*Note: The authors welcomed the opportunity to prepare this chapter on Cyprus because very little has been published on Cypriot sexuality in the international literature. This has been because of the lack of adequate funding and professionals to conduct methodologically sound research on the island, a lack of a coordinating body, the difficulties involved in collecting data given a conservative and sexually inhibited society, the suppressive influence of the Orthodox Church on human sexuality, and other factors. We have collected, analyzed, and integrated whatever information we could find, including statistical data, the results of professional experience and clinical work, and anecdotal reflections from professionals in fields related to sexology.
Cyprus, the third largest island in the Mediterranean Sea, lies off the eastern shore of the Greek Islands, the southern coast of Turkey, and the western shore of Syria, with Lebanon, Syria, and Israel to the southeast. Measuring 141 miles by 60 miles wide, the islands total land area is 4,867 square miles or 12,606 square kilometers, about the size of the state of Connecticut. The island is divided between Greek and Turkish regions, with 3,572 square miles (9,251 square kilometers) comprising the Republic of Cyprus and 1,295 square miles (3,355 square kilometers) in the Turkish Republic of Northern Cyprus. Two mountain ranges cross the island from east to west, separated by a wide, fertile plain.
According to the 1998 estimate, 78 percent of the 754,064 Cypriots are Greek with a Greek Orthodox religious affiliation, and approximately 18 percent are Turkish Muslims. About 70 percent of Cypriots live in the cities. All but about 0.5 percent (about 500) of Greek Cypriots live in the southern Republic; 1.3 percent of Turkish Cypriots also live in the south. The majority of Turkish Cypriots, 98.7 percent, live in the northern Turkish Republic. Cyprus also is home to 4,500 (0.6 percent) Maronites, 2,500 (0.3 percent) Armenians, 700 (0.1 percent) Latinos, and 23,000 (3.1 percent) other nationals, mainly British, Greek, European, Lebanese, and Arab.
One quarter of Cypriots are under the age of 15, 64 percent between the ages of 15 and 65, and 11 percent over age 65. Cypriots have a total fertility rate (TFR) of 2.3, slightly above replacement level, which ranks the nation 146 out of 227 nations. The 1995 estimated life expectancy was 74 years for males and 79 years for females. The birthrate in the Turkish Republic is 18 per 1,000 inhabitants; the Greek birthrate is 15 per 1,000. The Turkish infant mortality rate is 12 per 1,000; the Greek infant mortality rate is 8.2 per 1,000. The overall annual natural increase for Cypriots is 0.9 percent, with a 0.746 percent increase on the Greek side and 1.14 percent increase among the Turks. The 1992 literacy rate was 94 percent, with nine years of compulsory schooling. The island has one hospital bed for every 162 inhabitants and one physician for every 677 persons. The 1995 estimated per capita income was $13,000 per person in the Greek area and $3,900 per person in the Turkish area.
Recent excavations on the island of Cyprus have yielded evidence of human society at least 10,000 years old. The Mycenean (Greek) culture flourished in the second millennium B.C.E. After Phoenicians colonized the island in the tenth century B.C.E., Cyprus remained a major entre-pôt for trade in the eastern Mediterranean. Annexed by Rome in 58 B.C.E., Cyprus later became part of the Byzantine Empire until the English King Richard I (Lion-Heart) established a crusader state there in 1191 C.E. The Lusignan dynasty ruled until 1489, when Venice annexed the island. In 1571, Cyprus became part of the Ottoman Empire.
In 1878, the Congress of Berlin placed Cyprus under British administration. After annexing the island in 1914, Great Britain made it a British colony in 1925. Between 1945 and 1948 the British used the island as a detention area for illegal Jewish immigrants trying to reach Palestine.
After 1947, the Greek Cypriot community expanded its long-standing agitation for union (enosis) with Greece, a policy strongly opposed by the Turkish Cypriot community. After violence in 1954 and 1955, Cyprus gained full independence under a 1960 agreement that forbade either enosis or partition and included guarantees of the rights of both Greeks and Turks. Efforts by the president, Archbishop Makarios, to alter the Constitution in favor of the Greek majority led to more violence in 1964.
A Greek-Junta-inspired military coup against Makarios in 1974 led to Turkeys invasion of Cyprus and the de facto partition of the island and declaration of the northern 40 percent of the island as the Turkish Federated State of Cyprus. Some 200,000 Greek Cypriots were expelled from the Turkish area to the Republic, while many Turks fled the Republic for safety in the north. The Republic has experienced a return of political stability and economic prosperity, with agriculture, light manufacturing, and tourism leading the way. The economy in the Turkish sector has been generally stagnant, as the international community refused to recognize the 1983 declaration of independence by the Turkish Republic of Northern Cyprus. Tensions have eased since the United Nations-sponsored Greek-Turkish talks on Cypriot unity, even though little progress has been achieved thus far.
*Note: This combined section on gender roles, marriage, family, and ethnic and religious factors was written by Nicos Peristianis, president of the Association of Cypriot Sociologists, based upon his research and that of his colleagues.
Ethnographic and anthropological accounts of Cyprus (Peristiany 1974, Markides et al. 1978) stress the importance of the nuclear family as the paramount institution of Cypriot society, so much so that an individual exists only as a member of a family, and the self cannot be conceived independently from its familial roles. This is in marked contrast to Western solitary conceptions of the self (Mavratsas 1992). The family has acquired such significance because it was, and still is to a large degree, the primary social, economic, and moral unit of Cypriot society.
The economy of Cyprus maintained its predominantly agrarian character well into the twentieth century (Christodoulou 1992). The perennially heavy financial demands of conquerors and the especially hostile ecological factors - the strategic resources of water and land were always in limited supply and diseases frequently destroyed crops - led to competition being a keystone aspect of life and reliance on the family group being vital for survival. Economic activities were conducted by the entire household for the improvement of their common position, thus enhancing family solidarity and the strong distinctions between insiders and outsiders.
In his survey of rural life in the late 1920s, Surridge, a British colonial officer, noted an internal division of labor within the family, with men being responsible for heavy agricultural work and women (aided by the older children) for the lighter work in the fields, as well as housework. Usually one of the girls would stay behind to look after younger children and help with some housework (Surridge 1930). At the same time, much as in Greece and elsewhere in the Mediterranean, there was a moral division of labor inside the family, revolving around the cultural codes, or values, of honor and shame (Campbell 1983, Schneider 1971).
Honor (timi) refers to the value or worth of an individual - but since the individual exists as a member of a family, whatever worth one earns for oneself automatically spills over to the family. Correspondingly, shame (ntropi) refers to a loss of honor, esteem, or worth, which brings humiliation, staining the individual and family.
It is important to appreciate the salience of these codes on the lives of individuals in traditional Cypriot society. Peter Berger has argued convincingly that contrary to modern societies emphasis on dignity, which implies a notion of the self devoid of institutional attachments and roles, more traditional societies put an emphasis on honor, which implies that identity is essentially, or at least importantly, linked to an individuals institutional roles. In fact, an individual in a world of honor discovers his true identity in his roles. To turn away from the roles is to turn away from himself (Berger et al. 1973). What, then, were the roles through which individual Cypriot men and women discovered their true identities or selves?
The traditional role of the man in Cyprus was that of representing the family to the outside world. As head of the family, he engaged in all tasks necessary to protect and sustain the family. He was the main income earner who made decisions regarding production by obtaining knowledge about environmental conditions, resources, and markets. After work, he would spend time in the coffeehouse (kafeneion), where information was exchanged and contacts made, as well as views shared on political and village affairs. The highest value for man was love of honor (philotimo), that is, self-respect and self-assertive courage, which amounted to assertive masculinity, in all areas of social life, to protect the honor of the family.
The traditional role of the woman was to be responsible for the family inside the home. Her tasks revolved around three sets of duties: first, the duty of being a good mother, hence the tasks of nurturing and caring for the children; second, the duty of being a good housekeeper, responsible for cleaning the house, cooking, shopping, and looking after domestic animals; and finally, the duty of being a good wife, by being obedient, respectful, and submissive to her husband.
The separation of the sexes in traditional society, especially rural areas, was quite strict, even though it has lessened with modernization. A woman would keep away from public areas, which were the domain of men. Women would never enter coffeehouses or athletic clubs; similarly, they would rarely be seen passing through the central square of the village, where most male-dominated coffeehouses were concentrated. In churches, women would occupy the rear and upstairs sections, the front part being reserved for men only. Women could attain more freedom to circulate among men only when they were not considered sexually risk-bearing, i.e., young girls before puberty and elderly no longer sexually attractive women (well past menopause). In these cases, women could walk in the streets more freely, pass through the central square, and converse with men. But in no case could women enter and contaminate in church the holy of holies where the altar is housed.
Womens avoidance of public spaces related to their need to avoid sexual shame. In fact shame-avoidance was the principal value governing all female behavior in traditional society. In his classic study of a Cypriot highland village in the 1950s, Peristiany (1965) noted that womans foremost duty to self and family is to safeguard herself against all critical allusions to her sexual modesty. In dress, looks, attitudes and speech, a woman in the presence of men should be virginal as a maiden and matronly as a wife. A woman who behaves in conformity to the code regulating the behavior of her sex (femininity/passive modesty), is said to be an honorable woman (timia gynaika), whereas the one who doesnt is without honor (atime), or, what amounts to the same thing, without shame - shameless (adiantrope). Again, honor and shame, respectively, are not restricted to the woman, but spill over to her family. Thus, for instance, in case of an unmarried woman, shame taints directly the father and brothers, who did not protect or avenge her honor. After marriage, these responsibilities pass to the womans husband.
Whether father, brother, or husband, men bear the responsibility of caring for the women of the family. Indeed, this will be their conformity hallmark that regulates the behavior of their sex (manliness and assertion of masculinity). In both cases of non-conformity to the code of honor (an unmanly man, an immodest woman) the perpetrators are guilty not of breaking an externally given rule, but of betraying their very nature, their physis - because it is considered in the nature of men/women to act in this particular way (Peristiany 1974).
Gender roles are taught throughout the socialization process. A study of the lowland village of Lysi in the early 1970s, provides an account of the different patterns of socialization for the two sexes (Markides et al. 1978). From a very early age, in their games, boys try to imitate their fathers behavior and girls their mothers. Until the age of 6, children are free to play in the streets and visit neighbors and relatives homes. But after this age, girls begin to spend most of their time at home, playing with their sisters or other friends, but also learning how to clean, cook, sew, etc. As they grow older, they may be allowed to visit relatives or friends, once they have secured their mothers consent. No such limitations apply for the boys, who continue to be free to wander around and play in the streets, and to visit the kafeneion or other clubs and public places. Boys are encouraged to develop their masculinity as expressed through physical courage, toughness, competitiveness, aggressiveness, and defending ones honor, whereas girls are taught to cultivate their femininity as expressed through gentleness, expressiveness, responsiveness, tenderness and modesty (Balswick 1973). The most important virtues that girls must learn are, again, those related to modesty and shame-avoidance. A girl must demonstrate that she is a virgin not only in the flesh, but also in spirit. She should avoid not only physical but also social contact with men, because this could be associated with sexual desire. This entails accepting a number of social prohibitions, such as never to talk to a man in the street, unless he is a close relative; not to fraternize with men, and when a man looks at her she should avert her eyes and blush; she should not laugh in front of men and if she does so, she must bring her hand in front of her mouth (Markides et al. 1978).
If this behavior is maintained, her good name and family honor are preserved, which adds to her value as a future bride. Throughout socialization in the family and community, a girl learns to set marriage as the paramount goal of her life, since it allows her to become a wife and a mother. A woman who remains unmarried is destined to remain at the social and cultural periphery of the village, for she is not offered any role to play within the mainstream of society. Her destiny will in fact be to care for the elderly parents and the children of married sisters/brothers, and to engage in church-related activities.
Marriage and the creation of a family is also very important for young men, for it is only through them that they will be considered full and mature members of society with equal rights and responsibilities. A man reaches manhood only when he marries. Until then, he is still a kopellin, a lad, which means he cannot hold any responsible position within the power hierarchy of the village.
The roots of Cypruss modernization can be traced back to the beginnings of British colonialism. Prior to British control, Cyprus had been subject to Ottoman rule for approximately three hundred years, during which time the land was owned by the State; the peasants had the right to use the land in exchange for the appropriate taxes. British colonialism introduced a connection between individual production and the right to private property. Peasants could now own the land they cultivated; but they could also lose it! Indeed for various reasons, such as bad agricultural years and overspending on their childrens dowry, many peasants found themselves in heavy debt to insurers, to whom they had resorted for borrowing money, and to whom many eventually lost their land because they could not repay their mortgage.
Such destitute peasants sought employment in other sectors of the economy, namely the mines and small industries that started developing in the urban centers early on in the twentieth century. After Wold War II, when Britain was forced to abandon her bases in the Middle East and to grant independence to India, Cyprus acquired enhanced strategic value. In response, the British constructed two large military bases on the island, at Episkopi and Dhekelia, with the resulting construction industry providing new employment opportunities. Furthermore, the increased needs of the British military and administrative personnel provided further jobs and new commercial possibilities.
During the 1950s, the final decade of British rule in Cyprus, the average annual rate of growth of the economy reached 12 percent, an indicator of the progress that was being achieved. Urbanization had also grown dramatically: whereas at the beginning of British rule the urban population was only 17 percent, by the time they left, it amounted to 36 percent. As Attalides (1981) showed in his study of social change and urbanization in Cyprus, the majority of the people who migrated to the towns were those who had no land of their own and no work, mostly unmarried men and women. Another major reason for migration was the decision to attend high school. This was due to the recognition that education provided a way out of the villages and hard toil in the fields, into a better life in the towns and employment possibilities in the newly created white-collar jobs.
Gradually the urban centers became the foci of the economy as well as of social and cultural life. This, along with the emergence of a sizable urban middle class, led to a restructuring of power relations - a shift of power from the village to the city. As a result of these modernizing processes, the family underwent considerable change. Functions earlier performed by the family were gradually taken over by other institutions, even though not to the extent and with the consequences this had in the West. Thus, even though in many cases the family stopped being a production unit (as in the case of destitute peasants joining the working force in the mines or industry), in many other cases money earned from work in the towns found its way back to the villages to help the family pay off debts and maintain its land and unity. In yet other cases, family businesses were set up in towns, so the family kept its production role in a new context (Argyrou 1996).
It is also interesting to note that, whereas in many other developing societies urbanization led to a break-up of extended family systems into the nuclear system, in Cyprus there was somewhat of a reversal in the process. We have noted how rural Cypriot society was characterized by a nuclear family system; urbanization, in its early stages at least, had an expanding effect, since kin members were added to the nuclear core (usually younger relatives looking for a job in town). Thus, it does not seem that modernization and urbanization negatively affected family cohesiveness and strength (Attalides 1981).
