Sexology in Russia and Estonia: reflections on an exchange.
Acknowledgements: The authors would like to thank Larry Heinlein, Ph.D. for his helpful comments on an earlier draft of this manuscript.
In October 1995, a sexology delegation visited Russia and Estonia under the auspices of the Citizen Ambassador Program of People to People International founded by Dwight D. Eisenhower in 1956. Eisenhower believed that "people-to-people" communication outside of official diplomatic channels would contribute to world peace in a way that government-to-government communication could not. Since 1961, the Citizen Ambassador Program has been arranging these exchanges among the world's people in a variety of fields. A sexology delegation to China in 1993 (Herold & Byers, 1994) is one such example.
The 1995 delegation comprised twenty four professionals from Canada, the United States and Australia who represented all aspects of sexology including health, reproduction, education, criminology and research. The delegation was led by Dr. Sandra Byers, Professor of Psychology at the University of New Brunswick. During the two-week visit, the delegation visited the contrasting cities of Moscow and St. Petersburg in Russia, as well as Tallinn, the capital of Estonia.
The objectives of the sexology delegation were threefold: 1) To contribute to the growth of sexology as a profession and a science in Russia and Estonia through the exchange of knowledge and expertise among the members of the delegation and our counterparts in these two countries; 2) To assess our assumptions about the universality of some beliefs about human sexuality through exposure to knowledge, attitudes and behaviour within the Russian and Estonian cultures; 3) To build on these exchanges by furthering professional relationships after we returned to our respective countries.
THE PROCESS OF CULTURAL EXCHANGE
Reciprocity was one of the major principles guiding our delegation. The diversity of locations visited by the delegation added to the richness of the experience. These included university departments, specialist institutions, health care facilities both public and private, government departments, and new "grass roots" services. The settings themselves ranged from the generally rundown facilities in Russia to the well maintained institutions and settings in Estonia. A further contrast within Russia was the often hierarchical structure and formality of the meetings in the older institutions, particularly in Moscow, compared with the more informal and reciprocal exchanges in the non-government agencies. The Estonian meetings were marked by informality and mutual exchange.
Members of the delegation experienced a sense of anticipation and excitement prior to meeting our colleagues; many of our counterparts conveyed a similar spirit. The typical pattern at the professional meetings included: a welcoming speech by a senior member from the host organization; a response by the delegation leader, Dr. Byers, who would then introduce the delegation; an overview of the work of the institute; presentations by three or four members of our delegation who specialized in the area of focus of the meeting (e.g., HIV/AIDS education, sex therapy); and more in-depth round-table discussion. These discussions gave us a chance to recognize similarities to and differences between the experiences of members of our delegation and our Russian and Estonia counterparts. One of the more moving aspects of the exchange was the ritual "gift giving" by members of the delegation of papers, journals and more practical resources. Such resources have not been readily available to our colleagues in Russia and Estonia and were highly prized by them. On several occasions, they presented us with copies of their own publications and general information on their organizations, all of which were equally valued by us.
More relaxed exchanges occurred during the of official dinners hosted by the delegation in Moscow, St. Petersburg and Tallinn. In addition to participating in the main program, individual delegates were able to arrange additional meetings in areas of specific interest (or had done so previously). The subsequent sharing of these interactions with the whole delegation, usually "in transit" the next morning, added another layer to the total experience.
A number of experts indicated that there is currently a sexual revolution occurring in both Russia and Estonia. To more fully understand this, it is necessary to get a sense of the historical context in which change is occurring.
In his 1995 book, The Sexual Revolution in Russia, Igor Kon, the noted Russian sociologist and sexologist, identified some of the historical turning points with respect to sexual culture in Russia. According to Kon, in the 17th and 18th century, Russia was generally regarded as more liberal in its attitude to sexuality than Europe. This may have been because the Russian Orthodox Church, although still holding a patriarchal and puritanical position, was more tolerant than was the Roman Catholic Church on some sexual issues. In Estonia, both the Russian Orthodox and Lutheran churches were significant liberating influences.
Revolutionary Russia represented a major period of liberalism with regard to human sexuality. From 1917 to the late 1920s, Russia, especially St. Petersburg, enjoyed a flourishing of erotic art and culture, and introduced the most liberal sexual legislation known at that time. For example, homosexuality was decriminalized and abortion was legal, free and generally available to women. The period of the 1920s was also rich in sociological studies and informative literature in the sexuality area.
