measure, we also included the age squared 
variable into our models. Data analyses were conducted 
using Stata 14 statistical software.  

 

Results 

Respondents’ average comprehensive 
knowledge of HIV ranged from the lowest 2.60 (SD = 
1.49) in Tajikistan to the highest 3.86 (SD = 1.08) in 
Belarus (Table 1). Average age ranged from 29.45 (SD = 
9.97) in Uzbekistan to 32.31 (SD = 9.89) in Georgia. The 
majority of participants, ranging from 57.88% in 
Kazakhstan to 70.87% in Belarus, were currently 
married. A small percentage of respondents, ranging 
from 5.29% in Kazakhstan to 24.21% in Tajikistan, 
resided in the capital city.

2.
97 3.
36

9.
9

1.
68

0.
15 1.

14

3.
86

8.
88

6.
55

15
.4

6.
56

2.
58 3.

69

7

16
.7

9

15
.2

9

21
.4

9

14
.5

3

8.
48

10
.4

4

14
.9

7

25
.1

4 26
.4

9

23
.5

9

21
.7

23
.5

4

23
.2

4 25
.2

5

24
.1

6

27
.0

8

17
.1

9

24
.6

7

30
.2

7

29
.8

2

27
.2

8

22
.0

7

21
.2

4

12
.4

3

30
.8

7

34
.9

8

31
.6

7

21
.6

4

0

5

10

15

20

25

30

35

40

Kazakhstan Kyrgyzstan Tajikistan Uzbekistan Belarus Ukraine Georgia

Pr
op

or
tio

n 
of

 H
IV

/A
ID

S 
tra

ns
m

is
si

on
 a

nd
 p

re
ve

nt
io

n 
 k

no
w

le
dg

e 
sc

or
es

Notes: Source: MICS 2005-2006
Proportions (%) are presented for correctly identified modes of HIV/AIDS     
transmission and prevention

0 1 2 3 4 5

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 Kazakhstan 

(n=14,310) 

Mean (SD) 

or % 

Kyrgyzstan 

(n=6,493) 

Mean (SD) or 

% 

Tajikistan 

(n=4,676) 

Mean (SD) 

or % 

Uzbekistan 

(n=13,376) 

Mean (SD) 

or % 

Belarus 

(n=5,884) 

Mean (SD) 

or % 

Ukraine 

(n=6,066) 

Mean (SD) 

or % 

Georgia 

(n=7,727) 

Mean (SD) 

or % 

Comprehensive 

HIV/AIDS knowledge  

 

Age (range: 15-49) 

 

Marital status  

Currently married  

Not married 

 

Region of residence 

Capital 

  Other 

 

Area  

Urban 

Rural 

 

Education  

Higher  

Other 

 

Household wealth 

Lower income 

Middle income 

    Upper income 

 

3.25 (1.36) 

 

31.36 (10.32) 

 

 

57.88 

42.12 

 

 

5.29 

94.71 

 

 

52.65 

47.35 

 

 

25.60 

74.40 

 

 

33.11 

32.82 

34.07 

 

3.31 (1.32) 

 

29.56 (10.08) 

 

 

60.88 

39.12 

 

 

14.60 

85.40 

 

 

58.91 

41.09 

 

 

23.78 

76.22 

 

 

32.51 

32.62 

34.87 

 

2.60 (1.49) 

 

30.47 (9.48) 

 

 

65.44 

34.56 

 

 

24.21 

75.79 

 

 

43.69 

56.31 

 

 

17.39 

82.61 

 

 

25.58 

30.33 

44.10 

 

3.54 (1.32) 

 

29.45 (9.97) 

 

 

64.27 

35.73 

 

 

14.66 

85.34 

 

 

41.61 

58.39 

 

 

10.05 

89.95 

 

 

33.63 

33.27 

33.10 

 

3.86 (1.08) 

 

31.49 (9.35) 

 

 

70.87 

29.13 

 

 

16.04 

83.96 

 

 

68.13 

31.87 

 

 

25.19 

74.81 

 

 

33.21 

33.38 

33.41 

 

3.72 (1.18) 

 

30.65 (9.53) 

 

 

68.08 

31.92 

 

 

5.87 

94.13 

 

 

63.57 

36.43 

 

 

43.54 

56.46 

 

 

33.84 

33.55 

32.61 

 

3.30 (1.35) 

 

32.31 (9.89) 

 

 

63.50 

36.50 

 

 

18.18 

81.82 

 

 

59.60 

40.40 

 

 

39.11 

60.89 

 

 

30.93 

26.08 

42.99 

 

Notes: Means and standard deviations are presented for continuous variables; proportions (%) are presented for categorical variables. Due to 

differences in the number of regions across countries, only capital city is shown. 