There were, however, gradual changes in gender roles within the family. Two of the most important factors leading to these changes have been education and employment. Education became an important mechanism of social mobility, advancing both the status of peasants to that of whitecollar workers and improving the status of women (Persianis 1998). The first primary schools were established by the Orthodox Church toward the end of Ottoman rule. Very few girls attended these schools because womens destiny was to marry and have a family at an early age. Besides, because there were only male teachers at the time, parents were unwilling to allow their daughters to stay in school beyond the age of 8 or 9. For the same reasons, this absence was even more pronounced in the case of the few secondary schools, which were concentrated in the towns. The first girls to attend schools came from the wealthier (bourgeois) class, which valued the cultural benefits of education, expecting their girls to be taught how to be refined ladies, but also to remain modest and quiet. It is from the 1920s onwards, the period in which we start having increasing rates of urbanization and industrialization, that we have sizable increases in student numbers, including girls. Most of these new students were children of the wealthier rural and, primarily, urban classes. The motives henceforth became mainly economic because education was now considered instrumental in securing a job in the towns, in commercial shops, trading firms, banks, and similar work. Such motives were further strengthened in subsequent periods, when the economy grew at a faster pace, providing more and more opportunities for work. This was true after World War II, but especially after independence in 1960, when the service sector opened up. Cypriots thought service jobs to be more appropriate for women, since they more closely resembled their traditional roles.
The 1974, Turkish invasion brought destruction of biblical proportions to the Greek Cypriots. Almost 40 percent of the land came under Turkish control; a full third of the population became refugees and had to flee to the south for survival. Most of these ended up in refugee camps at the outskirts of the larger towns, creating a large new wave of forced urbanization. Women from such refugee families, especially of rural and working-class background, provided cheap labor for light manufacturing industries, mostly in shoes and clothing, which found unexpected opportunities for growth during this period. Furthermore, the expanded welfare and other state services, which tried to cater to the new needs, provided new opportunities for middle-class women, both refugee and non-refugee alike. The final pull was provided with the economic recovery and unprecedented boost, the economic miracle, in the early 1980s, which created numerous new jobs in tourism and the wider service sector.
Throughout this period, womens employment increased by leaps and bounds, as did schooling for girls. By 1995, womens employment was 38.6 percent of the total, as compared to 35.17 percent in 1985. In both primary and secondary education, the ratio of girls was equal to that of boys, with some marginal differences at the tertiary level, where more boys than girls study outside Cyprus, whereas more girls than boys study at tertiary institutions in Cyprus.
All these changes have obviously transformed the Cypriot family and gender roles within it, although continuity with past patterns remains strong. Mothers, especially of the younger generations, are not only allowed, but expected to work. Recent research by Papapetrou and Pendedeka in 1998 shows that family members believe the mother to be sensitive, permissive, and flexible toward childrens demands. She is over-protective and worries a lot about her children, spending time in discussion with them, certainly more so than the father, which may explain why she demonstrates more empathy and understanding toward the children. This is seen to be related to the fact that she carries the care of the household and family, spends many hours at home, and thus has more opportunities to see each family member separately. This, it is speculated, may also provide her with the opportunity to administer or rule, to know what and when something must take place. Such powers, however, are not tantamount to the role of leader, which is reserved for the father. She is expected to work, but she is also expected to ungrudgingly interrupt her career to raise children. After all, womans working role is seen as a secondary one, important for supplementing the familys income and not as the main breadwinner.
The father is the one considered to be really responsible for the economic well-being of the family. He is still considered to be the leader of the team and his opinions are determinative when it comes to serious matters, or matters which have an impact upon the whole family. He does very little in the house, his activity being mostly limited to heavy jobs (construction, repair-work) upon mothers requests. Usually he does not spend much time at home, but prefers the coffee shop, a hobby, or a second job; when he stays at home, he usually watches television, especially news reports. He is thus seen as austere, strongly opinionated, and distant. Often he is unexpressive, since mans socialization into masculinity (competitiveness, toughness, aggressiveness, physical courage, and defending ones honor) teaches him that expressiveness toward his wife and children is a feminine characteristic.
The traditional social and moral order has been sanctioned by the Cypriot Orthodox Church. The family is considered to be a divine institution, relations between its members being comparable to the relations between God, Mary, and the Christ Child. Icons were traditionally kept in a specific holder (ikonostasi) of every home, with an oil-lamp constantly burning, symbolizing the divine protection of the institutions of marriage and family.
During the marital ceremony, considered to be one of the seven Divine Mysteries or Sacraments through which Gods grace is bestowed to humans, St. Pauls Epistle to the Ephesians is read to the newlyweds, reminding them that in their relationship, the wife must fear her husband and be submissive to him at all times, whereas the husband must love the woman, as Christ loved the Church. Obedience, respect, and submission to husband are moral imperatives that highlight the patriarchal nature of traditional Cypriot society.
Modernization of all spheres of Cypriot life and secularization of the religious sphere have certainly brought about important changes. The 1960 Constitution of the Republic of Cyprus enshrines modern democratic ideals, including equality of men and women before the law. It also specifically prohibits any direct or indirect discrimination against any person on the ground of his [sic] community, race, religion, language, sex, political or other convictions, national or social descent, birth, color, wealth, social class or any ground whatsoever ... (Article 28).
Nevertheless, as has been pointed out by Stavrou (1998), the patriarchal logic lurks behind some of the provisions of the supreme legal document of the country. For instance, in determining the ethnic community to which a citizen should belong, after marrying someone from the opposite community (i.e., a Greek Cypriot marrying a Turkish Cypriot or vice-versa), the Constitution clarifies that: A married woman shall belong to the community to which her husband belongs. Similarly, in the case of children under the age of 21 who are not married, a child shall belong to the community to which his or her father belongs ... (Article 2: Par. 7).
This patriarchal logic pervades other sociolegal institutions and respective provisions or regulations. Thus, if an alien man marries a Cypriot woman, he does not automatically acquire Cypriot citizenship, unless he fulfills almost all the conditions that any other alien must fulfil in order to acquire citizenship. If, however, an alien woman is married to a Cypriot man, she thereby acquires his residence as well as his domicile.
While there are often no specific laws determining discriminatory social practices, traditional norms and values may produce such outcomes. For instance, there is no legal provision that regulates the name the parties in a marriage should assume. The practice, however, as has been customary throughout much of the European Christian world, is that upon marriage a woman takes her husbands family name. Also, the children take their fathers family name except in the case of illegitimate children, who take the name of the father of their mother (Stavrou 1998).
In many other instances, the laws may provide for equality and prohibit discrimination, but traditional institutions and practices may still prevail. A most glaring case is that of divorce, traditionally governed by Church law, which entails different divorce provisions for husband and wife. Two reasons that may be invoked only by the husband as against his wife are: First, that the wife was found not to be a virgin on the night of the wedding, which has to be reported to the local Bishop the next day; second, that the wife spent the night with persons unrelated to her (unless she could not find a relatives house to stay for the night, after being ousted from the home by her husband).
The Constitution perpetuated these unequal provisions, by declaring marriage and divorce matters as the domain of the Church. It was much later, when Civil Marriage Law 95/89 amended the relevant article of the Constitution, to allow free choice of civil weddings for Greek Cypriots, and to place matters such as divorce, judicial separation, and family relations, under the governance of special family courts. The Church of Cyprus reacted strongly against these legal changes and exerts all kinds of pressure in order to retain control of the institution of marriage. Until today, the Church insists that civil weddings are illegitimate and refuses to offer perpetrators the services of baptism and other holy sacraments. These pressures by the Church, but also (and perhaps most importantly), the weight of long-adhered-to traditions explain why the vast majority of Cypriots (more than 70 percent) still choose religious, instead of civil weddings. Indeed, civil marriages between Cypriots account for only 3.6 percent of total marriages.
A similar situation prevails with divorce. The procedures for securing divorce through the Church are not only long and laborious, but they are also much more exacting and discriminatory against women. Nevertheless, because of the Churchs pressures and the special weight of adhered-to traditions, most Greek Cypriots prefer to put up with the difficulties of Church divorce instead of resorting to civil divorce. They are afraid of getting themselves entangled into a web of socially difficult or embarrassing situations. For instance, should one wish to re-marry in church after a civil divorce, one may find oneself accused of attempting bigamy!
Interestingly, on the issue of abortion, womens span of control or available choices seems to be much greater than in many other countries, even of the developed West. This seems to have to do as much with historical circumstance as with current social realities. Up to the early 1970s, the Criminal Code completely prohibited the practice and provided severe penalties for perpetrators. Developments related to the 1974 Turkish invasion drastically changed the situation when many Greek Cypriot women became pregnant after being raped by Turkish soldiers during the hostilities. Obviously, Greek Cypriot society was not ready to accept the offspring of the barbarians into its midst. Many Greek Cypriot men found it difficult enough to accept the raped women themselves, who were violated or shamed publicly. Even though the women resisted this violation of their bodies, the public consequences of the rape indirectly brought shame on their families, and especially on their men. As a consequence, the relevant law was radically amended to allow medical intervention for the termination of unwanted pregnancy in such cases. In addition, a provision was made for pregnancy to be terminated if two doctors advised that the life of an expectant mother would be in danger should pregnancy be allowed to continue, or in cases in which a newborn baby would face the risk of serious physical or mental disability.
These loopholes in the law effectively opened wide the doors for abortions under almost any pretext. Although hard data are not available, there are many indications that a large number of abortions are carried out in modern-day Cyprus. This may appear strange for a society that is still quite conservative on a number of other counts. Even stranger is the fact that there hardly appears to be much anti-abortion talk from any quarters, let alone an anti-abortion movement. Finally, the Church, though in theory opposed to all forms of abortion, seems in practice to be only paying lip service to a cause it does not really care to fight for. One suspects that the main reason for this is that the Church cares mostly to control not the private decisions but the public behavior and choices of Greek Cypriots, since it is the latter which serves as an index of its power.
Obviously the historical circumstances, outlined earlier on, explain to some extent why abortions were initially legalized and why, consequently, once the legal prohibition was removed, the door was opened for abortions for all kinds of reasons. But why did the phenomenon grow to much larger proportions? It seems that social change and new realities in contemporary Cyprus account for the remaining part of the answer. Indeed, in recent decades there have been fast-pace and drastic socioeconomic changes, which seem to have eroded traditional values and norms, without allowing the time for new norms to develop - the phenomenon of cultural lag. This is evident in the area of sexual relationships. Many young people are experimenting with sex in their relationships, something that contemporary open or liberated Cypriot society seems to allow. Yet the relationships of these young people with their parents (and teachers) do not seem to be so liberated as to allow for straight talk about sex and contraception - thus the many unwanted pregnancies and the use of abortion as an alternative to contraception!
Besides the young, many older people have problems with their marriage; hence the increasing rates of divorce. Both young and older couples also seem to be resorting to relationships outside marriage, which may again lead to unwanted pregnancies and abortions.
To the above must be added the fact that Cypriot males, and sometimes their women partners, seem to think that male contraceptives will somehow render lovemaking less natural and enjoyable. Thus contraception ends up being the sole responsibility of women. And if she has not taken the necessary precautions, they end up with unwanted pregnancies and abortions.
The ease of abortions may be an important explanatory factor for the fact that children born out of wedlock are rarely found in Cyprus. To this, of course, we must add the prevailing conservative traditional values, which view unmarried mothers as immoral, since they are seen to be flagrantly violating the sexual code and carrying the shame of dishonor. Because stigma is a certain outcome for childbearing outside wedlock, and because abortions are so easy to arrange, it is no wonder that illegitimate births are almost non-existent.
Cyprus has, in fact, introduced legislation (Law 243/90) to bring itself in line with the provisions of the relevant European Convention. An interesting example, which highlights all the above issues, concerned a case in the mid 1990s of an unmarried woman working in the Church-run broadcasting station (Logos). When she decided to go against convention and not hide the fact that she was pregnant, she was soon fired, as she was seen to be a case of embarrassment for her employer and a bad moral example for all. The fired woman sued the station and managed to win the case and be awarded compensation (Fileleftheros, 9 May 1995).
Another recent law, which aims to protect women from the abuse of traditional norms, relates to the Prevention of Violence in the Family and the Protection of Victims of Violence (47(I)/94). Such a law was of absolute necessity in Cyprus, where many men consider it their legitimate right to uphold their power as husbands and/or fathers in the family through any means possible, including violence, whether it be physical or psychological violence against wife and children, or sexual violence against the wife.
For many years, women in the labor force suffered various forms of discrimination as regards inequality in pay for similar work done, conditions of work, type of employment, and opportunities of advancement. Gradually, as a result of a number of factors, such as pressures from womens organizations and the trade unions, and political pressures emanating from the signing by the Cypriot government of various international treaties, the situation has substantially improved, at least as far as legal provisions are concerned. This has not, however, substantially improved the situation for all women, nor has such legal improvements dramatically improved the life of women.
A good example is that of social insurance legislation, enacted since independence, which provides for a marriage grant payable to working women when they marry, as well as a maternity grant and allowance, the former paid to a woman giving birth, the latter paid during a maternity leave of up to twelve weeks. Unfortunately, the plan does not cover self-employed women or unpaid family workers in agriculture who comprise approximately a third of the total number of economically active women. Furthermore, it does not cover thousands of women involved with unpaid housework, as this is not considered proper work. This means that a great number of Cypriot women, particularly older women, have to remain in a state of complete dependence on their husbands. Social insurance legislation has been modified appropriately, after ratification of the International Labor Organization Convention 100, and the Equal Remuneration Law (158/89), to provide for equal pay for men and women for work of equal value. This has decreased the gap between male and female wages, although it has certainly not closed it, since equal remuneration is practiced only by the government and a few large corporations, mainly banks, but certainly not by the private sector at large. Among the laws that seek to improve the legal position of women in employment is the termination of employment law (24/87), under which sex, pregnancy, or maternity can never constitute reasons for the termination of employment. Again, however, evidence shows that many employers tend to ignore the law, and that in such cases few women proceed to take legal measures against the perpetrators (Varnavidon & Roussou 1995).
Another interesting example, which illustrates how small an effect changes in laws can have on actual social practices, is the abolition of the pre-independence law (180), which prohibited the employment of women during the night. For many years following abolition of this law, social resistance to the idea of women working outside their homes during the night has been such that few women still dare to do so. The result has been an intense shortage of women working in jobs for which night duties are essential, such as nursing and paramedical occupations. For this reason, private clinics have been given permission to employ women from foreign countries. Also, Cypriot women employed in the Cypriot Police Force and the National Guard, as well as those working in the thriving tourist industry, are exempt from night duties.
Lastly, we should underline the fact that in 1985 the Cyprus government ratified the United Nations Convention (34/180) on the Elimination of All Forms of Discrimination Against Women (Law 78/85). This symbolized Cypruss commitment to eliminate all forms of discrimination against women in all spheres of life, be it education, politics, employment, family, or public life.
In summary, two major comments could be made about legislative change and its impact on Cypriot society. To begin with, most ratifications of international conventions and relevant laws were passed in the recent decades, after independence in 1960, but mostly after 1974. This suggests that, until recent times, concerns about equality and the protection of the rights of various underprivileged groups in society, including women and children, were not a primary issue, because traditional Cypriot society was based on conservative norms, values, and morals. Cypriot life revolves around the central social institution of the patriarchal family with the father enjoying controlling power over the behavior of the other members of the family, especially women, as the preordained order of things, legitimated by religion.
