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1993 - VOLUME 3, NUMBER 2

93.57.06 - English - Herbert L. SMITH, Population Studies Center and Department of Sociology, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104-6298 (U.S.A.)

On the Limited Utility of KAP-style Survey Data in the Practical Epidemiology of AIDS, with Reference to the AIDS Epidemic in Chile (p. 1-16)

Population surveys concerning "risk behaviours" thought to be related to the AIDS epidemic are many. Nevertheless, unfocused inquiry into diffuse behaviours in undifferentiated populations is not productive in low-seroprevalence populations, especially when the point is to design some form of intervention that might actually avert further infection. This is because of a failure to distinguish conceptually between the relevance of AIDS-related behavioural data for individuals and for populations. An illustration is drawn from the AIDS epidemic in Santiago, Chile, and an alternative perspective, based on extensive interviews with persons with AIDS and a survey of current HIV-surveillance and blood-screening programmes, is described. (CHILE, AIDS, KAP SURVEYS, EPIDEMIOLOGY, METHODOLOGY)

93.57.07 - English - Huda ZURAYK, The Population Council Regional Office, P.O. Box 115, Dokki, Giza (Egypt) et al.

Concepts and Measures of Reproductive Morbidity (p. 17-40)

This paper presents a conceptual and methodological framework developed by an interdisciplinary group of researchers to diagnose reproductive morbidity at the community level. The paper also presents a determinants structure that delineates the health and social factors hypothesized to influence reproductive morbidity. The high prevalence of reproductive-morbidity conditions revealed by implementation of the study framework in two villages in Giza in Egypt is reported. Based on this research experience and the processes of presenting its results to the larger professional community, the paper discusses policy implications of the study in terms of reproductive health services, education and targeting programmes and research efforts for measurement of reproductive ill-health at a community setting. (EGYPT, MORBIDITY, MATERNAL AND CHILD HEALTH, RESEARCH METHODS)

93.57.08 - English - Elisha P. RENNE, Health Transition Centre, NCEPH, Australian National University, Canberra, ACT 0200 (Australia)

Condom Use and the Popular Press in Nigeria (p. 41-56)

The increased acceptability and use of condoms by men in south-western Nigeria is reflected in joking references to condoms in the comic-style popular press. Yet, these references display an ambivalence about condoms that is mirrored in survey data and in interviews regarding condom use by rural Ekiti Yoruba men. This ambivalence, which is often couched in terms of health, has implications for the acceptance of government-sponsored HIV/AIDS-related educational programmes. Because of the irreverence of comic-style newspapers and the "unofficial" nature of their authority which coincides with popular attitudes about health programmes, they have a credibility that could be useful in educating adolescents about sexually-transmitted diseases and HIV/AIDS. (NIGERIA, CONDOM, ATTITUDE, NEWSPAPERS, PUBLIC OPINION)

93.57.09 - English - Soniia DAVID, International Centre for Research in Agroforestry, P.O. Box 30677, Nairobi (Kenya)

Health Expenditure and Household Budgets in Rural Liberia (p. 57-76)

Fieldwork conducted in a Kpelle village in north-central Liberia revealed that health-care expenses constitute a major part of domestic spending. The actual transactions for major health-care expenditures are handled by men, typically using income that jointly belongs to the couple in addition to the husband's personal income. Women are likely to spend their personal incomes on minor health expenses for themselves and their children. Women's health expenditure, as well as their income handling arrangements, seem to differ according to the type of conjugal union they are in. Although Kpelle wives have input in most financial decisions, they tend to defer to men on issues which are associated with the Western world, namely Western health care, educational and tax expenditures. (LIBERIA, FAMILY BUDGET, HEALTH)

93.57.10 - English - Stan BECKER, Department of Population Dynamics, The Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205 (U.S.A.) et al.