The Stalinist era marked a sharp turning point. From the 1930s through to the 1960s, communist leaders effectively silenced any discussion of sexual issues as part of their efforts to create a totalitarian socialist state with its emphasis on rationalism, collectivism, and discipline. The ruling Communist Party systematically and ruthlessly eradicated sexual expression including sex research, sex education, erotic art, or erotic literature. Extremely repressive laws were introduced and sexual minorities were frequently sent to labour camps. This period is generally described by contemporary writers as the period of extreme sexophobia. Repressive sexophobia was an integral part of maintaining totalitarian control over individuality. Officially, Soviet society pretended to be absolutely asexual and even sexless (Kon, 1995).
From the 1960s, the totalitarian state gave way to a more authoritarian one. This slight shift allowed some research in sexuality in limited circles. Some new publications on sexuality appeared in 1979 to diverse reactions from the community. Slowly the moral climate and attitudes to human sexuality began to change (Kon, 1995).
PERESTROIKA AND THE SEXUAL REVOLUTION
Most writers consider 1986 as marking the beginning of the current "sexual revolution" in Russia. This coincides with the social, political and economic crisis and broader revolutionary change which led to the end of the USSR and to the beginning of the new Russian Republic. During this time period, the Baltic states, including Estonia, also declared their independence. In 1991 the Estonian Supreme Council declared Estonia's full and immediate independence as a republic with a parliamentary democracy.
Throughout its history of invasions by the Vikings, Germans, Danes, Swedes and the long period of Russian Czarist rule from 1703 until 1917, Estonia had experienced some periods of independence. Between the two world wars in this century, Estonia was a republic which took pride in its liberal attitudes and tolerance of difference. During this period, Estonia was also open to the influence of Scandinavia which imposed fewer restrictions on sexual expression. Restrictions were once again imposed during the Soviet occupation which began with the outbreak of World War II, and were not lifted until the period of perestroika.
SEXUALITY IN THE 1990S
The sections that follow summarize what we learned during our professional exchanges about various aspects of sexology including: sex education and family planning; sexual health; sex therapy; sexual minorities; sexual violence; prostitution and pornography; and sex research. We are aware that the three cities and the agencies we visited may not be representative of other urban centres, rural communities or of other Russian or Baltic states. Nevertheless, our observations provide a glimpse at sexuality-related issues in two countries which are just emerging from a prolonged period of sexual repression.
SEX EDUCATION AND FAMILY PLANNING
It is estimated that only 30% of Russian women use effective modern contraception. There are several reasons for this. First, most women have had limited sex education, and have limited knowledge about sexuality and contraception. Second, condoms are not fashionable, and negative attitudes toward condoms have restricted their use. Third, in the past, modern contraceptives were not readily available or were of poor quality. Contraceptives are now easily purchased on the street, at least in Moscow and other large cities, although Russia has only just started to produce the IUD, and there are many regions of the country in which oral contraceptives are not available. Fourth, the cost of condoms or the birth control pill is prohibitive on most incomes. This is in contrast to abortion, which is free. In addition, there is both a widespread fear, historically reinforced by government publications, of the side-effects of contraceptives, and also a male resistance to their use (Redmond, 1996). In Estonia, all kinds of contraceptives are available, but a lack of education contributes to their limited use. Cost is less of a factor in Estonia because part of the cost of birth control is refunded to Estonian women (but not, for example, Russian women living in Estonia). Nonetheless, due to the lack of education, many Estonian women see abortion as the only means of birth control. The numbers of abortions are on the increase in both countries. In Estonia, for example, recent statistics indicate rates of 1,600 abortions for 1,000 live births, or 56 abortions for every 1,000 women of fertile age; 12% of abortions annually are on minors. On average, women have 7 abortions during their life time. The implications of this high level of abortion for women's reproductive health are not fully known.
There has been a total lack of sexual education in schools in Russia for generations. Currently, there are major barriers to providing comprehensive sex education in Russia, including a significant generation gap between parents and children with respect to sexual attitudes, high levels of discomfort around sexuality for many teachers, a lack of teacher training, and a range of sexual myths to overcome. For example, there is widespread belief that masturbation is bad and can lead to infertility. The state mandated biology course includes a section on sexual anatomy. However, many teachers do not cover this material in class but rather assign it as a "self-study topic". Sex educators have had to be creative and resourceful to overcome these barriers. In addition, there is no government funding for sex education and there is also a huge population to reach. For example, Moscow, with a population of 8 million, has ninety-two high schools and six technical high schools. In our discussions, Kon indicated that he believed that there will be no systematic sex education in Russia for the foreseeable future.