Modernization and socioeconomic change have contributed to an opening-up of society and the gradual espousal of more liberal values and norms. Thus, the introduction of the various laws outlined above. Yet, it seems that Cyprus is going through a period of transition, in which new values co-exist with traditional ones. This, as well as the efforts of traditional male and clerical power holders to cling on to their powers, seems to explain the persistence of inequality between the sexes and generations.
Women themselves have been slow to organize and push for their rights. Traditionally, the main domain of womens participation in public life has been that of voluntary institutions, especially charitable organizations. This is true especially for upper- and middle-class women, the roots of the phenomenon dating back to the formative stages of the bourgeois class in Cyprus and its ideals of keeping women away from the world of production, as queens in the private realm of the family, into which men would retreat after work. Womens involvement with charitable institutions was accepted and encouraged, because, in dealing with these, they could expend similar feminine services as the ones expended within the families themselves, namely care, love, and affection (Peristianis 1998). Voluntary organizations, and especially charitable ones, seem to have increased in numbers after the Turkish invasion of 1974, with the appearance of new social groups in need of support (Antoniou 1992). Interestingly enough, the leadership of most of these organizations is composed of men, with the exception of a handful of organizations, such as the Cyprus Red Cross and the Association for the Prevention of Violence in the Family.
Women from the working classes had a more prominent role in the trade unions, which started organizing early on in the twentieth century. The oldest such union, PEO (Pancyprian Federation of Labor), is controlled by AKEL, the communist party of Cyprus. SEK (Federation of Cypriot Workers) is controlled by DISI, the right-wing party, and DEOK (Democratic Workers Federation of Cyprus), is controlled by the socialist party EDEK. There are also strong autonomous unions representing government employees (PASIDI) and bank employees (ETIK).
In the labor history of Cyprus, women have fought alongside men for basic labor rights such as social insurance, improvements in wages, and shorter working hours (Pyrgou 1993). However, trade unions do not appear to have actively pursued womens rights for equality in the labor market. In fact, trade unions have accepted pay discrimination against women in labor agreements with respective employers (House 1987). It is interesting that the first law (in 1961), which provided for equal pay for women in the public sector, was enacted, not after trade union pressure, but as a result of a private prosecution by a woman employee who sued the Republic of Cyprus for not upholding the Constitutional Laws provision for equal treatment of the sexes.
Cypriot women have never gone on strike in pursuit of their specific rights as women. One possible reason for this may be the fact that, whereas all unions have departments dealing with womens matters, policymaking of these departments is directed by men (Antoniou 1992). Overall, although women constitute more than a third of the total trade union membership, they seem to exert little influence of their own.
A contributing factor is obviously the control of all general unions by the political parties, who are, once again, male-dominated, and whose primary objectives have to do with furthering their political ambitions. Even more surprising is the fact that womens organizations themselves seem to be controlled or strongly affiliated with political parties. Thus POGO (Pancyprian Organization of Women) is controlled by the communist party; Equal Rights and Equal Responsibilities is controlled by the rightwing party. The Socialist Feminist Movement and the Womens Organization of the Democratic Party are even more forthright in declaring their affiliation in their own names.
For decades now, the primary focus of concern for the political parties has been the ethnic conflict between Greek and Turkish Cypriots, the Cyprus Problem. This has overshadowed all other issues, including those concerning women, equality of the sexes, and gender relations. Even though the higher officers of these womens organizations have the opportunity to participate in the decision-making processes of the political parties, their voices are seldom strong enough to make a real impact, as the leading teams are always male-dominated. This becomes even more obvious in times of elections, as women candidates seldom if ever make it on parties lists. Because of prejudices and stereotypes, hardly any women who do make it onto ballots manage to attract enough votes to enter the House. In 1999, there were only three women members out of a total of 53 members. Women seem to do somewhat better in local government, where they appear to be increasing their numbers yearly. Of course, these posts hold negligible political power, so womens gains in this area do not amount to a serious improvement in their status or impact.
In traditional Cypriot society, marriages were arranged by parents and had nothing or little to do with the personal preferences of the young people involved. Often a young man coming of wedding age would suggest to his parents a particular girl of his fancy (usually a girl he found attractive in external appearance, but had little knowledge of - since girls were expected to practice male-avoidance, in order to protect their reputation and honor). If the parents approved of their sons choice, they would proceed to sound out the parents of the girl, usually through the services of a mediator/matchmaker. If the parents disapproved of the choice, their objections usually prevailed, as they were supposed to know best because they were older and more experienced. Obviously the girls opinion was rarely asked for and her freedom of choice was much more restricted than the young mans.
The paramount criteria for parents preferences had to do with considerations of their familys best social and economic interests - thus, they had to be satisfied with the economic well-being of the girls family, the status of her family in the social hierarchy of the village, as well as the moral reputation/standing of the girl and her family in the village. Obviously, a good choice for marriage would enhance both the material resources as well as the status of their family in the village community. Parents would give a dowry to the young couple as a material aid to help the newlyweds make a good start in their married life. The brides family would usually contribute the house plus furniture, kitchen utensils, household linen, and similar items. The bridegrooms side would provide some land and animals. Attalides (1981) notes that marriage settlements imply a bargaining process of matching the assets brought to the new household by the respective partners. Moreover, the practice of giving equal inheritance to all children means that parents must be aware so that what they give to one child at the time of marriage does not jeopardize the share of any remaining children. In this situation it is understandable that control of pre-marital sexuality should be extremely strict for girls. Thus, if a girl acquires a bad reputation, the bargaining power of a potential husband is enormously increased, allowing him the chance to make virtually extortionate demands for a property settlement, thus incapacitating the domestic group from provision for further children (Attalides 1981). Of course, property considerations were only one set of reasons for the adherence to a strict moral code of behavior for women, but they were surely an important set.
The above constitutes one more set of reasons why families had to always be vigilant of the reputation of their women. Young women had to maintain their chastity until their wedding day. If a womans sexual purity was questioned, she risked her chance of ever marrying. Virginity was a necessary condition of a womans moral integrity and the principal prerequisite for marriage. It should be remembered that virginity did not entail only the physical purity of a girl, i.e., an intact hymen, but implied that the girl should avoid any social contact with men that is automatically associated with sexual desire (Markides et al. 1978).
So important was the value of female purity that during wedding celebrations the visual display of the bloodstained sheets, proving the brides virginity, had central importance. It has been noted (Argyrou 1996) that the virginity rite expressed female subjugation but also the wider subjugation of younger people of both sexes to their elders and in particular their parents, for the rite symbolized in a tangible and indisputable way that the parents had been managing and controlling the family well. Argyrou (1996) demonstrates how changes to the rite, leading to its disappearance, reflect changes in the power relations between the older and younger generations, as well as between the sexes. The first set of changes became visible in the 1940s, when new employment opportunities were created, giving young men the opportunity to move to the towns for jobs. The sons of wealthier parents moved to towns in order to obtain secondary education. Eventually, with mass education, this became true for all classes and for both sexes. Youngsters were now exposed to new ideas and values through books, magazines, and newspapers. Overall, opportunities for economic independence and education decreased the dependence of the young on their parents and eroded the latters authority and powers of control, as children could be more knowledgeable or competent than their parents in some areas.
Other developments also contributed to the changing nature of power relationships between generations. For instance, a young man moving to a town often found it practical to stay with his in-laws, so that his fiancée and mother-in-law could look after him and he could also save money to contribute to the costs of building a house. This practicality made vigilant observation of the engaged youngsters difficult for the parents. It also meant that parents themselves chose to avoid the embarrassment of asking for evidence of a brides virginity, whereas the couple itself increasingly considered the matter their private affair rather than a public spectacle. By the late 1960s and 1970s, the practice of having fiancees move in with their in-laws became generalized and engaged youngsters were sleeping together with the parents knowledge and implicit consent. Loizos (1975) notes that, in fact, by the 1960s, youngsters had acquired power to veto their parents choice of marriage partner. Balswick (1973) points out that by this time young people considered romantic love to be of primary importance, and this development was responsible for the challenging of parentally arranged marriages. The concept of romantic love was related to changing sexual standards. For if love was felt to be a prerequisite for marriage, then only the young people themselves could determine the existence of love, and this entailed a certain amount of familiarity with members of the opposite sex. Thus dating started becoming common.
Such developments cannot be taken to imply that youngsters have now been liberated from traditional values and that virginity and female chastity are no longer important to men. In fact, as Argyrou (1996) reminds us, what has changed has mostly to do with the timing of sexual access to the bride. Furthermore, the traditional double standards, requiring a woman to be a virgin till she marries but not so the man, are still prevalent in Cypriot society. Similarly, although some expected that modernization and romantic love would lead to the demise of the dowry system (Balswick 1973), the practice seems to be going strong with some minor changes. Nowadays, the brides parents are still the ones who contribute to the house and most other items needed for setting up the new household. The grooms parents are expected to have invested considerably in their sons education, which will have led, or hopefully will lead in the future, to very good employment.
After 1974, with the displacement and impoverization of a third of the population who lost all their wealth and became refugees so they could not give any dowry to their children, the tradition suffered a setback. However, traditional values and expectations were so strong that the state was pushed to donate land or money to all unmarried daughters of refugee families as a form of dowry for establishing their own households in the free south. Besides, the economic recovery and boom after the 1980s has enabled Cypriots to continue with the practice (Stavrou 1992). Some analysts point out that the willingness of Cypriot parents for deferred gratification in order to invest in their childrens dowry, may actually itself be one of the main reasons for the continued success of Cypruss economy (Balswick 1973, Mavratsas 1992). The above realities may account for an interesting paradox, revealed by social surveys. On the one hand, young Cypriots claim that love is what is important in marriage and that the giving of a dowry is an outdated practice that they do not believe in. On the other hand, they say that parents should help with a house and in other ways so the young couple can make a start in life(Intercollege, 1996). This seems to vindicate Argyrous (1996) position that we are looking at developments in sexual mores and related practices, which are the result of a struggle in which children won a dominated freedom and parents retained partial control through compromise.
In Cypriot society, the religious attitudes and beliefs of the Greek Orthodox Church exercise a strong influence on the sexual attitudes and behavior of the people. Some insight into this factor can be gained from the responses of Greek Orthodox priests to a semi-structured questionnaire regarding seven sexual topics: a) adultery, b) premarital sex, c) masturbation, d) abortion, e) contraception, f) homosexuality, and g) coital abstention. There were 130 (23.2 percent) responses from the total of 560 questionnaires distributed to all priests on the island, followed up with face-to-face interviews of 27 of the priests (Georgiou, 1990).
On the issue of premarital sex, the priests were asked for their pastoral response to the following situation:
A young, engaged Christian couple who has been cohabiting for three years is very much in love, but they cannot marry immediately as they have a number of difficulties. As they do not want to have sexual intercourse before the marriage ceremony, but are involved in heavy petting, they approach a priest for advice. (Georgiou, 1990)
For their pastoral advice, the priests chose the following:
A thematic analysis was performed using subjective responses based on 14 mutually exclusive general categories. The responses were: The couple:
Face-to-face interviews with the 27 priests revealed what appeared to be a confused attitude toward premarital sex. They offered a variety of legalistic definitions of premarital sex, which dichotomized sexual acts into acceptable or not acceptable. Some, for example, drew the line of acceptability at light kissing between a couple engaged to be married. Others drew the line at a light caress, rejecting all other sexual expressions as either unacceptable or sinful, and so on and so forth. There was also no consensus as to why premarital sex was a sin. The majority said that it was a sin because the Orthodox Church said so. None of the priests, however, could refer to any specific writings of the Orthodox Church to validate their claim. (See other responses from this survey of priests on homosexuality in Section 6B, on contraception in Section 9A, and on abortion in Section 9B.)
There are no specific government policies and programs for sex education. There are no formal sex education programs taught in schools beyond the biology lessons, which cover subjects such as the anatomy and physiology of the reproductive organs, fertilization, twins and genetics, sexually transmitted diseases, changes during puberty, and birthing. These lessons are normally taught by biology teachers, and it is left to their discretion to answer specific questions that may be raised in class. These lessons are taught from the age of 15 upwards.
There is an element of informal sex education from organizations such as the Family Planning Organization, but this only covers specific groups of people, such as married women seeking gynecological or family planning assistance, soldiers doing their National Guard service, and other minority groups. There is also some teaching in hospitals and schools, but limited staff does not allow for further expansion.
When the main author arrived on Cyprus from the United Kingdom in 1983, there were no explicit sexual articles published in the Cypriot media for fear of reprisals. I wrote my first article on Cypriot male sexuality during this period, but found it impossible to find an editor willing to publish it in their newspaper, as it contained words such as penis and vagina. There seemed to be an inherent fear of publishing sexual articles of any nature, as the editors believed that there would be a volcanic eruption from the Church and the conservative people of Cyprus. They could not have been further from the truth! When a brave editor of a relatively small, radical right-wing newspaper decided to publish the article, there was applause from many sectors of society; one of the long-lasting but superfluous taboos had been broken! Cypriots were thirsting to learn more about sexuality. After the newspaper editors initial enthusiasm, I proposed a weekly column, which would allow people to write in their problems anonymously and receive replies in the newspaper. He agreed, and the first sexual column in the history of Cyprus was launched in 1984 in the newspaper Alitheia (The Truth). The sales of this particular small newspaper increased dramatically in just over a year!
The degree of sexual ignorance from the questions being received was apparent: Can I get pregnant by swallowing sperm? What is the clitoris? and many, many other questions touching on topics such as anal sex, transvestitism, telephone sex, and sexual problems. At least a dozen letters were received every day. The columns gave people from all age groups and all walks of life an opportunity to write their questions or problems about sexuality, and get a response published in the media for all to read. The weekly column in the popular magazine To Periodiko, which ran from 1984 to 1994, reached a peak audience in excess of 30,000 people weekly. More than 1,000 articles covering all aspects of sexuality were published during this period. This, along with a weekly radio program titled Human Sexuality, broadcast live every Saturday at lunch time by the author, covered a wide variety of sexual topics and provided a large part of the informal sex education of the population. After a few years, other newspapers began to publish articles, usually translated from foreign magazines. Beginning in September 1999, this editor completed a series of six television programs on human sexuality for EF-EM, a local TV station in Larnaca. (See Section 10, Sexually Transmitted Diseases, for survey data on the knowledge of adolescents regarding STDs.)
In the Knowledge, Attitudes, Beliefs, and Practices (KABP) Survey on AIDS (Georgiou & Veresies, 1990, 1991; see also Sections 5B, Interpersonal Heterosexual Behaviors, Adolescents, 6A, Homoerotic, Homosexual, and Ambisexual Behaviors, Children and Adolescents, and 11C, HIV/AIDS, Availability of Treatment, Prevention Programs, Government Policies, below), 3,176 15- to 18-year-old school children gave us additional insights into their sources of sexuality information. The respondents reported receiving their first sexual information from five main sources: books and periodicals (24.1 percent), newspapers and magazines (15.4 percent), friends (12.0 percent), videos (12.3 percent), and television (12.2 percent). It is not clear from the questionnaire, however, who is actually providing this information in the sources mentioned. Sex differences showed that the boys were more likely to obtain their information from videos (9 percent v. 3.3 percent), probably commercial pornography, while the girls were more likely to obtain their information from books and periodicals (14.7 percent v. 9.4 percent) and mother (4.4 percent v. 0.6 percent). It appears that newspapers and magazines are read equally by both. Subsequent sources of additional sexual information included: television (13.2 percent), school teachers (12.3 percent), and medical personnel (11.7 percent). The same sex difference as those noted above emerged, with the exception of books and periodicals, which are again read equally by both sexes.