The Determinants of Use of Maternal and Child Health Services in Metro Cebu, the Philippines (p. 77-90)

The determinants of the use of family planning, prenatal care, childhood immunizations and oral rehydration salts (ORS) were studied with survey data of 8,000 women in Metro Cebu, the Philippines. Polytomous logistic regression methods were used. The level of maternal education was the most consistent and important determinant of use of these four health services in both urban and rural areas. For example, the estimated odds of using modern contraception increased by six and eleven per cent for each additional year of schooling in urban and rural start respectively. Economic status and access to service variables had less consistent patterns: women's work status, for example, was associated only with contraceptive use. (PHILIPPINES, MATERNAL AND CHILD HEALTH, FAMILY PLANNING PROGRAMMES, LEVELS OF EDUCATION)

1993 - VOLUME 3, NUMBER 2

93.57.11 - English - Francisca I. OMORODION, Department of Sociology and Anthropology, University of Benin, Benin City (Nigeria)

The Socio-cultural Context of Health Behaviour Among Esan Communities, Edo State, Nigeria (p. 125-136)

This paper reports on health beliefs and their influence on treatment decisions and behaviour among the Esan people of mid-west Nigeria. The sources for the study are the author's own experience of growing up in Esan society, anthropological field work and focus groups. The research revealed a transitional society where both traditional and modern medicine are employed and where the choice between them is determined by belief systems which are themselves in the process of change, as well as by distance and costs. The traditional health-belief system was one which placed most responsibility and blame upon women and a system of social control over the adult female population. Changing health beliefs are less the refusal of the introduction of a new health philosophy than of the retreat, under the impact of Christianity, of traditional religion which embodied the older health philosophy. (NIGERIA, VALUE SYSTEMS, RELIGION, HEALTH, TRADITIONAL MEDICINE)

93.57.12 - English - Sarah E. CASTLE, Population Studies and Training Center, Box 1916, Brown University, Providence, RI 02912 (U.S.A.)

Intra-household Differentials in Women's Status: Household Function and Focus as Determinants of Children's Illness Management and Care in Rural Mali (p. 137-158)

In West Africa, health-seeking behaviour can be better understood by assessing how women differ from each other, rather than how they differ from men, in terms of their socio-economic and political power within the domestic environment. Anthropological and demographic data were collected among rural Malian Fulani and Dogon populations who possess similar health beliefs and who live in the same ecological area. However, real differences between the two ethnic groups were reflected in variations in maternal status defined according to women's support and/or autonomy in their households. When a child becomes sick, status obligations result in limited degrees of cooperation between marital female relatives. By contrast, on a day-to-day basis, such assistance is rarely forthcoming and women rely on their own unmarried daughters or on external kin networks for surrogate child care. It is concluded that variations in health behaviour and mortality outcomes within these populations reflect not simply "ethnic" differences in beliefs or culture, but rather real differences in mothers' social positions within their family environments and in their access to household resources for children's treatment and care. (MALI, RURAL WOMEN, WOMEN'S STATUS, HEALTH, FAMILY ENVIRONMENT)

93.57.13 - English - John HOBCRAFT, Department of Population Studies and Centre for the Study of Global Governance, London School of Economics, Houghton Street, London WC2A 2AE (U.K.)

Women's Education, Child Welfare and Child Survival: A Review of the Evidence (p. 159-176)

This paper reviews recent evidence concerning the relative importance of women's education for child health, especially child survival in the Third World. Important regional patterns are uncovered and particular attention is paid to discussion of the weaker associations observed in sub-Saharan Africa. (AFRICA SOUTH OF SAHARA, LEVELS OF EDUCATION, WOMEN, HEALTH, INFANT MORTALITY)

93.57.14 - English - V.B. TULASIDHAR, National Institute of Public Finance and Policy, 18/2, Special Institutional Area, New Delhi 110 067 (India)

Maternal Education, Female Labour Force Participation and Child Mortality: Evidence from the Indian Census (p. 177-190)