We met with a number of professionals who are attempting to overcome some of these barriers. The Advisory Medical Centre for Family Health and Reproductive Health Care in Moscow is a family planning clinic which is geared towards teenage girls. The Centre's coordinator, Dr. Anna Vorobtsova, described it as a non-profit, non-government agency supported by grants from the European Economic Commission, and a member of both the Russian Association of Family Planning and the International Family Planning Council. Two other similar centres have recently been opened in Russia. One of the hallmarks of their programs is the time taken to conduct research on teenage sexuality before they design their programs. Their research indicates that 25% of 15 year old girls are having intercourse, many of whom say they are afraid that they will lose their boyfriends if they refuse. The clinic provides gynecological examinations and contraceptive information. One of the most heartwarming stories we heard was about the teenage girls who, after receiving contraceptive information at the clinic, brought their mothers to the clinic so that they could receive the same information.
The clinic's outreach program provides sex education in the schools. This started in 1991, and may have been the first comprehensive sex education program in Russia. In order to avoid alienating parents and teachers, the sex education program has been introduced under the title "Ethics and Psychology of Family Life", rather than sex education. Sex education is not mandatory, but Dr. Vorobtsova says that the program, which begins in primary school, has been successfully offered for voluntary adoption. The high school program, which consists of 30 hours per year over a three-year period, includes information on anatomy and physiology, reproduction, contraception, pregnancy, abortion, and STDs including HIV/AIDS. However, there is limited discussion of the less biological and more psychosocial aspects of sexuality, such as intimate and sexual relationships between young people, sexual orientation and the prevention of violence in sexual relationships. The agency is also providing seminar training to a limited number of teachers and other professionals who are comfortable with human sexuality. However, Western agencies and not the government are funding these sex education efforts and training in sex education is not part of the curriculum in teacher training programs. It may be some time before effective sex education is available to the majority of students in Russia.
Similar sex education programs are being offered in schools in St. Petersburg where research strongly suggests the need for such education. In a study of high school students by Lunin, Hall, Mandel, Kay, and Hearst (1995), 20% of females and 31% of males reported having had sexual intercourse, and 25% of females and 12% of males reported having been sexually abused. These adolescents displayed much misinformation about sexual matters and AIDS prevention. Only 25% of females and 34% of males believed that condoms should be used just once, and 38% believed that if washed, condoms could be used multiples times. Many respondents, especially males, rated their knowledge about sexual matters as either high or adequate, although their high level of misinformation suggested otherwise. Support for sex education was strong, especially among females, and students generally saw sex education as contributing to improvement in sexual pleasure.
Sex education in Estonia has followed a similar pattern, with little or no sex education having been available under the former Soviet regime. However, Estonia had taken initiatives earlier than Russia, albeit very traditional in content, with family education's having been introduced into schools as early as 1965. Survey results in the schools in the 1990s indicate the strong need for a comprehensive education program. Estonia's close ties with other Baltic and Scandinavian states suggest that Western models of sex education in schools and communities soon will be available to Estonia. Currently, a sex education curriculum is available to all schools, although it is optional and teachers are not trained. However, there is government support for inclusion of sex education in teacher training. The government representatives who met with us indicated their commitment to both sex education in the schools and teacher training in sexuality education as part of the curriculum for training new teachers. We also visited the Family Planning Association in Tallinn whose goals were to increase reproductive and sexual health, particularly among women and young people, to create and disseminate education materials, to train teachers to provide sex education, and to educate health care professionals in the field of family planning.
Health care is not a priority in Russia (only 1% of the budget goes to health care) and a prevalent attitude is that "everything that is not a disease is health." Sexually transmitted diseases are at epidemic proportions in both Russia and Estonia. For example, over the past five years there has been a 5-fold increase in the diagnosed cases of gonorrhea, and a 100-fold increase in the diagnosed cases of syphilis. The first diagnosed case of AIDS in Russia was in 1987. Official statistics put the incidence of HIV at a much lower rate than the incidence of other STDs. It is not known how various factors contribute to the increasing incidence of STDs (e.g., better diagnosis, increased sexual permissiveness, increased prostitution, etc.). However in Estonia, individuals working in the sexual health area state that many of the patients they see are in 2nd and 3rd stage syphilis, thus indicating that the historical lack of diagnosis and treatment is probably a major contributor to the STD epidemic. The epidemic of STDs is made worse by the attitudes of physicians in both countries. Few physicians speak to their patients about safer sex, many are not knowledgeable about STDs, and others convey condemnatory moralistic attitudes to their patients. Such factors are a barrier to individuals' seeking treatment for STDs.