When asked, Where would you prefer to get information about human sexual behavior? (Circle only your first choice), the great majority of respondents preferred to obtain their information from books and periodicals (24.1 percent), followed by newspapers and magazines (15.4 percent), friends (12.6 percent), videos (12.3 percent), and television (12.2 percent). All the other responses were below the 5 percent level.
It should be noted here that there are no known sex education videos circulating in Cyprus, apart from the commercial pornographic videos that are freely available for rental in most video shops, certainly before the clamp-down on piracy came about. It therefore appears that 12.3 percent of the respondents are obtaining their information from pornographic videos. When asked to name their second preferred source of sexual information, students listed books and periodicals (16.1 percent), newspapers and magazines (14.2 percent), television (13.7 percent), videos (12.7 percent), and friends (11.4 percent). The remaining responses were below the 5 percent level. Sex differences showed that more males than females would prefer the radio as an important second source of sexual information (108 males v. 46 females), newspapers and magazines (105 males v. 70 females), television (224 males v. 194 females), and videos (111 males v. 38 females). More females than males would prefer sources such as books and journals (153 females v. 137 males), mother (191 females v. 56 males), and doctors and nurses (226 females v. 143 males).
The survey gave no information regarding the specific books, videos, and magazines that students used, or how accurate the sex information was. Moreover, it is not clear how the students interpreted the question, From where do you get information about human sexuality? in a country where human sexuality courses have never been taught formally at school. Under the circumstances, the concept of human sexuality may be a difficult one for teenagers to interpret.
The only data available on child and adolescent autoerotic behavior comes from retrospective histories taken with a clinical sample of 840 patients whom the main author saw in clinical practice between 1993 and 1996. While male masturbation in this sample is far more prevalent than female masturbation (85 percent v. 15 percent), approximately 50 percent of masturbating females felt guilty about this behavior compared with 48 percent of males.
It appears that parents also have fears of the female losing her virginity if she is allowed to play about down there! Virginity is related to the honor (timi) of the family, and this is very carefully guarded. Males, on the other hand, are often encouraged and cajoled to continue, if they are caught fondling their genitals in infancy, as this is seen as a normal part of growing up. Given that the females get rather negative messages when caught masturbating, and indeed may be chastised for this behavior, then it is perhaps not a surprise to find that only 15 percent of the females in this sample masturbated.
Still, it may be a little surprising that such a large number of Cypriot girls begin masturbating at such a young age, before age 10. One of the factors is certainly the early growth spurt that females have in relation to boys, but there are probably other explanations also. Most males learn how to masturbate from their friends (77 percent) compared to only 26.5 percent of females. The majority of girls, however, learn to masturbate by themselves, through experimentation or accident (54 percent), compared to fewer boys (21 percent) that learn in this way. Again, more girls (19 percent) learn to masturbate from the media, books, magazines, and the like compared to about 2 percent of boys. It appears that girls tend not to talk as openly as boys do with their peers about masturbating, and therefore this is not the source of their information. Girls, it appears, prefer to find their sexual information from books and magazines, and self-experiment in the privacy of their own home.
The main authors clinical experience has shown that there is a widely reported incidence of childhood masturbation from infancy to nursery school age. These cases are often reported by parents and are accepted by parents and caretakers if the child is male, and it is often joked about: Hes as potent as his father. Look, hes started young. If the child is female, such behavior is often frowned upon, with punishment as a consequence if it continues. Over the last decade, I have had a number of parents coming to the clinic to discuss the normality of their young infant daughters masturbatory behavior, sometimes in horror that their little innocent should be capable of such disgusting actions! I have yet to see a parent come to discuss their sons masturbatory behavior!
There are no data available for adult masturbation, but from anecdotal evidence in clinical practice I would say that adult masturbation in a stable relationship is quite rare for both sexes. There are the few occasions when masturbation is reported by a married man who has problems approaching his wife sexually because of marital discord, but this occurred in less than 1 percent of the clinical population. I believe that the Cypriot male views masturbation more as a childs thing, and not the sort of thing that a man does, unless compelled to do so by circumstances.
Women, on the other hand, will often refuse to masturbate even when the husband is in therapy, believing that coitus is the proper thing. They prefer not to become part of the therapy until it reaches a stage where coitus is allowed. It follows from this that the treatment of anorgasmia using the traditional European or American treatment protocols is doomed to failure in Cyprus, as masturbating to orgasm is the essence of this therapy. (In Cyprus, one has to be a very creative sex therapist to succeed!)
No data have been gathered to date regarding childrens sexuality or sexual rehearsal play in Cyprus.
The only systematic survey that has been conducted to date in Cyprus regarding adolescent sexuality involves a sample of 3,176 (1,528 male and 1,643 female) Cypriot lyceum students conducted by Georgiou and Veresies in 1990 and 1991. The Knowledge, Attitudes, Beliefs, and Practices (KABP) Survey was organized and completed along the lines of work carried out by the World Health Organization (WHO), the Global Programme on AIDS, the Social and Behavioral Research Unit (SBR), the Cyprus National AIDS Committee, the Ministry of Health, and the Ministry of Education in Cyprus. The whole project was headed by the main author of this chapter as the WHO Principle Investigator.
Even though the premise of the research was to look at the knowledge, attitudes, beliefs, and practices of Cypriot adolescents toward HIV infection and AIDS, many of the 177 questions in the survey touched on other aspects of human sexuality. There were two questionnaires, one for high school adolescents and another for head teachers. A multistage random cluster sampling strategy was used to obtain data for the survey, using 27 schools - 20 (79.2 percent of the sample) in urban areas and 7 (20.8 percent) in rural ones. The 177-question survey was answered anonymously, and covered the following areas: sociodemographics, sources of information on AIDS, knowledge of AIDS, attitudes and beliefs about AIDS, attitudes toward people with AIDS, knowledge of sexually transmitted diseases (STDs), leisure-time activities, perceived norms in certain health-related behavior, drinking and drug abuse, attitudes about condom use, and sexual behavior.
Three quarters of the adolescents (76.7 percent) surveyed have experienced hugging at least once. Of these, the majority were boys (1,340 boys v. 1,075 girls). One in six (15 percent) of the boys and one third (32 percent) of the girls were sexually inexperienced, not having engaged even in petting. About half of the students have experienced deep open mouth kissing and some sort of petting above the waist. Again the majority of these were boys (963 boys v. 439 girls). About one third have petted below the waist (850 boys v. 289 girls) and a further one third have slept together without sexual intercourse (628 boys v. 242 girls). Sexual intercourse was attempted by approximately one quarter (18.6 percent) of the students (550 boys v. 97 girls), which means that about 94 percent of the girls and two thirds (66 percent) of the boys were technically still virgins, even though they may have had other sexual experiences.
Judging from the figures for sex differences, it appears that the boys are not having sexual intercourse with the indigenous females. This raises the question of who their sexual partners are. Is it mostly with prostitutes, either local girls or imported artists, or is it with tourist girls? This data does not answer these questions, but they are definitely worth further investigation because of the implications for HIV transmission.
A further 25 percent of the respondents reported experiencing oral sex at least once (563 boys v. 103 girls).
There is no doubt that the most dangerous sexual activity in terms of contracting HIV is receptive anal sexual intercourse. Masters, Johnson, and Kolodny (1988) point out that the risk from a single episode of anal intercourse with an infected partner is considerably higher than with other sexual activities - probably on the order of one in 50 to 100. Just over 15 percent of the respondents reported experiencing anal or rectal sex. Of these the majority were boys (424 boys v. 41 girls). It would certainly be worth investigating further whether the boys had homosexual or heterosexual anal intercourse, whether they had used a condom, and whether they were the receptors or the perpetrators. It is also not clear why there should be so many boys participating in anal intercourse. If the large majority of girls were involved, this would be understandable given the patriarchal attitudes that prevail in Cyprus regarding the preservation of a girls (technical) virginity. Perhaps the males are using anal sex as a means of birth control.
Among the 19.4 percent of respondents reporting having had vaginal intercourse, 11.7 percent (296 males and 75 females) reported having had one or two sexual partners, 4 percent (123 boys and 5 girls) between three and six partners, and 3.7 percent (115 boys and 4 girls) admitted to seven or more partners.
Of those who reported vaginal intercourse, the most frequent age of first intercourse was 14 to 16 years old, 14.4 percent (see Table 2). Girls showed a marked increase in sexual intercourse starting at age 15, whereas for boys a marked increase was noted after age 13. The figures for the 11- and 12-year-olds appear to be rather high on first impression and need to be examined further (see also Table 6.)
Table 3 shows the most common reasons given for having a first coital experience. Eleven males and only two females reported being raped; from anecdotal clinical evidence, male adolescent rape is uncommon in Cyprus.Contraceptive and Prophylactic Condom Use. Knowledge and use of condoms is another important area of adolescent sexual behavior, with 2,298 (72.4 percent; 1,378 boys v. 915 girls) admitting they had seen a condom, and 65.6 percent (1,312 boys v.771 girls) saying they knew how to use them. Of the roughly one-in-four teens who had had sex, 6.7 percent (168 boys and 45 girls) had never used a condom, 7.0 percent (193 boys and 7 girls) had used a condom sometimes, 3.6 percent (108 boys and 7 girls) most times, and 3.9 percent (110 and 15 girls) always.
These findings have dire implications for HIV and other STD transmission. Only one in five students who had had sexual intercourse at least once had always used condoms. Three out of four were unprotected sometimes or all of the time. Moreover, it is not clear from the question whether the condom was used correctly or not, whether it was placed on the penis before any type of intromission, or whether it was placed on the penis just before ejaculation for purely contraceptive purposes. It is also not clear whether the condom was used for other sexual practices such as anal and oral sex, which are also high-risk behaviors. These issues can be incorporated into any safe-sex and health education program.Kinds and Duration of Relationships. The disparity between a much higher incidence of sexual intercourse for Cypriot males and a much lower incidence for females raises the question about who the females are that these young men are having sex with. Questions were asked regarding the age of the sexual partner, the duration of the relationship, and the demographic identity of sexual partners. Given the very high influx of tourists every year - for the past six or seven years tourists have outnumbered the indigenous Cypriots - questions were asked that differentiated between the kinds of sexual partners Cypriot men and women have. Table 4 analyses the responses to these questions.
It appears that there are a large number of long-standing relationships with indigenous Cypriots. A total of 434 students (13.7 percent) said that they had a long-standing relationship with someone their own age. Of these, there were many more boys than girls (346 boys v. 88 girls). A further 146 (4.6 percent) admitted to having sexual intercourse with a Cypriot partner their own age whom they had recently met. Again, the majority of these were males (126 males v. 20 females).
Another category of partner preference that has implications for HIV transmission are the large number of students who had sexual intercourse with tourists their own age whom they had recently met. The overwhelming majority of these were boys (236 boys v. 13 girls). Another equally potentially high-risk behavior was with tourists their own age whom they had known a while, even though it is not clear how long a term is indicated by a while. Of these, again the majority were males (181 males v. 14 females). To the list of potentially high-risk partners could be added the students who had coitus with older tourists whom they had just met (120 males v. 12 females), and the older tourists whom they had known for some time (77 males v. 15 females). Further potentially high-risk partners would include Cypriot prostitutes (212 males v. 4 females) and foreign prostitutes (133 males v. 7 females). It is not clear why there are a small number of females in the prostitute categories, as it is unlikely that they frequented a male prostitute. Perhaps they misinterpreted the question to mean that they themselves were paid for having sexual intercourse - there have been such known cases in Cyprus among the student population.Cohabitation. In response to the question, Have you ever lived with a man or a woman as a regular sexual partner without being married? 148 (4.7 percent; 134 boys and 14 girls) said that they had cohabited with a sexual partner before marriage. Teen Pregnancy. A total of 73 boys said that they had made their partners pregnant, and a further 11 girls admitted to being made pregnant by their boyfriends. Age of Marriage. Table 5 summarizes the results of the question, At what age would you like to marry?
It is clear that far fewer males (9.4 percent) than females (69 percent) are virgins when they become engaged or marry. Family honor is at stake because of the prevailing belief that a non-virgin or soiled bride should be considered a second-rate citizen in no way equal in social and ethical standing to a virgin bride. Indeed, many brides-to-be have been accused of not being a virgin by their fiancés on the first night. This often results in both families getting involved, taking the female by force to be examined by a gynecologist, and deciding whether the couple should stay together based upon the doctors diagnosis. Needless to say, such affairs are extremely degrading for the female involved. Even if the couple decides to stay together, there is no guarantee their relationship will stabilize and survive. In my clinical practice, I have encountered many cases of males who believe that virgin females should bleed like a chicken with its head chopped off!
The males expect to see much blood on the sheets, and if this does not happen - which inevitably it does not - then the accusations will begin, and the horrid saga begins. (See also comments on premarital sex under Sociolegal Status of Males and Females, Children and Adults, in Section 1A.)
Non-virgins before marriage who have slept with a partner before making a firm commitment to marriage will often visit a gynecologist and ask for a hymenorrhaphy or hymen-repair operation. This is one way of fooling the potential husband and avoid being ridiculed and belittled by the expert spouse who thinks that he has the ability to differentiate between a virgin and non-virgin with his penis on the first night. My national live radio program at Radio Proto (1991 to 1992) and my advice column in the best-selling national magazine To Periodiko received many questions about hymen-repair operations. Gynecologists I spoke with admitted performing at least two or three such operations a week, for a total of thousands annually on the island.
Tables 6, 7, and 8 summarize some responses from the authors clinical population of 840 adults. There appears to be quite a range in the frequency of sex, with a fairly even spread between the sexes (Table 8). About two thirds of the sample have sex more than twice weekly, with the remaining third less than once weekly. Remember that this is a clinical sample that has come for sex therapy for some sexual dysfunction or other, which inevitably adversely affects the frequency of lovemaking. This picture may not be so representative of the general Cypriot population. My guess is that, given our Mediterranean temperament, we Cypriots are generally more hot-blooded than this!
There is a clearly significant difference between the sexes regarding the number of sexual partners in their lifetime (Table 9). Two thirds of the women tended to stick with only one partner mostly, compared to about 7 percent of males, while very few women have more than two to three partners compared to males (8 percent of females v. 73 percent of males). Whether this reflects the difference between the sexes or the inhibitions and taboos that exist in the Cypriot culture is not clear; the editors guess is that the taboo placed upon female promiscuity by family and society is certainly a hindrance to moving from one partner to the other. Certainly, females that are likely to have multiple partners that are known in society will be labeled with very nasty names, such as used, prostitute, ethically free, and others. These females tend to have difficulties finding a marriage partner, particularly if their behavior is well known. Usually when a marriage is about to take place, both sets of parents will begin conducting an informal character assessment by asking various individuals in the close community of the prenuptials for a character reference. If the girl has a bad name in this community, then this will be reported to the potential bridegrooms parents who will strongly advise their son not to proceed, and will continue to stand as an obstacle until their son sees sense! These societal norms and taboos are enough for young girls not to consciously want to repeat one mistake twice or more.