Table 1. Descriptive Statistics for the Sample 

Except for Uzbekistan (41.61%) and Tajikistan 
(43.69%), the majority of respondents in other countries 
resided in urban areas. Women in Uzbekistan (10.05%) 
and Tajikistan (17.39%) comprised the lowest percentage 
of respondents with higher (university/institute graduate) 
levels of education, whereas women in Georgia (39.11%) 
and Ukraine (43.54%) had the highest percentage. The 

percentage of household wealth was evenly distributed 
among three categories across all countries, except for 
Tajikistan and Georgia.   

The proportion of women who could not 
correctly identify a single mode of HIV/AIDS 
transmission and prevention was found to be the highest 

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among women in Tajikistan (9.9%) and lowest among 
women in Belarus (0.15%) (Figure 1). One third of the 
respondents in Uzbekistan (30.87%), Ukraine (31.67%), 
and Belarus (34.98%), every fifth respondent in 
Kazakhstan (22.07%), Kyrgyzstan (21.24%), and 
Georgia (21.64%), and only 12.43% of respondents in 
Tajikistan could correctly identify all five modes of 
HIV/AIDS transmission and prevention. Similarly across 
the countries of interest, over 20% of women could 
correctly identify three modes of transmission and 
prevention.   

 Across all of the analyzed countries, younger 
women’s comprehensive HIV knowledge was higher 
compared to older women (Table 2). Currently married 
women in Uzbekistan reported comprehensive HIV 
knowledge scores that were 0.03 points higher than non-
married women (p ≤ 0.01), whereas married women in 
Kyrgyzstan and Ukraine reported scores that were 0.04 
points lower than non-married women (p ≤ 0.05). Region 
of residence was inversely related to women’s 
comprehensive HIV knowledge in Uzbekistan, Belarus, 
Ukraine, and Georgia, whereas women residing in the 
capital cities of Kazakhstan, Kyrgyzstan, and Tajikistan 
reported scores that were respectively 0.04, 0.38, and 
0.15 points higher than those residing in one of the 
regions outside of the capital cities. Women from rural 
areas in Kazakhstan and Georgia reported scores that 
were respectively 0.03 and 0.07 points lower, and rural 
women from Kyrgyzstan reported scores that were 0.04 
points higher than women from urban areas. Education 
was positively related with women’s comprehensive HIV 
knowledge across all countries. Household wealth had a 
positive significant association with comprehensive HIV 
knowledge for women only in one Caucasian (Georgia) 
and three Central Asian (Kazakhstan, Tajikistan, and 
Uzbekistan) countries (p ≤ 0.001).  

 

Discussion 

As expected, the lowest levels of 
comprehensive HIV knowledge were found among 
respondents in Central Asia, whereas the highest levels 
were reported by women from Eastern European 
countries. The difference between Belarus with the 
highest levels and Tajikistan with the lowest levels of 
comprehensive knowledge was almost threefold. 
Uzbekistan was an exception among Central Asian 
countries. The percentage of women in Uzbekistan who 
could identify all five modes of HIV transmission and 
prevention was the third highest among the seven 
analyzed countries. It could be partially explained by the 
high levels of the country’s public expenditure on 
education. In 2006, among the 26 analyzed countries of 
Central and Eastern Europe and CIS, Uzbekistan reported 
the highest level of expenditure on education (6.3% of 
GDP).13 

Overall, the level of comprehensive HIV 
knowledge among women in all post-Soviet countries 
under investigation remains low. As a comparison, in 
2008-2009, 54% of young urban women in Kenya, a 
country greatly affected by AIDS pandemic, reported 
having comprehensive HIV knowledge.8 This difference 
can be attributed to the fact that Sub-Saharan Africa has 
been heavily affected by HIV/AIDS and consequently 
attracted substantial global interest and funding for 
HIV/AIDS treatment, raising the population awareness. 
Additionally, variations in public spending on HIV/AIDS 
can account for the difference. In 2001-2005, there was a 
moderate increase of 30% and 10% in domestic public 
expenditure on HIV/AIDS from governments of lower-
middle-income and upper-middle-income countries 
respectively, whereas sub-Saharan African countries 
witnessed an increase of 130% during the same time 
period.24  

 Among socio-demographic characterstics, 
we found that age, education, and region were strongly 
associated with women’s comprehensive HIV 
knowledge across all countries. With increase in age, 
women’s comprehensive HIV knowledge also increased. 