The objective of this paper is to examine how child mortality changes with different levels of maternal education and to quantify the impact of maternal education and female labour force participation. Child mortality gradients, according to years of education, are rather steep at the primary education level for both male and female children. In post-primary stages of education, incremental gains in mortality reduction are almost non-existent. Child mortality is inversely related to both maternal education and female labour force participation, but disaggregated analysis showed that female labour force participation has no impact on child mortality among females with fewer than seven years of education. The relative impact of maternal education on child mortality is three times stronger than that of female labour force participation. Excess female child mortality prevailing in certain parts of India also has an inverse relationship with the length of mothers' education and female labour force participation. Female labour force participation has a stronger influence on excess female child mortality than on absolute child mortality. The evidence in the paper lends support to Bardhan's hypothesis on excess female child mortality. (INDIA, WOMEN, LEVELS OF EDUCATION, LABOUR FORCE PARTICIPATION, INFANT MORTALITY, DAUGHTERS, EXCESS MORTALITY)

93.57.15 - English - Kathleen FORD, Department of Population Planning and International Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029 (U.S.A.)

AIDS Knowledge, Condom Beliefs and Sexual Behaviour Among Male Sex Workers and Male Tourist Clients in Bali, Indonesia (p. 191-204)

The objective of this paper is to describe the AIDS knowledge and risk behaviours of male sex workers who serve predominantly male clients in Bali, Indonesia, to discuss implications for the spread of the disease, and to discuss appropriate interventions for these groups. Data are drawn from a qualitative study of the workers and clients consisting of interviews with many open-ended questions. The results of the study are viewed in terms of the AIDS Risk Reduction Model (ARRM). The data indicate that there is a very active community of male sex workers and male clients in Bali that is at risk of AIDS infection. Multiple sexual partners, unprotected anal intercourse and frequent experience with STDs put both workers and clients at risk. Workers had limited knowledge of AIDS and STDs, although clients were mainly well informed. Both groups were characterized by frequent mobility. High levels of alcohol use by clients were reported before and during sexual encounters and may be a factor in increasing risky sexual behaviours. Interventions for these groups should include improving knowledge of workers, improving STD treatment for both clients and workers, skills training for sex workers and increasing availability of good quality condoms and lubricants. (INDONESIA, AIDS, PROSTITUTION, TOURISM, SEXUALLY TRANSMITTED DISEASES, SEXUAL BEHAVIOUR)

1993 - VOLUME 3 (Supplement)
Sexual networking and HIV/AIDS in West Africa

93.57.16 - English - John C. CALDWELL, Health Transition centre, NCEPH, ANU, Canberra, ACT 0200 (Australia) et al.

African Families and AIDS: Context, Reactions and Potential Interventions (p. 1-16)

This paper reviews publications and research reports on how sub-Saharan African families have been affected by, and reacted to, the AIDS epidemic. The nature of the African family and its variation across the regions is shown to be basic to both an understanding of how the epidemic spread and of its impact. The volume of good social science research undertaken until now on the disease in Africa is shown to be extremely small relative to the need. (AFRICA, AIDS, FAMILY, RESEARCH)

93.57.17 - English - H. PICKERING and H.A. WILKINS, Medical Research Council, P.O. Box 272, Banjul (Gambia)

Do Unmarried Women in African Towns Have to Sell Sex, or Is It a Matter of Choice? (p. 17-28)

This paper describes a survey of all women in a market town of 20,000 individuals, and examines the economic opportunities and social support of three groups of women; prostitutes, divorced or widowed and married women. It is necessary for all women to provide a substantial proportion of their daily income from their own resources. Most resorted to agriculture, the provision of domestic services or trade. Prostitutes differed from the other two groups in their comparatively high earnings, consumption patterns, lack of involvement with families or community and sexual behaviour. (GAMBIA, WOMEN'S STATUS, ECONOMIC RESOURCES, PROSTITUTION)

93.57.18 - English - John K. ANARFI, Institute for Statistical, Social and Economic Research, University of Ghana, Lagon, Accra (Ghana), and Kofi AWUSABO-ASARE, Department of Geography, University of Cape Coast, Cape Coast (Ghana)

Experimental Research on Sexual Networking in Some Selected Areas of Ghana (p. 29-44)