About one third of males and one fifth of females had never experienced giving or receiving cunnilingus (Table 10). A very small percentage of males tend to dislike giving cunnilingus (7 percent), whereas a much larger number of females dislike the act (21 percent), which could be for a variety of reasons. The most common reason cited by women in this sample was the partners inexperience, his ignorance about the clitoris, and his or her belief that the vagina is the most stimulating and sensitive of areas. Also cited were the inhibitions of females who feel that they are dirty down there, or that coitus is the only acceptable form of sex.
Not surprisingly, very few males do not enjoy being fellated - these being in the older age groups, which tend to be a lot more conservative in their sexual behaviors. About a fifth of the women in this clinical sample did not like giving fellatio to their partners, again probably related to taboos and inhibitions rife within the Cypriot community. Over a third of the men and a quarter of the women had never experienced this sexual behavior, but again these tend to be in the older age groups above 50 years old in the lower working social classes. Certainly one third of the women thoroughly enjoyed it, as did well over half of the men (Table 11).
A majority of the men and women who reported experimenting with anal sex appear divided about equally between those who tried it once or twice and those who were a bit more persistent, trying it three to six times before deciding not to continue with this sexual outlet (Table 12). A third of the women and 44 percent of the men who tried anal sex appear to have incorporated this outlet into their sex lifestyle on a perhaps more regular basis, despite the disapproval of this behavior by the Greek Orthodox Church and despite it generally being considered a no-no by most couples. Perhaps one of the reasons for its fairly widespread occurrence among both sexes is the availability and popularity of pornography. Additional questioning of this clinical population revealed that it is mostly the male who will subtly coerce his partner into trying it, mostly for the sake of experimentation, after viewing anal sex on a pornographic video. In many cases, the reaction of the wife will determine the frequency of anal sex thereafter.
Unfortunately, there has been no epidemiological study of the sexual behavior of Cypriots. This small clinical sample is the only data available at present and it is limited by focusing on details of sexual functioning among a group of people who at some point in their lives developed a sexual dysfunction. In my opinion, this does not necessarily mean that the sexual histories and behaviors of these particular people differ from those without sexual dysfunctions, as this sample of people were also likely normal - without dysfunction - at some point before they decided to seek sex therapy. Their dysfunctions did not exist all their lives. The ideal, of course, is to have a methodologically sound, longitudinal epidemiological study with a substantial random sample of subjects. The lack of funds at present has made this very difficult to impossible.
See comments under Sociolegal Status of Males and Females, Children and Adults, in Section 1A.
Many adolescents have some kind of sexual interaction with same-sex peers. This fairly common behavior, particularly among young adolescent males, might best be referred to as homoerotic rather than homosexual. Sorenson (1973) found that about 9 percent of young people in the United States had one or more sexuoerotic experiences with someone of their own sex between the ages of 13 to 19. The likelihood of homoerotic activities in adolescence is significantly greater among those who have had same-sex experiences prior to adolescence. Indeed, most adolescents have their first homoerotic experience with another adolescent.
In the Knowledge, Attitudes, Beliefs, and Practices (KABP) Survey (Georgiou & Veresies, 1990, 1991), about 34 percent of the respondents reported having hugged someone of the same sex at least once. Of these students, the majority were girls (722 girls v. 354 boys). A further 7.9 percent had kissed passionately and a further 5.3 percent had petted above the waist - of these the majority were males. Table 13 summarizes the frequency of various sexual activities with a same-sex partner.
The majority of students who reported experiencing same-sex anal intercourse were males (141 males v. 9 females). It is not clear, however, how these 9 females could be involved in homosexual anal intercourse, unless it was taken to mean anal penetration by a homosexual boy or with a dildo, but the likelihood of this is probably very small. These results are probably because of a misunderstanding of the question, or ignorance regarding anal sex.
When asked, With how many people of the same sex have you had oral or anal sex? 88.7 percent reported never experiencing oral or anal sex with a same-sex partner. An additional 4.3 percent had attempted homosexual oral or anal sex with between one to two partners (119 males v. 18 females), and 1.2 percent had with three to six partners.
It appears that the majority had their first homosexual experiences when they were between the ages of 13 to 16 (see Table 14). During these ages, 5.5 percent of the respondents reported having their first homosexual experience. There may be a latent period for homosexual experiences at the age of 12, but this cannot be confirmed by the data. It has been shown by Kinsey and his co-researchers that the age of puberty is related to the age of the initial sexual experiences, including homosexual ones. It is not clear from the data, however, when Cypriot boys reach puberty, even though it might be presumed that it is younger than 11 years old for some boys.
The authors clinical sample of 840 patients cited earlier gives us some idea of homosexual and bisexual behavioral practices in a group of men and women seeking help with some sexual problem or dysfunction. A second bias in this data is the gender balance, with 597 males to 243 females.
The respondents were asked during history taking if they had ever been approached sexually by another person of the same sex. This opening question was chosen as much less threatening than asking whether the client had actual same-sex experiences. If the response was yes, then they were asked simply, What happened? Of the total number of responses, 12.4 percent of the sample admitted to some type of sexual contact to orgasm with a same-sex partner; 11.6 percent were male and 0.8 percent female.
In order to avoid polarizing the population into homosexual versus heterosexual, the following clinical data were collected using the sevenpoint rating scale of heterosexual-homosexual attraction/behavior devised by Alfred Kinsey (1953).
It seems clear from the data that the majority of people who admitted to some type of homosexual contact or experience were Kinsey 1 or 2 (13.1 percent), with very few, 1.7 percent, in Kinsey 5 and 6. This indicates the transitory experiences of these people with a same-sex partner. Indeed, all of the male experiences, with the exception of eighteen cases discussed below, were age 18 to 20, the age when all Cypriot males are required to do their National Guard training as a soldier in an army camp for twenty-six months. It was during this period in the National Guard that most of these experiences occurred. Most of these young soldiers would be picked up by homosexuals cruising the scene and taken to their army camp. The deal would be struck in the car, and most of the time they were offered a small sum of money ranging from ten to fifteen dollars (US) in exchange for services, which meant the homosexual fellating the soldier, or the soldier penetrating the homosexual anally, but not the reverse. With most soldiers, this activity was a one-time experience; with a few, it was repeated two or three times.
The five exceptions that had not had these types of army experiences had encountered homosexuals while studying abroad, and they behaved in a similar fashion to what has been mentioned above. The other 18 males had a specifically homosexual orientation, and their homosexual experiences were more varied and more frequent. These homosexuals had voluntarily entered same-gender relationships, and their interest in opposite-sex partners was very limited. The women were mostly patients who had come to specifically discuss their sexual orientation, and they were involved with a single partner with whom they had fallen in love. All were married at the time.
*Note: The following perspective on homosexuality in Cyprus was provided by Alecos Modinos, B.Arch., A.R.I.B.A., president of the Gay Liberation Movement of Cyprus, and a chartered architect.
For centuries, this island, which is now an independent country only a hundred miles from the coast of Lebanon, was a model of social and familial conservatism. Family ties were close, the patriarchal concept was entrenched, and strict social mores were enforced by both Church and tradition. The pattern of life, while not unduly exciting, was extremely stable nevertheless.
Abruptly, in just a few short weeks twenty-five years ago, the pattern of centuries was destroyed when Turkey invaded and occupied almost 40 percent of the country. A great percentage of the population lost their homes and jobs, and fled to the southern half of the country before the advancing armies. Thousands were killed or injured and another 200,000 became refugees.
In those short weeks, the entire social fabric of Cyprus was destabilized. Family ties were abruptly loosened or disappeared altogether in the chaos that followed, and even now, 25 years later, there are still over 1,600 missing persons as a result of the invasion. In a small island-state of less than 700,000 people, the effects of the invasion and continuing occupation were profound.
In May 1989, the following headline appeared on the front cover of a popular national magazine and in daily newspapers: Homosexual Accuses Cyprus to the Council of Europe for Violation of His Human Rights. The article clearly demonstrated how many journalists were not only prejudiced, but knew very little about the subject. Cyprus is one of the few member countries of the Council of Europe that until very recently had not abolished its anti-homosexual laws. The existing criminal law, CAP 154, articles 171-174, considers homosexual acts a criminal offense punishable by five to fourteen years imprisonment. This law was influenced by the British Colonial occupation of the island between 1878 and 1960, and was incorporated in our legislation in 1929 in accordance with the British Criminal Law Amended Act of 1885, a good reflection of the Victorian period! In Britain, the 1885 anti-gay law was abolished with the Sexual Offenses Acts of 1967, but this had no effect in Cyprus, which by then was an independent state. Cyprus thus was left with an outdated colonial law that Britain had abolished 32 years ago. Homosexuality between women is not a criminal offense, but is completely ignored by the law as if it does not exist at all.
The first discussion on homosexuality was organized by the Pancyprian Mental Health Association in the fall of 1979. In the spring of 1982, a two-day seminar was organized by the same association on the same subject. About 500 persons attended; the great majority were women, and the absence of men was obvious! As a result of the second seminar, five gay men began working together. Five years later, after many difficult and laborious efforts, 16 gay men and a lesbian founded the Gay Liberation Movement of Cyprus on December 10, 1987. As of January 2000, less than half-a-dozen persons have come out of their closet, while the remaining hundreds of gay men and women members of the Gay Liberation Movement still remain in the closet for fear of reprisals.
From 1989 onwards, with great caution, two radio stations arranged live interviews with a gay man who answered questions from listeners calling in. Between 1991 and 1992, in a regular weekly radio program titled Human Sexuality presented by the main author of this chapter, homosexuality was included as a topic on three separate occasions. After this initial exposure on live radio, homosexuality was more openly discussed on a few other private radio and television stations.
On the December 6, 1990, the European Commission decided unanimously, with 15 Commissioners, in the case Modinos v. Cyprus that Cyprus was violating the human rights of homosexual people. The case went to the European Court, as the Government was reluctant to reform the law. Following a hearing on October 26, 1992, the European Court decided eight to one on April 23, 1993, that Cyprus was violating the human rights of homosexual persons, and ruled that the antiquated anti-homosexual law of 1885 must be abolished. The sole dissenting vote was cast by the judge from Cyprus.
The Greek Orthodox Church bitterly opposed this law reform and was supported by the majority of the members of Parliament. However, after a lot of pressure from the European Council of Ministers, over a period of five years, a week before the third ultimatum given to the Government was to expire, the Cypriot Parliament very reluctantly reformed the law in May 1998.
The new law, made to the satisfaction of the Church and the majority of the opposing Members of Parliament, was found unacceptable by Amnesty International, the human rights organizations of the island, practically all the Pancyprian scientific organizations including the Family Planning Organization, the Gay Liberation Movement and, on September 17, 1998, by the European Commission. The amended law, which the Cypriot government submitted in early 1999 to the European Council of Ministers, was rejected because it was full of discriminations. The Cypriot government planned to rewrite the law and submit it again in 2000.
The Cyprus government was obliged to revise the 1999 law in May 2000 because of the disciminations that were not accepted by the European Council of Ministers. During the voting procedure in Cyprus, 27 of the 40 Cypriot Members of Parliament walked out, and as the Cypriot media wrote, it was not for purposes of micturation [urination]! Of the remaining 13, two were against the law with the remaining 11 passing the amended law.
The main points in the amended law included:
Homosexuality is still a subject very few Cypriots talk about, despite the great publicity through the media since 1989. Cypriots in general are sympathetic and sensitive people who oppose any violations to human rights. There is, therefore, no organized movement against homosexual persons at present. General attitudes toward gays are slowly changing in a positive way because of the European Courts decision and the great publicity given by the media to the gay law reform. However, parents are very unhappy and bitterly disappointed if they have a lesbian daughter or a gay son. Given the slow progress toward liberalization, there still exists a lot of prejudice and discrimination from all walks of life against lesbians and gay men, and this is why the vast majority still remain in the closet.
Besides the clinical data gathered by the main author, there are some anecdotal data regarding homosexual behavior gathered from members who attended the weekly meetings of the Gay Liberation Movement, but this is not in a presentable format that would make any scientific sense. There is clearly a need for further research on this important topic of human sexuality, but the lack of funding makes this difficult.
The difficulties that homosexual and lesbian Cypriots encounter stem from the great social stigma associated with the limits on open homosexuality in the small Cypriot society, the legal system, which still considers gays criminals, and the powerful Orthodox Church, which considers homosexual relationships the gravest of sins.
Most Cypriot homosexuals conceal their identity behind the curtain of wedlock; it is estimated that about 80 percent of homosexual males are married with families. Marriage makes them feel accepted and secure in a patriarchal, very family-oriented society. Homosexual activities outside marriage are usually conducted with other married homosexuals, or indeed, married heterosexuals who are willing to service the gay partner with anal penetration without this being reciprocated. Other willing partners include tourists who frequent the island; there is a huge choice, given that Cyprus welcomes about 1.5 million tourists annually!
Because Cyprus did not have its own university until recently, a record number of young Cypriots study abroad. Away from home, they are free to join gay groups, become gay activists, take part in gay parades, and thoroughly enjoy a very active gay life, including one-night stands - a way of life forbidden to them at home. Some even develop long-term relationships. After finishing their studies, many settle down abroad. Those who return home have the same predicament that practically all gay people have in Cyprus. Very few of them remain free at home and travel abroad for holidays and business trips; the great majority will get married, have children, and lead a double life.
There are no organized gay bars or clubs on the island. However, there are a couple of bars/pubs in the main towns, usually owned by gay persons, that are known meeting places with a mixed clientele. Beaches, parks, and cottages in the main towns are listed in all European gay guides, but are best avoided because many people frequenting these places, especially during the summer months, land in trouble with plainclothes young policemen acting as provocateurs. Cypruss many exercise gymnasiums are another popular meeting place. Good cinemas and theatrical productions, recitals and concerts, as well as ballet performances from visiting companies, attract a number of gay men. Often they socialize with other gay friends over coffee, sometimes for dinner, and most of the time with mixed groups of friends without anybody knowing, perhaps not even suspecting, they are gay.
The great majority of adult gay men and women who remain single and tire of one-night stands want to eventually settle down in a permanent relationship. Such relationships are much easier to achieve between women than men and are, thus, more numerous. The majority of adult lesbians have a lasting relationship. Cypriot men grow up to be strong and to conceal their emotions, and they find it very difficult to be tender and loving toward another man. The Gay Liberation Movement and specialists trained abroad, enlightened with the latest scientific discoveries concerning human sexuality, have assisted many gay persons who seek counseling, with the result that we now have over 30 male couples who have been living together for six to ten years in the main towns. Very few of these couples have talked this over with their family. For the great majority, there is unspoken understanding and silent acceptance, a practice terribly common between all who have a gay son or a lesbian in their families.