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Yet, this positive effect declined with advanced age. One 
speculation is women’s loss of interest in the subject, due 
to their decreasing levels of sexual activity. Another 
explanation can be linked to cohort differences. The older 
women may be less likely to have received the same 
information or public health messaging about HIV when 
compared to the younger women.  

Compared to less educated women, women with 
higher education reported higher levels of comprehensive 
HIV/AIDS knowledge. This finding is consistent with 
previous studies6,7,8

, and also supported by ethnographic 
research demonstrating that highly educated women 
possess more detailed knowledge about HIV/AIDS.25  

Interestingly, the association between 
comprehensive HIV knowledge and the capital city 
region of residence was positive among women in 
Kazakhstan, Kyrgyzstan, and Tajikistan, and negative 
among women in Uzbekistan, Georgia, Ukraine, and 
Belarus. This differential effect could be attributed to 
varying degrees of access to information and healthcare 
services. One may speculate that women residing in the 
capital cities of Kazakhstan, Kyrgyzstan, and Tajikistan 
have better access to information about HIV/AIDS, are 
more aware of HIV, and resort to HIV testing compared 
to respondents from Uzbekistan, Georgia, Ukraine, and 
Belarus.  

The effects of several covariates on 
comprehensive HIV knowledge varied from country to 
country. Being currently married increased 
comprehensive HIV knowledge among women in 
Uzbekistan, but had a reverse effect on women’s 
knowledge in Kyrgyzstan and Ukraine. Prior research 
suggests that married women might benefit from their 
husbands’ knowledge, as it can be a case for Uzbekistan. 
However, they can also take fewer precautions in their 
marital sex, neglecting the possibility of their husbands’ 
sexual relationships outside of marriage.8  

Mixed results were also found for the area of 
residence. Living in rural areas decreased comprehensive 

HIV knowledge for women in Kazakhstan and Georgia, 
which is consistent with prior studies.6 Yet, for women 
from Kyrgyzstan the association was reverse. The 
positive association between rural area and 
comprehensive HIV knowledge can be linked to high 
levels of labor migration among rural dwellers. Experts 
have already raised alarms about the growing numbers of 
HIV infections among labor migrants, and growing risk 
for HIV transmission to their home countries.26  

Household wealth is positively associated with 
comprehensive HIV knowledge, although the effects 
were mostly significant for Central Asian countries. 
Respondents in the middle and upper income tertiles 
reported significantly higher levels of comprehensive 
HIV knowledge than those in the lower income tertile. 
This finding corroborates previous research.6 
Insignificant effects of wealth on comprehensive HIV 
knowledge in other countries under investigation are 
consistent with another group of studies and can be 
attributed to the association betweeb wealth and 
education, another proxy of social status.7  

The present study has several limitations. First, 
the exploratory nature and scope of the present study do 
not allow us to include factors beyond sociodemographic 
characteristics. Future research can explore other 
potential factors, such as access to HIV testing and care, 
knowledge of HIV status, and exposure to information on 
HIV prevention and transmission that could influence 
women’s comprehensive HIV knowledge. Second, 
although Cronbach’s alphas for created scales are within 
the range of previous studies, they are relatively low. 
Upon availability of other surveys producing scales with 
relatively high degrees of internal consistency, the study 
should be replicated to see whether the observed patterns 
persist across time periods and countries. Future studies 
should also investigate clinical and public health 
significance of these findings.  

The recent growth of HIV infection through 
heterosexual transmission in post-Soviet countries of 
Eastern Europe and Central Asia, especially among 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

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women, is alarming. This study revealed differences in 
the comprehensive HIV knowledge, but it was low 
among the studied countries. Across all countries, the 
strongest predictors of comprehensive HIV/AIDS 
knowledge were age, education, and region of residence. 
The percentage of women who could correctly identify 
all five modes of HIV/AIDS transmission and prevention 
was highest in Belarus (34.98%) and Ukraine (31.67%), 
suggesting that knowledge increases as the population 
level of the HIV epidemic increases. 

 

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	A Comparison of Comprehensive HIV/AIDS Knowledge Among Women Across Seven Post-Soviet Countries
	Abstract
	Keywords: HIV infection; comprehensive HIV/AIDS knowledge; women; heterosexual transmission; post-Soviet countries
	A Comparison of Comprehensive HIV/AIDS Knowledge Among Women Across Seven Post-Soviet Countries
	Research

