People's Perception of HIV/STD Risk and Unwanted Pregnancy

Bauni EK,1 Garimoi CO,2 Maharaj P,3 Mushingeh ACS,4 Neema S,2
Ngirwamungu E,5 and Riwa P5

A key question for the researchers in the African study was how do ordinary men and women perceive the risk of HIV and STDs. To make the question more insightful for health policy-makers, the researchers sought to learn how HIV and STDs were regarded by the focus group discussion (FGD) participants in relation to other illnesses that affected the community. The researchers also probed into the participants' knowledge about HIV infection and its prevention.

HIV/STDs well known as health risks

The Kenya study comprised 12 FGDs, each involving 7–10 persons in the Nakuru district of Rift Valley Province. The male groups included sexually active men, while the women's groups were of two kinds: those for users of contraceptive methods and those for non-users.

The Kenyan participants stated that the most important illnesses affecting the local adult population are STDs and malaria. HIV/AIDS was mentioned as a serious problem by seven out of the 12 groups. Four of the five groups that did not consider HIV/AIDS to be a serious problem included rural people, which the researchers interpreted to mean that HIV/AIDS may be a more serious problem in urban than in rural areas.

In Uganda, some men blamed traditional healers for the spread of HIV through the use of unsterilized instruments and through sex with female clients.

All Kenyan FGD participants were generally well informed about the causes of HIV/AIDS. However, none of the participants cited mother-to-infant transmission of HIV. Two FGDs pointed to economic hardship as a cause of women being driven into prostitution, which they cited as an important route of spread of HIV.

The majority opinion in the Kenyan FGDs was that STDs were a very serious problem. Like HIV, those who did not consider STDs to be a serious problem were rural inhabitants. There was general agreement that STDs were preventable and curable.

In the South Africa study (being conducted under the supervison of Eleanor Preston-Whyte), 12 focus groups of 6–8 persons in KwaZulu Natal were involved. Six groups were in urban areas and six were in rural areas, with two of each consisting of female current contraceptive users, female non-users and sexually active men. Participants in the South African focus groups in both urban and rural areas identified AIDS, tuberculosis and cancer as the major health risks. Like the Kenyans, the FGD participants in South Africa were well informed about the causes of, and ways to prevent, HIV/AIDS. Rural groups mentioned certain groups (such as sex workers, foreigners, taxi drivers and policemen) as likely to spread HIV. All groups, except for rural men, agreed that HIV is fatal.

The South African researchers noted that there remain many myths and false beliefs regarding the treatment of AIDS. To illustrate their point, they cited the following statement from an FGD involving sexually active men: "You can cure AIDS by sleeping with a child under 10 years". The researchers also point out that rural men in the FGDs believed that traditional Zulu healers could cure the disease.

STDs were regarded as a serious problem by the South African focus groups. The participants were generally well informed about the causes and prevention of STDs, although some sexually active men suggested that STDs could be caused by medication. For the treatment of STDs the researchers observed that, unlike women, men said that they would feel more comfortable visiting traditional healers than hospitals or clinics; men complained about the negative attitude of service providers in clinics.

The focus group discussions in Tanzania were divided between rural and urban parts of Morogoro district . Again, 12 focus groups took part in the research with four consisting of female contraceptive users, four of female non-users and four of men aged 20–49 years. Important health concerns identified by the groups were malaria, cholera, typhoid, schistosomiasis, STDs and AIDS. HIV/AIDS was considered a serious problem because the FGD participants had seen people dying of AIDS, and there were no facilities for testing or cure. The groups said that many people were infected with STDs, with gonorrhoea and syphilis being the most common. While most people knew that HIV and other STDs could be prevented by the use of condoms, the participants said that many people did not use them.

The 12 focus groups in the Uganda research were selected in the Jinja district and again involved rural and urban groups of female users, female non-users, and sexually active males. These groups identified STDs (syphilis, AIDS and gonorrhoea) as the major illnesses. Pelvic inflammatory disease was also mentioned, though only by women's groups.To the surprise of the resarchers, some men blamed traditional healers for the spread of HIV through the use of unsterilized instruments and through sex with female clients.Male circumcision was mentioned as a method of avoiding STDs.

The Zambia research involved 16 FGDs in Kabwe and Mapiri Mposhi. The groups of women users were recruited at a family planning clinic and the non-users were recruited at antenatal clinics. The sexually active men were of two categories: those recruited at an STD clinic and those with no evidence of an STD, recruited at their workplace. STDs and HIV/AIDS were reported as the major health problems affecting many people in the areas of study. HIV/AIDS, gonorrhoea, syphilis, chancroid, malaria and tuberculosis were mentioned in this order of importance. Much STD infection was felt to be due to the extramarital relationships of both men and women. The researchers identified eight different local names for AIDS (in contrast to three for other STDs), which they said points to the seriousness of the HIV/AIDS problem in Zambia. The spread of HIV was blamed on men having "all kinds of relationships outside marriage".

Participants in the South African focus groups in both urban and rural areas identified AIDS, tuberculosis and cancer as the major health risks.

Unwanted pregnancy too common

The researchers concluded from the FGDs in Kenya that unwanted pregnancy is so widespread "that it is almost becoming a norm". Unwanted pregnancy was also considered a major problem by the South African groups. This, the researchers say, is also supported by the large number of abortions in the study areas.

In Tanzania, unwanted pregnancy was said to have been a serious problem in the past but that now it affects only women who do not use family planning services. Participants in the FGDs mentioned that these were primarily younger women.

Most groups in Uganda also said that unwanted pregnancies were a major problem and that both abortions and school drop-out were common. Some Ugandan groups, on the other hand, felt that it was not as serious a problem as in the past, since most men had stopped having casual relationships.

Sources

1. Bauni EK. Family planning and sexual behaviour in the era of HIV/AIDS/STDs: a multicountry study—Kenya. Nairobi, Population Council, 1998.

2. Neema S, Garimoi CO. Family planning and sexual behaviour in the era of HIV/AIDS/STDs: a multicountry study—Uganda. Kampala, Makerere Institute of Social Research, 1998.

3. Maharaj P. Family planning and sexual behaviour in the era of HIV/AIDS/STDs: a multicountry study—South Africa. University of Natal, 1998.

4. Mushingeh ACS. Family planning and sexual behaviour in the era of HIV/AIDS/STDs: a multicountry study—Zambia. University of Zambia, 1998.

5. Riwa P, Ngirwamungu E. Perception of the risk of STD/HIV/AIDS and unwanted pregnancy. National Family Planning Programme, Ministry of Health, 1998.

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