Lesbians are discriminated against both as women and as lesbians. Practically all get married and have children; very few of them will dare or manage to have a special friendship with another woman. In the past, they were active members of feminist organizations or womens groups, without letting anybody know of their homosexual inclinations. Unavoidably, special friendships were formed and, as a result, suspicion and prejudice made all such womens groups slowly disappear. Some lesbian couples in the main towns live together, but most live with their families or in separate flats, even though they have been together for several years. This provides them with good cover for family, friends, and colleagues alike.
The younger generation of lesbians today are somewhat more rebellious and daring. They refuse to get married, even to socialize with other young men as a cover-up, especially if they are economically independent. They usually live on their own, not with their families. They socialize with small groups of five or six other lesbians of the same age on the look-out for a partner. They usually form relationships lasting only a few months. Sometimes, they may meet the right person and settle down to a more permanent relationship, but many of these will have relationships on the side for quite a while before making a final commitment to one person.
Single lesbians, especially those who have given up hope of finding a permanent friend, avoid the company of straight men and often meet and socialize with gay young men who share the same interests. The necessity to socialize with the opposite sex brought many homosexual men and women together, thanks to the Gay Liberation Movement, which helped to disperse the myths and stop the prejudices that existed between them.
Recently, although they still dare not come out in the open, the women of very wealthy families who have studied abroad live their lives and form friendships with other women. They ignore the drawing-room gossip about them, much as that hurts and makes them and their families miserable. They often put up a fight with their own families, who may accept their sexual orientation, but they are concerned about what the other people say.
Practically all Cypriot gay men take holidays abroad, even those who can hardly afford it. They travel alone or with friends. They are out to enjoy themselves and have as many sexual relationships as possible, trying to make up for that which is forbidden for them at home. Greece is a very popular, with the gay bars of Athens, the saunas, and the gay beaches of Myconos and other Aegean islands coming first. Amsterdam, Paris, London, and other European cities are always resorts for those who can afford them.
Homosexual men are not accepted or retained in the army if their homosexuality is discovered. Except for half a dozen or so cases, all members of the Gay Liberation Movement have served their national service and have excelled in the posts they were assigned by their officers.
Apart from occasional parties at Christmas and special occasions, where about 50 gay men and some lesbians are invited, there are few gay private parties. The first one was in December 1990 to celebrate the unanimous decision of the European Committee, when the 15 Commissioners condemned Cyprus for violating the human rights of homosexual people. The second took place in April 1993 to celebrate the European Courts decision against the Government for the same reason, and since then, two more to raise money for people with AIDS. About 350 gays attended these huge parties that were considered a great success by all who attended.
Cyprus is a divided country, proud to be a member of the Council of Europe and trying hard to become a member of the European Union. To achieve this, a first necessary step is the equality of all citizens in the eyes of the law. But this is a minimum demand. What must be achieved is true equality in the minds of all people in everyday life. To achieve this, we still have a long way to go!
In the main authors 1990 survey of Greek Orthodox priests (mentioned in Section 1/2B, Religious Beliefs Affecting Sexuality), the priests were asked for their pastoral response to a second situation involving an 18-year-old boy who is having a sexual relationship with another boy, and finding it rewarding and fulfilling. He has heard from someone that it is wrong, and approaches a priest for guidance and advice. The responses chosen by the 130 priests responding to the questionnaire were:
The subjective responses given by the 27 priests interviewed face-to-face were analysed using a thematic analysis consisting of 16 general categories, some of which are included below:
The face-to-face interviews elicited more attitudes from the Cypriot priests that were similar to the survey responses cited above. There was a belief that all homosexuals are really promiscuous heterosexuals who choose same-sex partners for fun, as their passions have overrun them, and that this was definitely the work of the devil. The focus appears to be on the homosexual act, as opposed to the homosexual person. This was further reinforced by the belief that the homosexual person was seen to be the person who accepts being penetrated. This true homosexual was referred to by many of the priests interviewed as the passive partner, whereas the active penetrative partner was not seen as being homosexual by many priests. This appears to be congruent with St. Chrysostomoss belief of gender expectations, or men behaving inappropriately like women.
There is no information available on this topic. There are certainly a few transsexuals and transvestites living on the island, as they appeared in media interviews seven or eight years ago, but little is really known about their situation. The main author has also seen a couple of transvestites and one transsexual in clinical practice, mostly seeking advice regarding sex-change procedures and relationship problems.
*Note: The editor is grateful to Nathaniel Papageorgiou, Chief Superintendent in the Criminal Investigation Department (CID) of the Ministry of Justice and Public Order, for providing parts of this section on sexual crimes.
Because Cyprus is a close-knit community, it is difficult to conceal sexual abuse and incest with children. The police statistics cover only a minor portion of what happens within families. For example, there has only been one case of incest reported between 1995 and 1997. In the same period, 15 cases of sexual assault on a minor between ages 13 and 16 years old were reported, with 5 cases of assault on a minor younger than 13 years of age. From a sample of 840 patient interviews (see Section 12, Sexual Dysfunctions, Counseling, and Therapies, for details), 3.6 percent or 29 females and one male reported sexual encounters with relatives. These encounters were with a cousin (1.8 percent), uncle or grandfather (1.3 percent), father (0.4 percent), and brother (0.1 percent). This rather small sample of the general population indicates that the problem of incest is far larger than what is reflected in police statistics. It seems reasonable to assume that most such cases are hushed-up by the families and by the authorities to avoid shame for the family and having to face all the consequences thereafter. If such incestuous practices were known, the family would be stigmatized, and the chances of the female victim finding an appropriate partner for life would be severely affected.
Of the 25 cases of rape reported to the police between 1995 and 1997, all involved tourist women visiting the island. Some of the rapes were perpetrated by Cypriot males on the prowl, while many others have been by foreigners living or visiting the island. Most of the female victims were from Scandinavian countries, with a few from Europe. There is no doubt that there have been more such cases that were not reported for various reasons.
Perhaps the most common sexual assault is that perpetrated by husbands on their wives. The author has encounter many such cases, including sexual coercion and abuse. If these cases are reported to the police, they are usually covered up and do not go to the courts for fear of shaming the family and destroying its honor. Many times the police and family members persuade the wife to keep this within the family and not to press charges. Even cases that are reported are often struck-off the record after intervention by family members concerned about the probable effect on family ties and honor. (See comments at the end of Sociolegal Status of Males and Females, Children and Adults, in Section 1A.)
Sexual harassment is perhaps the most commonly occurring crime in the workplace and by Cypriot men harassing tourist women. Sexual harassment in the workplace has been a frequent topic of discussion by the local media, as this was a way of life here in Cyprus. In the workplace, it involves male supervisors using their position and power against women, or women who want to improve their work status or to obtain a promotion. This type of behavior still occurs, but not on the scale that it was once practiced.
A study involving sexual harassment was conducted in 1997 by the Research and Development Center of Intercollege, a large private college in Cyprus, using 1,500 questionnaires that were distributed anonymously to both men and women. About 85 percent of the sample felt that sexual harassment was a serious social problem in Cyprus. About 40 percent of the sample actually knew first-hand of people who had been victims of sexual harassment; most of these took place in nightclubs (cabarets) with strippers (96 percent), with foreign home workers (73 percent), in hotels (64 percent), in factories (38 percent), in shops and offices (28 percent), and at schools and colleges (17 percent).
There has not been any systematic study conducted on the rather large population of prostitutes in Cyprus. Apart from the local indigenous prostitutes, there is a growing group of foreign artists who have been specially imported by cabaret and nightclub owners for entertainment in their clubs. These girls, from the Philippines, Russia, Bulgaria, and India, are given work-permits and visas by the Cypriot government to work as dancers in these clubs. It is estimated that there are over a thousand foreign girls working on the island, plus an unknown number of Cypriot women. The latter are probably dwindling because of the growing number of foreign imports who are favored by the Cypriot males who frequent such clubs. These foreign girls are not officially registered to work as prostitutes, but it is often recognized by the authorities that this happens. These girls are monitored for sexually transmitted diseases on a regular basis by the authorities.
In the last few years, there have been cases where the owners of these clubs have been convicted of coercing these women to have sex with customers against their will. These cases are usually reported because of some dispute over pay for services rendered between the women and their boss. Most of these cabarets are frequented by Cypriot businessmen in groups who are out for a laugh and a bit of fun with their friends; most are married.
Pornography and all types of erotica are freely available in Cyprus to those who want it. Before the ban on video piracy which the government implemented about two years ago, there were literally hundreds of video shops where anyone of reasonable age could go and ask for a porno tape behind-the-counter. These tapes cover the whole gamut of sexual behavior, from straight heterosexual sex, to anal and oral sex, homosexuality, bestiality, sadomasochism, fisting, and all the other sexual behaviors in between. Cypriots can rent their usual thrillers or soap movies on a regular basis, and while in the video shop, pick up a porno movie to watch while the children are in bed. Many of these tapes were subsequently copied and are still circulating in many households in Cyprus, often entertaining the children as well who happen to find their hidden location while the parents are at work.
There were large groups of Cypriots who out of sheer curiosity and fascination were requesting harder and harder varieties of porn that consisted of acrotomophilia, anaclitism, anolingus, bestiality, bondage, coprophilia, fisting, klismaphilia, and much more. This surfaced about twelve years ago when the author had the opportunity to interview one of the main suppliers of pornographic material on the island. He mentioned that the more perverse or deviant the sex he could obtain on video, the greater his business!
Cyprus, being a small and relatively conservative community, is not expected to have a large number of sexual crimes. In fact, until quite recently, the number of sexual crimes committed each year was negligible (see Table 15). Judging from media articles and news coverage for 1999, it appears that these offenses are on the increase, and it will be interesting to see future statistics.
*Note: The editor is grateful for information supplied for this section by the staff at the Family Planning Association of Cyprus.
In the main authors clinical sample, 33 percent reported using the condom, and 21 percent used coitus interruptus. The IUD ranked third at 7.3 percent, followed by 6.7 percent for the contraceptive pill. Very few Cypriot women use the diaphragm, cervical cap, or contraceptive foam - only 0.1 percent for each. Cypriot women tend to have concerns about placing objects in their vagina, not necessarily because they may injure themselves, but because there is a repulsion to placing items in the vagina. This seems to be a cultural attitude reported in the sexual histories taken by the author. Touching the vulva seems to be out-of-bounds for most Cypriot women, and this is reflected in the relatively low frequency of women who masturbate. The IUD is slightly more acceptable because this is placed by the gynecologist and does not entail self-insertion. One-in-five survey subjects reported using no contraceptive, and 3.8 percent reported sterility. (See Section 5B, Interpersonal Heterosexual Behaviors, Adolescents.)
In the 1990 survey of priests conducted by the main author, the priests were presented with a case for pastoral counseling involving:
a Christian couple with five children. The husband is 35 years old and the wife 30. Only the husband is working and earning a small income, which provides the essentials for the family. Under the circumstances, the couple has decided to use artificial contraceptives (that do not allow fertilisation to take place), and go to a priest to discuss the matter. (Georgiou, 1990)
The priests responded as follows:
Older (over 65) and less-educated priests (junior school with additional training in the Theological School of the Cypriot Archbishopric) tended to be more against the use of contraception than the younger, more-educated priests (p = 0.0002).
The thematic analysis of the subjective responses included seventeen mutually exclusive general categories, some of which are presented below:
Perhaps the fact that over half of the main authors sample do not use adequate contraception should lead us to the conclusion that many Cypriots have abortions or have numerous children. The latter is not the case, and epidemiological statistics for abortion are unavailable. Using the same clinical sample of 840 patients (see Section 12, Sexual Dysfunctions, Counseling, and Therapies), 21.5 percent said they had had an abortion. Examining the statistics from the unpublished Cyprus Family Planning Association study (see Section 9A, Contraception), 20 percent of the total sample of 496 women reported having at least one abortion during the years 1995 to 1997, with 19 percent having at least one from 1985 to 1987. Interestingly, in the 1980s, 25 percent of these women were single, 18 percent were engaged, and 19 percent were married, whereas in the 1990s, only 3 percent were single, with more married women (27 percent) having abortions than before. It is certainly difficult to be certain about precise figures, but a figure of approximately 20 percent of the female population during any one year would be a fair estimate of the incidence of abortion. In the same study, about 7 percent of women had two abortions between the years 1995 to 1997, compared to 11 percent of women who had two between 1985 and 1987. (See also Sociolegal Status of Males and Females, Children and Adults, in Section 1.A.)
It is known that there are about 10,000 births per year, and it has been estimated that there are probably 12,000 to 13,000 abortions yearly. It appears that many Cypriots use abortion as a method of contraception after all else fails. The majority of gynecologists on the island will freely give abortion upon demand, due to a loop-hole in the law amended after the 1974 invasion of Cyprus by the Turks, allowing abortions for women who had been raped by Turkish troops or based on medical grounds with the permission of two medical doctors. This law still exists and allows gynecologists to practice abortion upon demand. There are only two gynecologists on the island whom the author knows that do not perform abortions for ethical and religious reasons.
In the main authors 1990 survey, Greek Orthodox priests were presented with the following situation involving abortion:
A Christian woman is pregnant with her fourth child, even though her doctor warned her not to have another child as she would be endangering her health. Presently three doctors have told her that if she continues the pregnancy there is a chance that she would die. She has been advised, therefore, to have an abortion. As she is a woman who believes in God, she approaches a priest for advice. (Georgiou, 1990)
The responses selected by the priests were as follows:
An additional 3.1 percent of the total sample of 130 priests avoided the question.
A thematic analysis of the subjective and something else responses produced fourteen mutually exclusive general categories, some of which are examined below:
The total population of Cyprus was estimated at 746,100 at the end of 1997, compared with 741,000 in 1996, having increased by 0.7 percent. In 1997, the number of births in the Government-controlled areas (the Greek Cypriot side) declined from 9,638 in 1996 to 9,275 in 1997, giving a crude birthrate of 14.2 per thousand in 1997 compared to 14.9 in 1996. Both the number of births and the crude birthrate have followed a declining trend in recent years. The total fertility rate (TFR), which describes reproductive behavior unaffected by changes in the age of the population, is 2.3, slightly above replacement level but declining.
Cyprus has one of the lowest rates of extramarital births in Europe, and fertility is almost exclusively marital fertility. In 1997, only 146 children were born out of wedlock constituting a mere 1.6 percent of the total number of births. The mean age of women at the birth of their first child was 25.8 years old, while the mean age at birth irrespective of the older child was 28 years old in 1997. Women in rural areas tend to start younger, compared to urban areas: 24.8 years and 26.3 years, respectively.
At the Special Session of the United Nations on Population and Development in New York, June 30 to July 2, 1999, the Cyprus Delegation reported that:
Cyprus is undergoing demographic changes worth mentioning. Fertility is falling below replacement level and shows no sign of recovery. Concurrently, mortality is on the decline and currently is at 7.9 deaths per 1000 population. Also, infant mortality is 8.0 per 1000 live births, while maternal mortality is practically zero. Moreover, life expectancy is seventy-five years for males and eighty years for females. These are indications that Cyprus is going through a period of nearly stagnant population growth, 1.0 percent per year in the last five years, a phenomenon of population aging. Although, aging does not mean an old population, still my Government is worried about the problems that come in its way and in particular the social and economic implications.