Most of our discussions on sexual health related to HIV and AIDS, in part because we visited a number of non-governmental agencies which deal specifically with HIV (e.g., the AESOP Centre, Estonia Association "Anti-AIDS".) Official Russian government policy designed to prevent HIV is centred exclusively around massive testing. Thus millions of Russians have been screened for HIV. The official figures indicate that there were about 1,000 diagnosed cases of HIV in Russia in 1995, and none of these individuals were I.V. drug users, an extremely low figure considering the population. We had several discussions about the accuracy of this figure. Individuals connected with the government suggest it is highly accurate given the very few cases of HIV that have been identified through the massive testing program. Other colleagues feel that the figure is an underestimation of the actual number of persons infected with HIV. Government AIDS centres do AIDS testing in 80 regions, but there is little accompanying counselling, education, prevention outreach or treatment (the cost of drugs is prohibitive for most individuals). Although there are a number of agencies (all funded by Western sources) which are providing education about HIV and AIDS, research indicates that there is still a great deal of misinformation.
In Moscow, we met with staff at the AESOP Centre, a non-governmental organization founded in 1993 by Kevin Gardner, a social worker from the United States, to promote sexual health and prevent HIV. The staff indicated that their work is made more difficult by the Russian taboo of talking about sexual health. While at the Centre, we were able to see the Russian AIDS quilt. Viewing its few squares, some of which were dedicated to children who had died in hospital due to lack of hygienic conditions, was an extremely moving and poignant experience.
In Estonia, the first case of AIDS was diagnosed in 1988. Following perestroika, Estonia has discontinued the Soviet policy of massive HIV testing. Within the 15-24 year old age group, the incidence of STDs is higher for women than for men, in part because so many young women work as sex workers. In older age groups, the incidence of STDs is higher for men than for women. In 1995, there were 47 diagnosed cases of HIV in Estonia. The economic situation is affecting the programs that community-based organizations are able to offer. In addition to a lack of funding, there is a lack of volunteers, since many individuals have to work more than one job in order to support themselves.
Sex therapy in Russia was described either as "medical sexology" or as "sexopathology". This is indicative of the strong influence of the medical model in conceptualizing sexual dysfunction, as well as the traditional emphasis on disease and illness. According to Kon, psychological and social factors have only recently been acknowledged as contributors to the sexual problems experienced by men and women.
The high prevalence of sexual concerns among the general population in both Russia and Estonia belies the professional view of such sexual problems as sexopathology. For example, in a survey by the Independent Analytical Centre in St. Petersburg, 68% of respondents reported that they had a sex problem and that they needed more information about sex. More than half of those with a problem reported that the services and information they needed were not available, and that professionals such as physicians were generally unwilling to discuss sexual difficulties. According to Shcheglov, a major contributor to the sex therapy field in Russia whom we met in St. Petersburg, about 10-15% of clients who present to sex therapy clinics do so because of "distorted knowledge of sex".
According to Shcheglov (1993), the first sexopathology service in the USSR occurred during the 1970s, when patients suffering from sexual disorders were given advice and treatment in virtually all 15 union republican capitals and the major cities. The locations of service varied considerably and included sexopathology clinics, marriage and family advice bureaus, medical-psychological advice units, and family guidance clinics. There are now also private practitioners and Western-style clinics as the old socialized system of health breaks down, and the right to private practice becomes available to medical specialists. However, most agencies do not have specialists in sexopathology or sex therapy. There also are "hot lines" in Moscow and St. Petersburg which focus on crises such as rape, but also provide some brief counselling regarding sexual concerns.
According to Professor G.S. Vasilchenko, Chief of the Department of Sexopathology at the Psychiatric Research Institute in Moscow, the most common male sexual problems presenting to the Institute are disturbances of drive, erection, and ejaculation. The most common presenting problems for women are orgasmic dysfunction, vaginismus and "dysharmonic relations". In recent years, there has also been a marked increase in visits from individuals with paraphilias.
In Russia, far more men than women present with sexual concerns. Similarly, there are few publications on female sexuality. According to several authors, the percentage of Russian women among the patients of sexopathologist doctors varies from 1% to 10%, and most of those are invited for consultation in connection with their husband's or partner's sexual problems. Shcheglov (1993) argued that the principle motive for women to turn to a sexopathologist (up to 75% of the few women who do present) is lack of sexual satisfaction. The view at the Independent Analytical Centre in St. Petersburg is that practical aspects of time and money are important barriers to the sexual satisfaction of Russian women, as they generally work 8-hour days and carry most of the responsibilities for their families. Shcheglov indicated that in the 1990s, there has been a small but steady rise in the number of Russian women visiting sexopathologists and that, in contrast to the past, women's sexual satisfaction is increasingly recognized as important to the sexual compatibility of partners.
Shcheglov contributes to a men's health television program entitled "Adams Apple", which he uses as a venue for raising questions around male sexuality and challenging many of the male myths. He reports a strong response to this program, with many viewers writing letters about their sexual difficulties. He also believes many women now watch this program; however, there is no parallel program dealing with female sexuality. Sexuality is only a small part of "Adams Apple", and it is not clear to us how explicit Shcheglov is able to be in his discussion of sexual issues.
