rural Uganda revealed that circumcised men tend to be Moslem traders concentrated in high-prevalence trading towns (Serwadda et al., 1992). Although circumcision is found to be protective, the authors do not investigate whether there are behavioral factors associated with being Moslem that might also be protective. Further research is required to illuminate not only the association between male circumcision status and acquisition of HIV, but also the causal factors and specific mechanisms involved (Mertens and Caraël, 1995).

Alcohol

Drinking is often thought to be associated with lower self-control and greater risk-taking behavior with regard to sex. However, few studies have examined the effects of alcohol consumption on sexual behavior in sub-Saharan Africa, although some income expenditure studies show that a significant portion of disposable income is spent on the consumption of various forms of alcoholic beverages. Bars and nightclubs that sell alcohol are often popular meeting places and are frequented by people looking for commercial or casual sex. Six of the nine WHO/GPA surveys in sub-Saharan Africa included a module on drinking habits (Central African Republic, Côte d'Ivoire, Guinea-Bissau, Lesotho, Tanzania, and Lusaka, Zambia). Analysis of these data established that alcohol consumption is common in these countries and that it is positively associated with risk behavior, even when other factors are held constant (Ferry, 1995b).

In Uganda, alcohol and sexual activity are linked in both commercial and social spheres (Olowo-Freers and Barton, 1992). The brewing of various forms of alcoholic beverages is a major source of cash income for may women, particularly in urban slum areas. The alcohol trade is closely intertwined with commercial sex activity. Many women who make and sell beer are also known as prostitutes (Olowo-Freers and Barton, 1992). In Kampala, beer gardens are popular places for finding casual sexual partners. Drinking is particularly heavy among students and urban slum dwellers. In one study of urban slum dwellers in Kampala, over 60 percent of heads of households drink daily (Kayobosi, 1988, cited in Olowo-Freers and Barton, 1992).

SEXUAL PRACTICES AND BELIEFS

While quantitative studies are useful in defining the incidence of common practices, they will never identify all of the beliefs and practices that, albeit far from universal—indeed sometimes apparently at odds with survey data—may help indicate acceptable interventions with the potential for having some impact on behavior. This section reviews some of the beliefs and practices examined by the literature on sexual behavior in sub-Saharan Africa, particularly qualitative studies.



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