Indeed, the government certainly wants to increase the declining population of 600,000 Cypriots on the island, and is giving incentives to this effect. All parents who have four or more children, so-called multi-sibling families, receive monetary and social incentives. For example, each child is entitled to a child benefit allowance of about $60.00 per child per month, and mothers receive a mothers allowance. Also, all health expenses are paid by the government, as well as subsidies on school fees, books, entrance to museums, theatres, low-interest loans for building or repair of existing home, reduction in months spent doing National Service, tax incentives, and others. There is even discussion in parliament at present to offer a duty-free car of choice, which is a huge incentive for most families, as car duties can exceed 100 percent of the value of the car.
In Cyprus, reproductive health is integrated into the primary health care system, and is provided free of charge by public sector institutions and at affordable rates by the private sector. The total expenditure dedicated to health purposes, from all sources, is on the order of 6 percent of GDP, or 16 percent of all public expenditure. This compares very favorably with most developed countries.
In Cyprus family planning issues are entrusted to specialist doctors in the private sector, but more so to an NGO subsidized mainly by Government. The services provided are not confined within the narrow meaning of population control but also include access to information relating to sexual and reproductive rights, sexual education, including health issues, reproductive choice and gender equality; it also provides counseling on sexual relations and more recently on the prevention of HIV/AIDS. (United Nations Cyprus Delegation, June 30-July 2, 1999)
Some information regarding the work of the Cyprus Family Planning Association (CFPA) is provided in a recent unpublished study. The data were obtained retrospectively by examining 495 patient records of visits to the CFPA between 1985 and 1997. Most of the women visiting the CFPA were married between the ages of 21 and 41. The most commonly requested services were for birth control and cytology tests. The four major services that women requested were Pap tests, IUD insertions, breast examinations, and prescriptions for the contraceptive pill.
There are no systematic surveys that have been conducted regarding sexually transmitted diseases, as most of the population with STDs saw private practitioners who do not need to report these statistics. There are, however, some official statistics, which are based mainly on the monthly returns from the dermatology clinics of the four Government general hospitals. Although rare, certain cases may be reported by gynecologists, urologists, and possibly general practitioners in the private sector. The diseases recorded are those that are considered notifiable and reported to the World Health Organization (see Table 16). The sharp increase in AIDS cases in 1997 is because of the adoption of a new case definition by the United States Centers for Disease Control in 1993. A workshop on epidemic preparedness was held in November 1999, during which the list of notifiable diseases was revised to include other STDs such as chlamydia.
From the KABP Survey on AIDS of 3,176 schoolchildren examining their knowledge, attitudes, beliefs, and practices related to AIDS, there were a few questions regarding STDs that would be worthy of note (Georgiou & Veresies, 1990, 1991).
Twelve questions were designed to tap respondents knowledge about syphilis, gonorrhea, chlamydia, and genital herpes:
Overall, it appears that the Cypriot school adolescents are relatively ignorant regarding STDs compared to their American, Canadian, and English counterparts. This relative ignorance, probably related to the fact that there is no formal sex or health education in schools, needs to be addressed.
Asked more specific questions regarding STDs, the great majority of students were uncertain. Overall, it appears that less than 20 to 25 percent of the students have correct knowledge regarding ways of transmission, therapy, prevention, and asymptomatic status of STDs. Perhaps the most striking finding is the fact that only about 25 percent of the students were aware that condoms can protect against gonorrhea. The overwhelming majority (63.1 percent) were uncertain about the prophylactic use of condoms. There was also high uncertainty regarding syphilis transmission from an asymptomatic person (57.8 percent), and whether a person who has caught syphilis once can catch it again (64.3 percent uncertain, with 15 percent incorrect). It is clear that these issues need to be urgently addressed in any program on human sexuality.
*Note: The following data for HIV/AIDS, from the Ministry of Health, National AIDS Programme (NAP), under the auspices of the World Health Organization, covers the period between the first reported AIDS case in 1986 and 31 August 1999. Laura Papantoniou, M.D., National AIDS Programme Manager, prepared this section, after collating the information provided by several contributors working in her specialty.
In Cyprus, as in most countries, the main mode of transmission of HIV is sexual intercourse, both hetero- and homosexual. Consequently, our efforts are mainly focused on the first principle, i.e., prevention of sexual transmission of HIV. Implementation of the National AIDS Programme (NAP) is included in the areas of activities described below.
The figures below are current to December 1, 2000, with certain figures to the end of December 2000. N is the cumulative total of tests since 1986. Sources of cases have been recorded according to the latest guidelines disseminated by the World Health Organization. The N is very low for certain categories, Cypriot prostitutes, IV-drug users, non-IV-drug users, and patients with STDs, because many of these persons go untested. Only registered prostitutes can be regularly tested as a group; patients with STDs visit a large variety of centers, such as private dermatologists and gynecologists; and drug abusers, though tested, are not reported regularly to our services. However, individuals in these categories who do test positive will very likely be reported to our services, since the country is small and there is only one center, the Ministry of Health, that collects this data. Sooner or later these people will need counseling, treatment, and socioeconomic support, so they will come to us. The only problem is that, once they are reported, it is impossible to relate them to a definite source population and calculate rates. All we can do in this case is to include them in the pool of seropositives and calculate them as part of the percent distribution of the total. The same is true for the homosexual community, where no regular testing is done at all.
It is a fact that the rate of HIV infection in Cyprus is truly very low at present (0.1%, which is about one tenth of the world mean rate), and this has been confirmed by Geneva Headquarters where our available data have been sent and evaluated. The very low rates among National Guard personnel, aged 17 to 19, is not surprising, because the mean age at diagnosis for Cypriots is around 32, which situates the probable mean age of infection at around age 22 to 25. Of course there is no complacency about this, and we are now planning to conduct sentinel surveillance at the time of exit, after the National Guard personnel have spent 26 months in the service. Nor is there complacency about the fact that the rates among the general population are, for the time being, low, because we know that risk factors exist, should be evaluated, and appropriate remedies accordingly taken. In early 2001, we are conducting a behavioral survey among the general population, and hope soon to be able to conduct more surveys among school youth and among specific groups of the population.
The rate among foreign workers and students appears higher that the actual rate, because a large number are tested in the private sector and only positive cases are reported, while the N in this case includes only the total number tested in the government service. We are cooperating with the Aliens Department to obtain the figures of all those who are tested each year, since 1997, when the data were entered in the computer. This will allow us to calculate the true rates.
Monthly epidemiological reporting is based on data collected from the sources shown in Table 17.
Unlinked anonymous epidemiological sentinel surveillance for HIV is being done among STD patients of the Dermatology Clinic of Nicosia General Hospital. This group and site were chosen as being an area of high risk. There have been no positive results among the approximately 1,000 samples tested in this group since the surveillance started in 1992. In the event of a positive result, sentinel surveillance will be resumed among the group of people undergoing the premarital testing for thalassemia, considered to be a low-risk group, where sentinel was already conducted in 1992, with no positive results.
A protocol for sentinel surveillance among army recruits aged 17 to 19 has been initiated in cooperation with an external researcher. To date, 1,600 tests have been conducted with no positive results.
The number of cases recorded since 1986 until August 1999 has reached 319, consisting of 190 (59.6%) Cypriots and 129 (40.4%) foreigners. These numbers correspond to rates of 0.029 per 100 populations of all ages (190 cases in Cypriots per 663,300 population - 1998) and 0.052 per 100 - population aged 15 to 50 (174 cases per 334,000 population). It is estimated that the true numbers are greater and that, as in any other country, there exist a number of cases that have not yet been diagnosed. This is due mainly to the long asymptomatic period during which the HIV-positive status may be unknown even to the HIV-infected persons themselves, so that many cases are not reported to the relevant services.
The number of AIDS cases may be a more reliable index. Ninety-seven adult AIDS cases (83 men and 14 women) were reported. There are no AIDS cases in children under age 15. Forty-six people have died from AIDS since 1986.
A total of 354 cases of HIV infection were reported by the end of 2000 (213 Cypriots and 141 foreigners). The number of AIDS cases by end of fourth quarter of 2000 (included in the 354 seropositives) is 125. The sex ratio for Cypriots is 6 males to 1 female. On average, 23 cases have been recorded each year between 1986 and 2000, 14 Cypriots and 9 foreigners. The numbers of new cases by year are as follows:
|Up to 1986:||11||1991:||22||1996:||28|
Out of the 190 Cypriot seropositives, 163 (86.0 percent) are men and 27 (14.0 percent) are women. The sex ratio has remained stable at six men for one woman. Almost 90 percent of all cases are between 20 and 40. The mean age at diagnosis is 32.7 years for both men and women. Given the long asymptomatic period, it may be conjectured that infection takes place between 20 and 25 years old, which is slightly advanced by international standards.
Almost 90 percent of all infections are reported to have been acquired through sexual intercourse. Heterosexual transmission accounts for 44 percent of all cases and homo-/bisexual transmission for 45 percent.
All 8 cases of transmission through blood and its products took place before 1987. Almost all cases after 1986 were infected through sexual intercourse, with the exception of one case of perinatal transmission and five through the use of intravenous drugs.
Based on reported cases only, the rate of infection per 100 population of Cypriots living in Cyprus is 0.03, but this differs by district. The Limassol district of Cyprus has the highest rate at 0.04, followed by the Famagusta district with 0.03, the Nicosia and the Larnaca district with 0.02 and the Paphos district with 0.01.
As noted earlier, a drop in the number of new cases was recorded in the years 1995 to 1998. It is noted that todays rates in new cases per year reflect the trends in transmission rates that existed five to ten years ago, given the long asymptomatic period of the HIV infection. For this reason, current cases cannot provide an adequate picture concerning todays trends and need to be complemented by special surveys on knowledge, attitudes, and behaviors among the sexually active population. Anonymous epidemiological surveys are currently being carried out. The results of these surveys will serve for the formulation of our policy for the control of the epidemic.
Based on the international experience that knowledge does not necessarily lead to behavior change, a new orientation is now being promoted, with the development of peer education projects in schools. Despite the fact that the first attempts were highly encouraging and successful, peer education has not yet been applied on a routine basis in schools because of a shortage of staff and time constraints. Most other health education activities are also focusing on the area of behavior change in youth and other sections of the population. Such activities are information kiosks, special events, lectures, messages and programs using mass media, youth meetings, and others.
It should be noted that health education is facilitated by the fact that sex issues and the subject of condom use may be easily addressed in Cyprus because of the high level of knowledge and sensitization among the population. Opposition from certain society leaders, mainly the Church, is hampering full implementation of effective health education. New material is being constantly developed, such as brochures, booklets, posters, TV spots, videos, and various advertising items (key rings, T-shirts, etc) as a necessary complement to these activities.
Health education focuses mainly on sexual behavior, but all other important issues, i.e., compassion and avoidance of discrimination, safe blood donation, dangers of drugs and other habit-forming substances, and the hazards of perinatal transmission, are addressed as well.
Before 1992, AIDS cases were treated in medical wards of hospitals. Between 1992 and 1996, clinical care for AIDS patients had been delivered through the AIDS Ward in Nicosia General Hospital. A new ward was created in 1996, in Larnaca General Hospital, to meet added needs, due to the increase in the number of patients followed by our services and to the introduction of new methodologies for the management of HIV infection. Following two decisions of the Council of Ministers, treatment of cancers and opportunistic infections, and triple antiretroviral therapy are offered free of charge to all HIV-infected Cypriots who satisfy the necessary clinical criteria. With the introduction of the new antiretroviral therapy, new criteria have been adopted by the U.S. Centers for Disease Control for the clinical coding of cases.
The cost of HIV/AIDS treatment is as follows: Antiretroviral treatment (delivery statistics) (1 Cypriot pound (£ CYP) is approximately US$2): 1996, £76,097; 1997, £255,483; 1998, £324,591; 1999, £368,376; and 2000 (through October 5): £122,838. The cost of other components of care are:
Financing is provided as follows:
All individuals undergoing testing for HIV receive pre- and post-test counseling at the counseling service of Archbishop Makarios III Hospital in Nicosia. HIV-infected individuals and their families are under the constant care and guidance of the counseling service, which works in close cooperation with the Welfare Services of the Ministry of Labor. Increasing workload is dictating the need for the expansion and decentralization of these services to all towns in Cyprus.
The National AIDS Committee (NAC), which is composed of relevant government services and non-governmental and other organizations implementing the NAP. The reorganization of the NAC is currently under study, aiming to adapt available services to the new demands of the NAP.
In the general frame of the latest internationally accepted principles, intersectoral collaboration, and in particular the role of NGOs, is receiving increasing consideration, and program activities are being rescheduled to meet these prerequisites. The main projects developed with the NGOs concern peer education and social support. More resources are needed for the full development of this intersectoral cooperation.
Cyprus belongs to the East Mediterranean Regional Office of the World Health Organization. The Ministry of Health is also promoting the development of cooperation with other countries in Europe, in particular, in view of our impending entry into the European Union.
Program evaluation is an integral part of the NAP, according to WHO guidelines. Prevention indicators and targets included in our program are based on the WHO prevention indicators and targets.
Indicators and targets were evaluated in 1997 in youth through the KABP surveys (Georgiou & Veresies, 1990, 1991), using a self-administered questionnaire in private schools. The evaluation process in public schools has not yet been initiated, despite efforts to overcome resistance from the Church, who consider that such an approach would increase the risk of promiscuity among young people.
New methodologies are currently being considered for the evaluation of the remaining indicators and targets included in the program and of other related issues in target populations other than youth, including the adult male population and the personnel responsible for delivering STD care. In addition, it should be noted that it is very difficult to have access and conduct evaluation surveys (as well as health education) in the homosexual, drug-user, and middle-aged-male-with-risky-behavior target populations. Efforts are being made to overcome these difficulties, through cooperation with the Gay Liberation Movement of Cyprus and with the Centre for Drug Education and Treatment of Drug Addicted Persons (with little or no response from the latter), and by approaching individuals in various contexts, e.g., where routine testing is conducted for other reasons.
In the light of the above epidemiological and general information, it is evident that the HIV/AIDS situation in Cyprus is comparable to that in other Western countries. Based on current epidemiological evidence, health education activities are focused mainly on prevention of transmission of HIV through sexual intercourse, with the main emphasis on abstinence, delayed sex, mutual faithfulness, and the correct use of condoms. Peer education in schools and in youth NGOs is being promoted, though at present it has only been implemented on a pilot basis. Program evaluation is planned according to WHO guidelines and constitutes an integral part of the NAP, but has not been implemented to a satisfactory degree to date.
There is scant information on sexual dysfunctions and therapies in Cyprus, mainly because of the lack of qualified, professional therapists who can systematically collect such data. As of 1999, the main author was still the only professionally qualified sexologist with doctoral training on the island. There were a few psychologists who attempted sex therapy using psychoanalytic techniques with very poor results. There were also a number of medically qualified dermatologists, STD specialists, and urologists who advertised as sexologist, but are not qualified in any form of sex therapy and have no specific training in this field. Their treatments included mostly drugs and papaverine and prostaglandin penile injections for both erectile problems and premature ejaculation, regardless of etiology. In 1999, Viagra was granted an import license, and no doubt this will be used widely. The situation is quite sad really, as many patients fall victim to costly medical treatments without seeing any benefit.