Despite increasing evidence that West Africa is at a critical stage in its experience of the AIDS pandemic, there is a lack of specific information about the sexual behaviour of people in the society. To provide such information, 360 individuals were surveyed. Results indicate that the nature of sexual contacts within Ghanaian society has the potential to promote the spread of STDs and AIDS. Polygyny, central in Ghanaian sociocultural organization, underlies the male tendency to seek multiple sexual partners. Early widowhood, the general instability of marriage and the high level of remarriage, also suggest that there is a high level of sexual networking within the society. Although Ghanaian society accepts sexual networking, and some people are even casual about the AIDS scare, it appears that people are changing their sexual habits in response to the campaign on AIDS, which seems to have succeeded in instilling fear. (GHANA, AIDS, SEXUAL BEHAVIOUR, POLYGAMY)

93.57.19 - English - John K. ANARFI, Institute for Statistical, Social and Economic Research, University of Ghana, Lagon, Accra (Ghana)

Sexuality, Migration and AIDS in Ghana (p. 45-68)

Sexual behaviour in Ghana characterizes a society in transition. Although cultural restrictions against sexuality are no longer strictly enforced, the very nature of the social organization puts a brake on some excesses. Migration removes people from these restrictions into a situation where sexual fulfilment is enhanced. This paper explores the risk factors associated with migration. Results of a large survey across Ghana indicate widespread sexual networking. There is, however, an apparent decline in the number of sexual partners in recent periods which may be related to the AIDS campaign. Yet migration acts to increase the extent of sexual networking. While many migrants have regular sexual partners, there are a substantial number of encounters with casual partners. The circular nature of migration and the maintenance of links with home through frequent visits puts people at risk at both ends of the migratory movement. This risk is increased with international migration, associated with higher than average numbers of sexual partners. An appropriate policy for the control of the spread of AIDS in Ghana, therefore, would be one which combines educational programs with strategies for removing the factors which compel young people to migrate. (GHANA, AIDS, SEXUAL BEHAVIOUR, MIGRATION)

93.57.20 - English - Kofi AWUSABO-ASARE, Department of Geography, Dominic K. AGYEMAN, Department of Sociology, University of Cape Coast, Cape Coast (Ghana), and John K. ANARFI, Institute for Statistical, Social and Economic Research, University of Ghana, Lagon, Accra (Ghana)

Women's Control Over Their Sexuality and the Spread of STDs and HIV/AIDS in Ghana (p. 69-84)

Given the present spread of AIDS, there is a need to examine the extent to which the vulnerability of women to STDs and AIDS is reinforced by social values. This paper discusses the rights of Ghanaian women over their sexuality and its implications for the spread of STDs in general and AIDS in particular. Women in Ghana, particularly the matrilineal Akans, in theory have rights over their sexuality and can assert their rights over an offending husband, but, their poor status in the modern economy means that economic concerns now overshadow traditional norms which governed marital relations in the past. Some women have become economically dependent and, therefore, less likely to take control over their sexuality. Programs to improve women's education and, hence, their employment opportunities may empower women to control some of the factors related to their sexuality. Meanwhile, gender-specific information, education and communication must be intensified to increase women's awareness of the dangers of AIDS. (GHANA, AIDS, SEXUAL BEHAVIOUR, WOMEN'S RIGHTS)

93.57.21 - English - Marie L. EGO and Margaret MORAN, Holy Family Hospital, Box 21, Berekum B/A (Ghana)

HIV/AIDS Counselling Program: A Rural Ghana Experience (p. 85-92)

This paper describes an HIV/AIDS counselling training program which has run for two-and-a-half years at the Holy Family Hospital, Berekum. The training is designed to teach para-professionals active listening skills to cope with the spiritual and emotional dimension of the person who is HIV-positive. Parallel to this training, the Hospital established counselling services which have been extended to include home visiting. Difficulties have been the need for emotional support of counsellors, a lack of time and staff, and the lack of financial resources. The overall success of the program, however, has indicated that this form of counselling training is an effective way of addressing the emotional care of persons with HIV/AIDS. (GHANA, AIDS, PARAMEDICAL PERSONNEL, TRAINING)

93.57.22 - English - I.O. ORUBULOYE, Faculty of the Social Sciences, Ondo State University, Ado-Ekiti (Nigeria), John C. CALDWELL and Pat CALDWELL, Health Transition Centre, NCEPH, Australian National Unversity, Canberra ACT 0200 (Australia)

