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Risk, STD and HIV infection in Kampala

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The clinical association between HIV and other sexually transmitted disease is accepted medical wisdom and it is widely recognised, even among those persons most at risk, that the same behaviours are implicated in the spread of both infections. How is it then that sexually transmitted disease remains a life-threatening problem in so many areas? One answer is that too little attention is paid to social and cultural risk factors embedded in the context of ordinary people's lives; that reduction of health risk is never a matter of 'simple' behaviour change. This article sets out the interaction of risk factors in the context of a low-income Kampala parish. It demonstrates the logic of 'risk' patterns in the management of sexually transmitted disease-not only of delaying or avoiding treatment altogether, but also of the common first recourse to self-prescription and home treatment, and of the preference for traditional over Western options. These choices are made by people who are aware of the risks to health and life associated with venereal infections, and who 'know' that biomedicine administered in the nearby hospital is optimal in their treatment. The anomaly is explained by the fact that sexually transmitted disease and the risk of HIV are never the only things they have to worry about. The specifics of this case show that external efforts to control HIV/AIDS will be improved by sensitivity to other-than-health risks inherent in the context of sexually transmitted disease treatment/non-treatment choices. The observation that health and life may be put at risk for reasons having little to do with poverty and/or ignorance has general application in the prevention of other diseases and the design of more appropriate intervention programmes.


Document Type: Research Article


Affiliations: Department of Anthropology, University College London, Gower Street, London WC1E 6BT, UK

Publication date: 2000-07-01

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