Unfortunately, at present, Cypriot law does not regulate the training, certification, or licensing of sex counselors or therapists. Anyone can advertise freely on their signs whatever they wish, on the condition that they do not use the adjective specialist. So dermatologist-sexologist is a legal sign, but dermatologist-specialist sexologist would be illegal if the individual does not have qualifications and clinical training in sexology. Few Cypriots are aware of this distinction and its inevitable consequences for the delivery of effective health care in this specialized area.
The following observations have been culled from 840 clinical cases of Cypriots with sexual dysfunctions who sought treatment at the editors Natural Therapy Centre in Larnaca between 1993 and 1996. Some additional insights came from a survey of sexual knowledge, attitudes, beliefs, and practices of 3,176 schoolchildren aged 14 to 18 years old conducted under the auspices of the World Health Organization (Georgiou et al., 1990), a study of the sexual attitudes of Greek Orthodox priests (Georgiou, 1990), a 1995 book on the treatment of premature ejaculation by the editor, and Homosexuality, a book written in 1982 by the PanCyprian Society of Psychic Health after a seminar on homosexuality.
A quarter of the editors clinical population were age 18 to 25, 40 percent between ages 26 and 35, 21 percent from age 36 to 45, 9 percent ages 46 to 55, 4 percent between the ages of 56 to 65, and the remaining one percent 66 and older. One percent of the sample had not completed elementary school, 12 percent had attended junior high school but not graduated, 12 percent had attended school to age 15, 40 percent had completed high school, and about 20 percent were university graduates. Two thirds of the subjects were married, 12 percent engaged, 2 percent separated, 1.5 percent divorced, 1 percent widowed, and 18 percent single. Some of the 840 attending were partnered, but individual histories were taken, and are presented here as such. The sample is quite representative of the spread of occupations on the island, and covers professionals (13 percent), technical - plumbers, electricians, etc. (9 percent), business people (20 percent), clerical (12 percent), civil servants (10 percent), housewife (6 percent), agricultural (11 percent), unskilled (9 percent), students (3 percent), unemployed (1.5 percent), waiters and hotel workers (5 percent), and others (4 percent). All clients completed a sexual history questionnaire covering 75 topics or questions modeled on Wardell Pomeroy et al.s Taking a Sex History (1982).
In terms of the whole sample of 840 patients, the most common problem was secondary erectile dysfunction (30 percent), with an additional 2 percent primary erectile dysfunction. Other male dysfunctions included premature ejaculation (24 percent), retarded ejaculation (2 percent), and male sexual desire disorder (5 percent). Secondary inhibited orgasm (7 percent) was the most common female complaint, with an additional 3 percent presenting with primary inhibited orgasm - the total of female inhibited orgasm: 11 percent. Other female dysfunctions included vaginismus/ coital phobia (11 percent) and female sexual desire disorder (6.5 percent). One percent presented with problem paraphilias, mostly flashing.
Males suffering from premature ejaculation commonly postpone treatment for years, waiting until the stress and anxiety of the chronic situation makes the problem a lot worse and their marriage is threatened. Only 15 percent of premature ejaculators seek help within three years of onset. 37 percent wait four to ten years, 31 percent wait eleven to twenty years, and four percent wait more than twenty years. In comparison, men with erectile dysfunction are much quicker to seek help, probably because their problem directly threatens their male ego. Ninety-two percent of impotent men sought help within three years of onset, 4 percent within four to ten years, and 4 percent in eleven to twenty years. A strong majority of premature ejaculators recall ejaculating quickly from their early masturbatory experiences.
This appears to support Helen Singer Kaplans (1983) theory of the ejaculatory reflex being conditioned to ejaculate early from the initial sexual experiences. Very few of the males recalled otherwise. Most of the males who came for treatment for premature ejaculation had the problem for many years, on average about ten years, but only decided to seek help when additional stress factors had exacerbated the problems to such a degree that many were ejaculating before intromission. Certainly the majority where finishing in ten to twenty seconds, to the womans growing frustration. At this point, additional coercion from the wife resulted the men seeking help.
Many cases of erectile problems began with an extramarital partner, and not with the wife or major partner. This may be because of the tremendous performance anxiety that is again related to the huge Mediterranean masculine ego to conquer the woman and show her that one is a man. I have also thought that it may have been because of the anxiety related to the prickling of consciences, but having spoken at length to many of these men, this does not appear to be the case. Indeed, many of them had come to me not so much to improve their relationship with their wives, but to help them get it up so that they could prove their manhood with their girlfriends. Many actually expressed satisfaction in the wish to do it just once with the girlfriend, and that would be enough! The shame, disappointment, anguish, and bruised ego was very apparent in many of these men. The vast majority of them had no sexual or relationship problems with the spouse - their motivation in pursuing an extramarital partner was purely to satisfy their ego, and not much else.
In addition to these psychological problems, I have found causes related to dietary stresses and abuses, smoking, nutritional deficiencies, sub-clinical hormonal imbalances, sub-clinical hypothyroidism, reactive hypoglycemia, toxic metal status, systemic toxemia, and others. These causes I would consider as organic, but not in the traditional classical medical view of organic. There may not be any obvious pathology that can be measured on blood tests, doppler, or morphological changes, but there is a continuum of health and disease, with a lot of gray areas in between. Many of these men have malfunctioning organs and tissues, which inevitably will affect penile functioning, unless one holds the view that the penis has its own will and personality and is totally independent of other bodily functions. Cognitive-behavioral sex theory is often quite effective in treating an erectile problem that is strictly psychogenic in etiology, but compound a psychological factor with smoking two packs of cigarettes a day, eating fast foods full of empty calories and fats, working a twelve- to eighteen-hour day, drinking alcohol regularly to destress, being anxious and insecure about the future, etc., as many Cypriot males do, and it is obvious that something more than traditional cognitive-behavioral sex therapy may be indicated, including nutritional and homeopathic remedies.
A clinical incidence of 11 percent for vaginal spasms in Cypriot women is much higher that reported in other countries, where the reported incidence ranges between one and four percent. The origin of this difference, I believe, lies in the cultural dynamics, and specifically the sexual messages that both sexes receive while growing up in Cyprus. The male child get messages based around: You are a male, so it is normal, acceptable, and a sign of your manhood to pursue and conquer females sexually, whereas the woman gets a very different message: You are a female and must remain a virgin, as this has direct links with your honor, and that of your family - be careful as males are cunning and are only after one thing. Sixty-nine percent of the women in this clinical sample were virgins until they married, compared to only 9 percent of the men. The women had limited premarital experiences, and their sexual knowledge was obtained mainly from friends and media - with all the misconstrued ideas and prejudices that are inevitable from such sources, mixed with a high level of anxiety and neuroticism. A large majority of the vaginismic women reported dwelling on the fear of coitus starting when some friend or cousin shared her initial painful sexual experiences, saying that the pain was unbearable, and that they had hemorrhaged. Without exception, these women had high scores on the Spielberger Trait Anxiety Inventory (SPAI), averaging at least one or more standard deviations above the mean for their age group.
There appears to be a problem with the statistics for dysorgasmia, which one would expect to be higher than the 10 percent reported in this limited clinical sample, particularly when 24 percent of the males have a chronic problem with premature ejaculation. Again, the answer may lie in cultural values and conditioning. Cypriot women are very reluctant to discuss their sexual lives with a complete stranger, even when that person is a competent professional in the sex field. Also, Cypriot women have been taught not to consider or make a fuss about the quality of their sexual pleasure, given that their male is performing like an epividoras (stud). Cypriot women tend to lament in silence, perhaps until things in the marriage get to such a point where frustrations can no longer be tethered. Other causes may include physical and mental fatigue from coping with home, work, and many children, an insensitive husband who is tender only in bed, limited sexual foreplay because of ignorance and inhibitions, marital discord, and certain naturopathic organic causes. Similarly, I believe the incidence of female sexual desire disorder, a scant 6.5 percent in my clinical sample, is not indicative of the actual incidence of female inhibited sexual desire in the general population. Cypriot women are not taught to expect much from their sexual relations, and so they suffer in silence. We simply do not see these people in clinical practice.
A recent development in this limited clinical sample has been a three- to four-fold increase over the past two or three years (compared with five years ago) in the incidence of males seeking help with unconsummated relationships owing to their own coital fears. I have no explanation for this fascinating phenomenon, which is certainly worthy of being researched.
The main authors clinical experience with over 10,000 patients in the last sixteen years in Cyprus suggests that the treatment of sexual problems in both sexes is getting more and more difficult. Modern Cypriots are more stressed and anxious, more concerned about finances, apprehensive about the future, concerned about personal safety, have less time for relaxation and leisure activities, are more affluent with all the consequences of bad eating and drinking leading to poor health, and more.
Certainly there is much research that needs to be done in the field of human sexuality on the island of Cyprus. Lack of funding for such research has left the island literally virginal territory for sexology.
The tertiary educational establishments on the island, and there are many, do not even have a single course geared to human sexuality. Perhaps the administrators and educators see it as unnecessary, or fear that it would take up additional space on a busy curriculum. Perhaps it is the inhibitions of the governing bodies to include such topics in the curriculum. Whatever the case, these topics do not exist, neither in the private institutions that award undergraduate and postgraduate degrees from external universities, nor in the one and only newly opened University of Cyprus. It goes without saying that there are no sexological journals and periodicals published in Cyprus, or indeed any national and regional sexological organizations. It is difficult to set these up with only one member!
Certainly the talent for research exists on the island. We have the second highest rate of university graduates per population ratio in the world, as well as the technology and infrastructure. We also have keen researchers who would love to participate in ongoing research. If someone will fund, research will progress.
Alastos, D. 1976. Cyprus in history: A survey of five thousand years (2nd ed.). London: Zenou.
Antoniou, C. 1992. The revolution of Cypriot women in society and their increased participation in civil engineering. Unpublished Master of Philosophy thesis. London: University of London.
Attalides, M. 1981. Social changes and urbanization in Cyprus: A study of Nicosia. Nicosia, Cyprus: Social Research Centre.
Argyrou, V. 1996. Tradition and modernity in the Mediterranean. Cambridge, UK: Cambridge University Press.
Balswick, J. 1973. The Greek Cypriot family in a changing society. Lanarca, Cyprus: Department of Social Welfare Services, Ministry of Labour and Social Insurance.
Berger, P., Berger, B., & Hansfried, K. 1973. The homeless mind. London: Penguin Books.
Campbell, J. K. 1964. Honor, family and patronage: A study of institutions and moral values in a Greek mountain community. New York: Oxford University Press.
Christodoulou, D. 1992. Inside the Cyprus miracle. Minneapolis, MN: University of Minnesota.
Charalambous, N., & Peristianis, N. 1998. Ethnic groups, space and identity. Unpublished paper presented at the Space Syntax Second International Symposium, Brazilia, Brazil.
Department of Statistics and Research, Ministry of Finance. 1998. Demographic report 1997. Lanarca: Printing Office, Republic of Cyprus.
Georgiou, G. J. 1990. Sexual attitudes of Greek Orthodox priests in Cyprus. Dissertation for the degree of Doctor of Philosophy in Human Sexuality. San Francisco: The Institute for Advanced Study of Human Sexuality.
Georgiou, G. J. 1992. Sexual attitudes of Greek Orthodox priests in Cyprus. The Cyprus Review, 4:2. Nicosia, Cyprus: Intercollege.
Georgiou, G. J. 1995. Premature ejaculation (in Greek). Athens: Hellenic Letters.
Georgiou, G. J., & Veresies, K. 1990. AIDS knowledge, attitudes, beliefs, and practices (KABP) pilot study undertaken in Cyprus: Preliminary report. Geneva: World Health Organization (WHO).
Georgiou, G. J., & Veresies, K. 1991. AIDS knowledge, attitudes, beliefs, and practices (KABP) study of Cypriot schoolchildren in Cyprus. Geneva: World Health Organization (WHO).
House, W. J. 1987. Population and labour force growth and development. Nicosia, Cyprus: Department of Statistics and Research, Ministry of Finance. Intercollege, Research and Development Centre. 1996. Youth and leisure time in Cyprus. Nicosia, Cyprus: Intercollege.
Intercollege, Research and Development Centre. 1997. Sexual harassment in the workplace in Cyprus. Nicosia, Cyprus: Intercollege.
Kaplan, H. S. 1983. The evaluation of sexual disorders. New York: Brunner/Mazel.
Kinsey, A. C., et al. 1953. Sexual behavior in the human female. Philadelphia: Saunders.
Kolodny, R. C., Masters, W. H., & Johnson, V. E. 1979. Textbook of sexual medicine. Boston: Little, Brown and Company.
Loizos, P. 1975. Changes in property transfer among Greek Cypriot villages. Man [U.S.],
Mavrastas, C. 1992. The Greek-Cypriot economic ethos: A socio-cultural analysis. The Cyprus Review, 4:2. Nicosia, Cyprus: Intercollege.
Mavros, E. 1989. A critical review of economic development in Cyprus: 1960-1974. The Cyprus Review, 1:1. Nicosia, Cyprus: Intercollege.
Markides, K. E., Nikita, N., & Rangou, E. 1978. Lysi: Social change in a Cypriot village. Nicosia, Cyprus: Social Research Centre.
Mylona, L., et al. 1981. I Kipria ghineka [Cypriot woman]. Nicosia, Cyprus: Author.
Pancyprian Association of Psychic Health. 1982. Homosexuality. Nicosia, Cyprus: Author.
Papapetrou, S., & Pendedeka, M. 1998. The Cypriot family: The evolution of the institution through time: Trends of change. Unpublished paper presented at the Annual Conference of the Cyprus Sociological Association.
Peristiany, J. G. 1965. Honour and shame in a Cypriot highland village. In: J. G.
Peristiany, ed., Honour and shame: The values of Mediterranean society. London: Weidenfeld and Nicolson.
Persianis, P. 1998. Istoria tis ekpedefsis koritsion stin Kipro [History of the education of girls in Cyprus]. Nicosia, Cyprus: Author.
Pomeroy, W. B., Flax, C. C., & Wheeler, C. C. 1982. Taking a sex history: Interviewing and recording. New York: Free Press/Macmillan Publishing.
Pyrgos, M. 1995. The Cypriot woman at a glance. Nicosia, Cyprus: Author.
Schneider, J. 1971. Of vigilance and virgins: Honor, shame and access to resources in Mediterranean societies. Ethnology, 1:1-24.
Stavrou, S. 1992. Social changes and the position of women in Cyprus. The Cyprus Review, 4:2. Nicosia, Cyprus: Intercollege.
Stavrou, S. 1997. Cypriot women at work. The Cyprus Review, 9:2. Nicosia, Cyprus: Intercollege.
Surridge, B. J. 1930. A survey of rural life in Cyprus. Nicosia, Cyprus: Printing Office of the Government of Cyprus.
Vassiliadou, M. 1997. Herstory: The missing woman of Cyprus. The Cyprus Review, 9:1. Nicosia, Cyprus: Intercollege.
Yeshilada, B. 1989. Social progress and political development in the Turkish Republic of Northern Cyprus. The Cyprus Review, 1:2. Nicosia, Cyprus: Intercollege.