The training of professionals in sexopathology appears to have been haphazard during the 1960s and 1970s. More organized approaches for medical specialists, psychologists and psychiatrists developed in the `80s and `90s, at the Psychiatric Research Institute in Moscow, the East European Institute of Psychoanalysis in St. Petersburg, and at other regional centres. However, several of our counterparts indicated that most medical specialists, including gynecologists, know very little about sexual concerns and do not appear interested in becoming knowledgeable in the area.
In Estonia, sex therapy services are largely based in private practice. The delegation visited the Family Counselling Clinic, a multidisciplinary practice of 19 specialists and consultants. Our lively discussions and exchanges regarding therapeutic approaches and issues indicated that in general, the Estonians seemed to have similar multidisciplinary models of the causes and treatment of sexual dysfunction to our own. Dr. Imre Rammul, Director of the Family Counselling Clinic, is one of five sexologists in Estonia. Other specialists at the clinic include gynecologists, psychologists, psychiatrists, urologists, psychotherapists and physical therapists. The facilities were extremely comfortable, and included rooms for therapy, massage, sauna and a crisis hot line. A fee for service is charged, with a percentage of each fee going toward the operation of the clinic. The staff see 8,000 to 9,000 patients per year, and the ratio of couples to individuals seen is about 50:50. In contrast to Russia where most of the clients are men, about 50% of the individual patients are women.
In Estonia, the main presenting sexual concerns followed similar patterns to clinics in North America and Australia (e.g., for men premature ejaculation, erectile difficulties, for women vaginismus and anorgasmia, and for couples, differences in sexual desire and arousal difficulties). Assessment includes an investigation of both medical and psychological and social causes. Treatment models include psychoanalysis, hypnosis, (EMDR), drug therapy, behavioural training, sex therapy, and mechanical devices. When working with couples, the specialists attempt to discover the factors that are affecting the sexual relationship, and an emphasis is placed on sexual happiness and enrichment. The clinic also provides family therapy and has access to a wide range of resource materials.
According to Kon (1995), attitudes toward sexual minorities in Russia reflect the extremes of sexual repression and tolerance. The major minority group has been homosexuals or "blues". This contrasts with pre-revolutionary Russia, when attitudes towards homosexuality were generally more tolerant than Europe's (Kon, 1993). According to Kon, open public discussion of homosexuality by professionals and journalists began in 1987. However, it was not until 1990 that gay men and lesbians became publicly vocal about sexual orientation as a human rights issue. Following the dissolution of the Soviet Union, some republics, including Estonia, revoked their anti-homosexual legislation. In Russia, anti-homosexual legislation was not revoked until 1993. Since then, the homosexual underground has taken some steps toward becoming a gay and lesbian community with its own organizations, publications and centres.
The delegation's experience with homophobic attitudes varied considerably between Russia and Estonia. In Russia, although homosexuality is now legal, discrimination and homophobia are still prevalent. For example, Kon (1989) reported the results of a survey which asked 2,600 Russians "How ought we to deal with homosexuals?" Respondents gave the following responses: 33% "eliminating them"; 30% "isolating them from society"; 10% "leaving them to themselves"; 6% "helping them". Similarly, in a sociological survey undertaken by the Moscow Youth Institute in 1990 in 16 regions in Russia, 62% sharply condemned homosexuals (Kon, 1995). Although there is research which shows a shift toward greater tolerance, homosexuals have been shown to still be the most hated and stigmatized minority group in Russia (Isayev, 1993). Further, some gay organizations (e.g., the Triangle Centre) have been denied the right to register as an official organization by the government because they "contradict standards of public morality". Although female homosexuality was not criminalized but generally ignored in the past, lesbians have found it difficult to gain support and establish networks in Russia. However, the Tchaikovsky Cultural Foundation in St. Petersburg represents a recent example of a lesbian organization. Several members of the delegation were invited to a gay bar in Moscow, and were surprised to be thoroughly frisked for weapons before being allowed to enter.
In contrast, in Estonia the professionals we spoke to indicated that homophobia is not widespread. Culturally, it is considered impolite to display negative attitudes towards people who are "different", and Estonians pride themselves on having been a safe haven for minority groups, such as the Jews, who were persecuted in other countries in Eastern Europe. Many famous Estonian historical figures were openly gay. Several members of the delegation went to a party celebrating the anniversary of the founding of a lesbian organization and got the impression that lesbians were not afraid to be open about their sexual orientation. However, at the AIDS Information and Support Centre in Tallinn, gay men living with HIV openly discussed their experience of discrimination in the health and medical system. It appears that, as in North America, gays and lesbians only experience total acceptance in "gay-friendly" services, such as the above centres, or in the homosexual networks, such as gay bars.
