This study describes the sexual behaviour of men and women in a fishing village on the shores of Lake Victoria in southwest Uganda. The village is near a well known trading town-truckstop on the main trans-Africa highway with a high recorded prevalence of HIV infection. Data were obtained on the daily travel and sexual activities of 26 women and 54 men with particular attention paid to the rate of partner change and the proportion of sexual contacts with people outside the village. During a total of 587 person weeks the men made 1086 trips, mostly returning home the same day. They had a total of 1226 sexual contacts, most of which occurred either in their own village (83%) or a neighbouring fishing village (11%); 17 per cent of sexual contacts were with new partners. Fifteen of the women described themselves as married; 42 per cent of their sexual contacts were casual, paying partners. Of the eleven women who were single, between 80 and 100 per cent of contacts were with paying partners. Most of the women's partners were resident in the village. These data show a very high rate of sexual mixing within the village. Such communities should be targeted in future STD control programs.
Interview data were collected from 1749 men and 1976 women of mean age 36.0-39.7 years in Ado-Ekiti, Ondo State; Ibadan, Oyo State; Badagry, Lagos State; Ekiti West and Ekiti Southeast, Ondo State; and Egbeda Local Government Area, Oyo State. It is generally believed that men have a greater need for sex than do women, and that men should have unlimited sexual freedom while women are expected to have only one partner. Men's extramarital sexual activity is largely taken for granted. However, a growing number of men and women now believe that one woman is enough for one man at any given time and over a lifetime. Respondents often mentioned being afraid of sexually transmitted diseases and AIDS. Extramarital relations during a wife's postpartum abstinence are no longer important because of the rising level of contraception and the rapid decline in the duration of breastfeeding and postpartum abstinence. The double standards of male and female sex behavior will diminish with increased access to education and the move toward monogamous unions.
Patterns of migration do not simply arise out of chance. In South Africa, for example, migration patterns are a result of decades of legislation aimed at restricting the movements of the majority of the population and providing a steady flow of cheap black labour to the gold mines and other industries. In the new democratic South Africa, restrictive laws have been lifted, but circular migration remains a way of life for several million black South Africans. This paper examines the social and epidemiological implications of widespread circular migration from the perspective of a rural South African Health District. In particular, we report our findings on the patterns and prevalence of migration into and out of the Hlabisa Health District in rural KwaZulu/Natal, and the patterns of sexual networking of migrants and their rural partners. We conclude by examining the implications of these patterns of migration and sexual networking for the spread of HIV and other STDs.
Divorced or separated persons are more likely to be infected with HIV than those in marital unions: sexual partner instability appears to have significant implications in STD/HIV transmission. While this appears empirically true, most current STD/HIV preventive strategies do not seem to address partner instability as an important underlying factor in STD/HIV transmission and control. This paper describes reasons why young females may be motivated to change sexual partners or have more than one sexual partner. The problems appear to be dissatisfaction due to infidelity of the male partner, fear of getting STD from current partner, drunken or unattractive male partner, economic problems, lack of leisure time together, male partner's children with other women, and male partner's relatives' influence. STD/AIDS Control Programs should note that dissatisfaction with partner may be an underlying factor in HIV transmission.
The paper examines the relationship between the lifetime risk of dying from AIDS and HIV prevalence, using a female stable population model in which the epidemic has stabilized. In addition to prevalence, lifetime risk is determined by various other factors, notably the level of mortality from causes other than AIDS, age at infection, and survival time between infection and death. Typically, the lifetime risk of dying from AIDS is between three and five times the HIV prevalence. Regression equations are developed for estimating lifetime risk from the prevalence and other parameters. The methods are applied to data for Kenya, and it is shown that the 1995 prevalence estimate of 7.5 per cent for the population aged 15 and over would be equivalent to a lifetime risk of about 30 per cent. HIV prevalence, or the proportion of the adult population which is HIV-positive, is the most commonly used index for measuring the scale of the epidemic. In African countries, national estimates of HIV prevalence are generally only available for females, as the main source of data is the anonymous testing of women who use antenatal services. More direct measures of the effect of HIV could be found from the annual death rate due to AIDS in the adult population, or the proportion of all adult deaths which are due to AIDS. These measures are rarely available in practice, as most African countries do not have death registration systems, and in any case, AIDS deaths are frequently perceived as due to other causes (Boerma et al. 1997). None of the above measures tells us about the overall risk of contracting HIV or dying from AIDS faced by an individual approaching adulthood and sexual maturity. But this last measure, which for a disease like AIDS is three or four times as large as the current prevalence measure, is one which would be very useful to planners and health educators alike. It would enable those who train skilled workers and professionals to judge what proportion of their cadres would be lost to this disease before the end of their working lives. It would allow insurance companies to set realistic premiums in countries affected by the epidemic. And it could provide a powerful advocacy tool for those trying to persuade young people not to follow the norm in terms of widely prevalent unsafe sexual behaviour. HIV prevalence, or the proportion of the adult population which is HIV-positive, is the most commonly used index for measuring the scale of the epidemic. In African countries, national estimates of HIV prevalence are generally only available for females, as the main source of data is the anonymous testing of women who use antenatal services. This paper investigates the relationship between HIV prevalence and lifetime risk, using models of age-specific incidence which have been tailored to reflect the type of sexual union formation patterns observed amongst females in a wide range of African populations. We focus on females because information on HIV prevalence, participation in sexual unions and fertility is widely available for females but not for males. The relationships which we discover