The Role of Religious Leaders in Changing Sexual Behaviour in Southwest Nigeria in an Era of AIDS (p. 93-104)

Nigerian Christian and Muslim religious leaders have long preached against premarital and extramarital sexual relations. The AIDS epidemic has provided an additional case for such preaching. As part of a study of the teachings of religious leaders with regard to sexual behaviour and AIDS, this paper reports on interviews and survey responses during 1992 with 81 leaders of African Independent Churches and 40 Muslim leaders in the Yoruba area of southwest Nigeria. It was found that nearly all preach that the AIDS epidemic is a divine punishment for sexual immorality and most had intensified their teaching against sex outside marriage, with, however, a greater emphasis on female than male behaviour. Most have not used the epidemic to go to excessive lengths and the majority believe that government health campaigns are more likely to change sexual behaviour than are the teachings of religious leaders. (NIGERIA, AIDS, PROTESTANTISM, ISLAM)

93.57.23 - English - S.C. OGBUAGU and J.O. CHARLES, Department of Sociology, University of Calabar, Calabar (Nigeria)

Survey of Sexual Networking in Calabar (p. 105-120)

Calabar is known for its easy-going sexual morality. In such a setting HIV/AIDS could spread extremely rapidly. It was therefore decided to conduct a survey among the inhabitants to determine the nature and extent of sexual networking, and people's awareness of AIDS and STDs as health risks. At least one-quarter of respondents had their first sexual experience before the age of 14 and premarital sexual contact is widespread. Many residents have more than one sexual partner and sexual networking is widespread. While most respondents had heard of AIDS and were aware of condoms, very few used them for AIDS prevention or, indeed, at all. The study demonstrates that the city is a high-risk area for the transmission of HIV and STDs and an effective awareness campaign is urgently needed. (NIGERIA, AIDS, SEXUALLY TRANSMITTED DISEASES, SEXUAL PERMISSIVENESS, CONDOM)

93.57.24 - English - Elisha P. RENNE, Health Transition Centre, NCEPH, Australian National Unversity, Canberra ACT 0200 (Australia)

Changes in Adolescent Sexuality and the Perception of Virginity in a Southwestern Nigeria Village (p. 121-134)

This paper examines changes in the perception of virginity and premarital female sexuality over the past 60 years in a rural Ekiti Yoruba village, based on interviews with 95 women, aged 15-80. Formerly, virginity was considered an important part of arranged marriage and was believed to facilitate pregnancy. Now virginity is associated with antisocial behaviour, disease, and infertility by many younger women. This shift in attitudes illustrates how the perception of health and fertility relates to societal change, in this case the introduction of divorce and the end of arranged marriage. These women's remarks suggest that as the effects of HIV-AIDS become more evident, adolescent female sexuality may once again undergo a rapid reassessment as it did earlier in the century. (NIGERIA, AIDS, VIRGINITY, SOCIAL NORM, WOMEN'S STATUS)

93.57.25 - English - Josephine O'TOOLE ERWIN, Demography Division, RSSS, Australian National University, Canberra ACT 0200 (Australia)

Reproductive Tract Infections Among Women in Ado-Ekiti, Nigeria: Symptoms Recognition, Perceived Causes and Treatment Choices (p. 135-150)

The advent of the AIDS epidemic and recent initiatives in women's health have highlighted reproductive tract infections as important common causes of morbidity among women. This article explores aspects of health-seeking behaviour in relation to reproductive tract infections in Southwest Nigeria and discusses their implications for the development of an approach to reproductive health designed to meet the needs of Nigerian women and their partners. (NIGERIA, AIDS, MATERNAL AND CHILD HEALTH, FEMALE GENITALIA)

93.57.26 - English - Beatrice Adenike OLOKO and A.O. OMOBOLOYE, Department of Sociology, University of Lagos, Lagos (Nigeria)

Sexual Networking Among Some Lagos State Adolescent Yoruba Students (p. 151-158)