In the various centres concerned with HIV/AIDS that we visited in both countries (e.g., the AESOP Centre in Moscow and the AIDS Information and Support Centre in Tallinn), community education was a major strategy used to break down homophobia. Another major contributing factor to changing homophobic attitudes has been the linking of the gay and lesbian alliances in Russia and Estonia with international networks. The first international conference on sexual minorities and changing attitudes to homosexuality to be held on Soviet territory took place in May 1990 in Tallinn, the Estonian capital. In September 1991, Moscow was the venue for a round table discussion on "Human Rights for Gays and Lesbians in Eastern Europe", and in the summer of 1992, an international conference on gay and lesbian lifestyles took place in Moscow. These significant events have continued to keep the needs and rights of homosexual minorities in the public eye.
The term sexual minority is not only used to refer to homosexuals, but also to individuals with various paraphilias, gender dysphoria and atypical sexual behaviour such as sadomasochism. Here too, the medical emphasis on understanding these sexual preferences has meant that the psychosocial aspects have been ignored and the considerable differences have not been acknowledged (Kon, 1995). In Russia, the majority of requests for sexual reassignment surgery are for female to male, the reverse of what is generally found in Western countries. Although no discussions were held on sexual minorities other than gays and lesbians in Estonia, the greater tolerance for difference would suggest a broader and less medical approach.
PROSTITUTION AND PORNOGRAPHY
Prostitution and other sex work has never been a criminal offense in Russia because it officially did not exist during the Soviet period. The Soviets saw prostitution as rising out of a capitalist society, and therefore, something that could not occur under communism. Currently, prostitution is widespread. For example, prostitutes were evident in the lobbies of the hotels in which we stayed. So were their pimps, who were reported to be members of the Russian Mafia. Although the Mafia has existed in Russia throughout this century, it has grown rapidly in recent years with the increased freedom of movement. There are also no laws regulating prostitutes in Estonia.
Most of our discussion of prostitution occurred in Estonia where, as in Russia, there has been an increase in the number of sex workers since perestroika. Our counterparts attributed this increase to three factors: the open border, increased personal freedom, and economics. Many prostitutes are highly educated and choose prostitution for financial reasons, given the low wages of many jobs. For example, the earnings of a prostitute are five to ten times those of a physician. Prostitutes in Tallinn could make 300-500 crone per hour ($25-$45 U.S.), whereas the average monthly salary in Estonia is 1,000 crone per month ($90 U.S.). The majority of workers in the sex trade are women between 15 and 19 years old. Many are ethnic Russians who do not speak Estonian. There are few street prostitutes in Estonia; almost all prostitutes work for companies. Prostitution is also seen as a viable way of earning a living by many Russians. For example, Afanasyov and Skorobogatov (1994) reported that, among those under 25, 10% consider prostitution "to be a relatively acceptable and legal way of making money". Similarly, in 1990, 24% of the students and 14% of the teachers in schools in St. Petersburg believed prostitution "to be the private affair of teenage individuals".
Work with prostitutes in Estonia by the Information Support AIDS-Centre in Talinn (AIDS Info) indicates that prostitutes lack the information they need to protect themselves from STDs. For example, although many prostitutes say they use condoms, most do not use them correctly. Few use spermicides because of the expense. Most have never heard of syphilis, and warnings about the effects of STDs on health have little influence. In contrast, a successful approach to increasing condom use and safer sex behaviours has been to warn women that these diseases can affect their beauty and that their hair could fall out. Dr. Nelli Kalikova described an interesting study on the provision of safer sex education that had been done by AIDS Info with 118 prostitutes. The educational intervention resulted in a dramatic decrease in STDs which was maintained 2 to 8 months following the intervention.
There are also no laws regulating pornography and' erotica in either Russia or Estonia. In Russia, sex magazines are widely available at every magazine kiosk. For example, Playboy and Penthouse are available in both their English editions, and in Russian editions. There are also some sexual publications homegrown in Russia. The one we purchased was more like a newspaper than a magazine, and contained few sexually explicit pictures. It had pictures of both naked men and naked women and apparently was targeted at both men and women.
Official statistics in Russia indicated that 14,000 women were killed by their partners in 1994. The actual figure may be much higher. Our counterparts also indicated that there was a great deal of sexual victimization of women, as well as emotional, physical and sexual abuse of children. For example, a survey of 10th grade students in St. Petersburg indicated that 25% of the girls and 34% of the boys reported having been sexually abused (Lunin, Hall, Mandel, Kay, & Hearst, 1995).
