Letters
HIV infection in Uganda
EDITOR, - In the Rakai district of Uganda, Maria J Wawer and colleagues have shown that, despite universal knowledge of AIDS, extensive education, and programmes for distributing condoms, the incidence of HIV infection remains high.1 The failure of such programmes to curb the epidemic may not be unique to Rakai, given that HIV continues to spread in many parts of Africa where prevention programmes exist.2 Rather than intensifying programmes,1 however, we must ask why the necessary behavioural change has not occurred. We therefore conducted in depth interviews about the context in which people have sex. We drew our sample - 17 key informants from three villages in Rakai and 31 female prostitutes and 44 other residents from Kimwanyi, a poor neighbourhood of Kampala - from those used in two unpublished studies that required representativeness of the population.Preliminary analysis suggests the importance of three themes. Firstly, despite knowledge that a man has died of AIDS the tradition of "widow inheritance" continues; secondly, technical knowledge of use of condoms is poor: 25 of 32 men expressed uncertainty about how to put on a condom; and thirdly, many places where sexual intercourse is practised lack privacy and this thus adds stress to sexual play. In Rakai all respondents were or had been living with their parents until marriage; as love making is prohibited in the parents' house they could have sexual intercourse only in the banana plantation and the bush. In Kimwanyi 31 of the 44 non-prostitutes had frequented public latrines, 19 had used back streets, and 22 had used the bush for sex with premarital or extramarital partners in the past five years. Most of the prostitutes (26 of the 31), however, took their clients to their rooms, regardless of the presence of others.
Several questions emerge from the above. Firstly, why do men sleep with widows of men who have died of AIDS and why do widows have new sex partners? Secondly, how can young people learn to use safer sex? Thirdly, how can people practise safer sex in the bush? There are no straightforward answers, but, clearly, information in itself does not make people change behaviour. Sexuality is deeply rooted in people and cannot be modified in isolation of sociocultural and emotional aspects of life. Sex education will continue to remain difficult, but, unless contextual factors are taken into account, studies like that of Wawer and colleagues are likely to continue to generate concerns about the adequacy of prevention of transmission of HIV in many parts of Africa.
G Bantebya, E Konings
Makerere University, Department of Women Studies, PO Box 7062, Kampala, Uganda Institut Universitaire de Medecine Sociale et Preventive, Bugnon 17, 1005 Lausanne, Switzerland.
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- Incidence of HIV-1 infection in a rural region of Uganda
- M J Wawer, N K Sewankambo, S Berkley, D Serwadda, S D Musgrave, H R Gray, M Musagara, Y R Stallings, and K J Konde-Lule
BMJ 1994 308: 171-173.[Abstract] [Full Text]
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