Adolescent sexual behaviour was studied in order to provide more valid data on the onset of sexual experience and aspects of premarital sexual networking which may influence sexuality in later life. Yoruba students from five secondary schools were surveyed. Almost half the respondents were sexually active and most had more than two sexual partners. Despite this, most respondents favoured premarital chastity for girls. More students had heard of AIDS than STDs but, even so, knowledge of transmission was limited. Yet, nearly one-third indicated that they knew of someone with AIDS. The evaluation, however, of premarital chastity as desirable suggests that subsequent sexual behaviour may be amenable to shaping through family-life education, a possible route for AIDS control campaigns. (NIGERIA, AIDS, ADOLESCENTS, PREMARITAL SEX BEHAVIOUR)

93.57.27 - English - Francisca Isi OMORODION, Department of Sociology and Anthropology, University of Benin, Benin (Nigeria)

Sexual Networking Among Market Women in Benin City, Bendel State, Nigeria (p. 159-170)

A survey of market women was conducted in Benin City. These women are vulnerable to HIV/AIDS and STD infections since their trading activities involve long-distance travelling away from families and sexual exposure to strangers. The questionnaire included questions on socioeconomic background, sexual and health behaviour. Results indicate that there is a high level of sexual networking , especially extramarital: 26 per cent of the women have sexual intercourse with strangers, and 70 per cent have extramarital sexual relationships. A high proportion of the market women and those in close contact have contracted STDs. It is evident, therefore, that public-health education concerning AIDS and STDs is urgently needed. (NIGERIA, AIDS, SEXUALLY TRANSMITTED DISEASES, WOMEN, TRADE, MIGRATION)

93.57.28 - English - O.Y. OYENEYE and Sina KAWONISE, Department of Sociology, Ogun State University, Ago Iwoye (Nigeria)

Sexual Networking in Ijebu-Ode, Nigeria: An Exploratory Study (p. 171-184)

This paper describes an exploratory study to determine the degree of sexual networking in Ijebu-Ode. The data generated will be compared to a survey in Ekiti (Orbuloye, Caldwell and Caldwell 1991) and provide the groundwork for later, more detailed studies. A major objective was to investigate whether sexual networking can be studied in this area. Results indicate that virginity at marriage is losing its importance and that most respondents engaged in multiple sexual relations for fun. Despite an awareness of STDs, extramarital sexual relationships, especially amongst men, are common. Most knew of HIV/AIDS and its transmission, yet there was a general belief that it could be cured through orthodox medical treatment. The study highlights a gap in the effectiveness of the government nationwide campaign and the need for further work on sexual networking. (NIGERIA, AIDS, SEXUALLY TRANSMITTED DISEASES, SEXUAL BEHAVIOUR)

93.57.29 - English - W.A. SHOKUNBI, I. SALIU and E.M. ESSIEN, Department of Haematology, University College Hospital, Ibadan (Nigeria)

Incidence of Antibodies to HIV1 and HIV2 Gene Products in Seropositive Cases Seen in Ibadan, Nigeria (p. 185-188)

Between July 1987 and December 1988, sera from 6,389 individuals were screened for HIV1, but only 1,861 of these samples were randomly screened for HIV2. The majority of those screened for HIV infection were blood donors (89.6%), 5.1% were international travellers, and 5.3% were multiply transfused patients and those suspected of having HIV infection. Screening for HIV antibodies was done using ELISA and the confirmatory test used was Western blot. The seroprevalence rate for HIV in the blood donors was 0.51% while that of HIV2 was 0.33%. The seroprevalence rates for HIV1, and HIV2 amongst the travellers were 0.93% and 0.31% respectively and the comparative rates in the multiply transfused patients were 0.89% and 0.59% respectively. Evidence of dual infection by HIV1, and HIV2 was obtained from 16.7% of the scropositive individuals. The dual infection rate in seropositive Nigerians is similar to that reported for some other West African countries. We strongly suggest that all blood samples for HIV tests in Nigerians should be screened for both HIV1, and HIV2 . (NIGERIA, AIDS, MEDICAL TESTS)

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