There are currently no programs to educate children about abuse and protection. Further, there is no equivalent of child protection services. As the state has no right to intervene or remove from the home a child who is being abused by a parent, abused children usually stay with their families. However, a parent can lay charges against someone who has abused his/her child, or the child can lay charges if s/he is older than 15. In any case, there are no facilities (e.g., foster care) in which to place a child who is not living with his/her parents.
Although child abuse has also been reported within institutions, the government in Russia has not announced any plans to introduce child protection services. At the government-funded Children's Psychiatric Institute in St. Petersburg, we met with a group of professionals who work with child victims of violence, including victims of sexual abuse. The Institute also offers an anonymous crisis service, but despite the importance of these services, the staff was concerned about ongoing government funding and seemed quite dispirited.
A community-based domestic abuse hotline and sexual assault hotline were established in Moscow in 1993. Both this crisis line and a similar line in St. Petersburg claim to be the first of their kind in the country. The lines in Moscow got 25-30 calls per day about domestic abuse, and 12-14 calls per day about sexual assault. There are plans to open the first women's shelter in Moscow, and the first sexual assault centre in the country was recently opened in Moscow. Sexual assault of women, both on the street and within intimate relationships, is frequent (Riordan, 1993). However, criminal action has rarely been brought against men who abuse their partners. In fact, sexual abuse and sexual harassment are often condoned. For example, we were told that although sexual harassment of women is common, if a woman objects to being touched or propositioned at work, the most prevalent attitude would be that "she does not want to get ahead". Sexism and sexual harassment, although prevalent, did not appear to be acknowledged or areas targeted for immediate action by any of the groups with whom we met.
According to our counterparts, the average Estonian does not acknowledge sexual abuse within the family as a problem. Nonetheless, government officials with whom we met recognized that there has been an increase in sexual assault, that child sexual abuse is a problem, and that there is a problem with children being sold for the pornography industry. The government of Estonia is developing a social service system to intervene with children who experience abuse within the family. Currently, there are services for victims of abuse only if they come forward.
Treatment of sex offenders is,fairly new in Russia. In fact, one of the main institutions working in forensic sexology, the Institute of Serbsky, only began working with sex offenders in 1993 after a public outcry resulting from press reports of the details about a serial rapist/murderer. The staff at the institution indicated that they primarily see offenders who have been convicted of sexual assault, child sexual assault or exhibitionism, although we got the impression that they do not have a well-defined treatment program as yet, and have seen few offenders. There is currently no treatment for perpetrators of sex crimes in Estonia.
RESEARCH IN SEXOLOGY
There was little sex research in Russia prior to perestroika, but since 1991, the number of sex researchers appears to have increased. We met quite a few researchers at the independent Analytical Centre, which is a body of independent researchers who study public opinion, including human sexuality, and other social phenomena. Public opinion polling itself has only recently been introduced in Russia. During the Soviet period, leaders justified their actions as reflecting public opinions, but never actually assessed what those public opinions were. As a result, laws in the sexuality area often do not reflect public sentiment. For example, the city council in St. Petersburg decided to close all sex shops within two kilometres of schools, kindergartens, and other educational institutions. Unfortunately, as these institutions are scattered throughout the city, implementation of this law would have involved closing almost all sex shops. They justified their action on the basis that it reflected public opinion. In contrast, public opinion polling indicated that 60% of those surveyed were opposed to these regulations. Researchers at the Independent Analytic Centre interpreted this finding as not only indicating that public attitudes toward sex shops are more liberal than those of administrators, but also that the public does not feel that the government has the competence to regulate sexuality.
Research in Russia has tended to be at the level of collecting normative data, mostly by using convenience samples. Little research we heard about was hypothesis-testing. A questionnaire distributed in a health magazine resulted in 500,000 returned questionnaires out of the 18,000,000 distributed. These (non-random) responses indicated that individuals were ignorant about sex. Other research (cited above) has documented prevalent negative attitudes towards homosexuals, myths and misinformation about sex, and limited use of contraceptives. Research tends to have been done in cities but not in small towns or rural areas, an omission that may be due to the cost and logistical difficulties of doing research in such areas (e.g., small villages rarely have hotels).
Researchers at the Independent Analytical Centre indicated that they usually get an excellent response rate to their sexual surveys: 50% for mailed surveys, 90-100% for telephone surveys. They suggested that Russians had lived so long in a society in which the opinions of the public were never sought, that people were pleased to be asked and willing to give their opinions on any topic, including sexual topics.
In addition to Kalikova's intervention study to increase condom usage among female prostitutes described above, we learned about other sex research in Estonia, including a survey of the sex knowledge of children in school, and a collaboration between researchers in Estonia, Finland, and Russia to compare survivors of Chernobyl, survivors of the Estonian ferry disaster, and survivors of child sexual abuse. In both Russia and Estonia, we found that researchers were interested in collaborating with Western colleagues.
Our major recollection of meetings with our counterparts in Russia and Estonia is of open round table discussions, informal conversations, and networking. In this respect, the sexology delegation more than met our primary objective, the exchange of knowledge and expertise. This sense of reciprocity was particularly marked in Tallinn, in some of our meetings in St. Petersburg, and in our interactions with non-government organizations more so than with government institutions. The process of exchange was clearly limited in the more structured and formal meetings.
We had a palpable sense of history and of long periods of repression regarding sexuality, and at the same time, an awareness of radical changes occurring at all levels in both societies. It was hard to gauge whether a "sexual revolution" was actually occurring, but it was clear that dramatic changes have taken place in at least some areas of human sexuality. We had a sense, at times, of chaos in Russia, characterized by high levels of unpredictability about the future. The general lack of funding will continue to be a major issue for those seeking to effect changes.
Some of the consequences of the long years of sexual repression and neglect in Russia have been summarized by Riordan (1993):
1. Extreme ignorance of sex as a result of a lack of sex education at school and home.
2. A low contraceptive culture and a high abortion rate.
3. A sharp rise in reported sexual violence and child sexual abuse.
4. Increase in AIDS and STDs and inadequate resources to address this social health issue.
5. Increase in pornography and prostitution.
6. The uncertain future for sexual minorities.
Most of these consequences are also apparent in Estonia. However, the more liberal attitudes of Estonians and the more active involvement of the Estonian government in developing comprehensive sex education, teacher training, child protection services, et cetera, suggest that progress toward developing a sex-positive society and a sex-knowledgeable population in Estonia will far outpace these changes in Russia.
To North American and Australian sexologists, the above legacy appears almost overwhelming. We were impressed with the many people we met who were dedicated to improving the sexual life of people in Russia and Estonia. Since almost all public discourse about sexuality was prohibited until 1991, great strides have been taken in a number of key areas of sexology. These achievements are even more remarkable because they have been accomplished with so few resources. Most of our counterparts were not daunted by the enormity of the task ahead or by the limited resources available to address it. Rather, they frequently demonstrated an inspiring level of commitment and courage to find solutions. During our visit, we did not see close networking between different groups and organizations in Russia. As Kon stated, "[In Russia] everyone wants to be independent and invent everything from beginning to end." Some of the unique features of Estonia, including its small size and connections with Scandinavia, may work to create closer professional networks than those in Russia.
Some of our own assumptions about the universality of some beliefs about human sexuality were challenged, particularly in Russia. This divergence of views was most clear on issues of gender (e.g., our own North American/Australian notions of sexist attitudes and behaviour), and on the issue of the state's role in protecting children against family violence. We found that even with more liberal-minded colleagues, it was difficult to pursue conversations about sexism or sexual harassment in the workplace as they did not hold similar ideas. The dominance of the medical model and of Freud's original psychoanalytic formulations differed from our more psychosocial or postmodern approach to understanding sexual dysfunction. Such differences in perspective were more noticeable with our counterparts in Russia than in Estonia.
Our objective of strengthening professional relations with our Russian and Estonian counterparts, after we returned to our respective countries is occurring in often creative and interesting ways. A number of members of our delegation have continued to correspond with colleagues they met on our trip, they have introduced other visiting professionals to key people in Russia and Estonia, and they have presented their experience of the exchange to colleagues and the media (e.g., Byers, 1996; Slattery, 1995). The ritual gift-giving of papers, texts and journals which began during the visit has also continued. For example the Sex Information and Education Council of Canada (SIECCAN) now sends The Canadian Journal of Human Sexuality to key individuals free of charge. Other professional organizations in sexology have also offered honorary membership to Russian and Estonian sexologists. On the research level, one of the authors (ESB) submitted a research grant, with a number of Russian colleagues, to the Soros Foundation to investigate sexual satisfaction in Russia.
In short, the visit of the sexology delegation to Russia and Estonia provided a timely opportunity to promote understanding, exchange ideas and knowledge, and build closer collaboration for the future.
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Correspondence concerning this article may be addressed to E. Sandra Byers, Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, CANADA E3B 6E4.
Geraldine Slattery, Therapist, private practice Kensington Park, South Australia, Geraldine Slattery participated in the Russia/Estonia exchange visit as a member of the Sexual Concerns Unit, Relationships Australia (SA) Inc.
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|Author:||Byers, E. Sandra; Slattery, Geraldine|
|Publication:||The Canadian Journal of Human Sexuality|
|Date:||Mar 22, 1997|
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