in Uganda (see also Olowo-Freers and Barton, 1992). The practice also remains quite common in parts of West Africa. In East African patrilineal societies, such as the Masai, Nandi, Kikuyu, Kisii, and Meru in Kenya, widow-inheritance used to be the rule, and widows had limited rights of appeal (Lesthaeghe, 1989). Nowadays, widows often have more choice in the matter (Lesthaeghe, 1989; Olowo-Freers and Barton, 1992). They may choose among the potential heirs or even choose not to remarry at all (Olowo-Freers and Barton, 1992).


Almost all studies report a very high awareness of the existence of HIV/AIDS, with the WHO/GPA surveys recording that over 9 out of 10 people know of the disease everywhere except Francophone West Africa (Table 4-5). The lowest awareness recorded in any study was in Togo, where just under two-thirds of respondents had heard of AIDS, and where the sex differential in knowledge was also greatest. In multivariate analysis, media exposure and education appeared as major predictors of AIDS awareness. Controlling for education diminished the independent effect of age. This section reviews levels of AIDS awareness with respect to the specific issues of modes of transmission, asymptomatic transmission, severity and perceived threat, attitudes toward sufferers, and testing.

Modes of Transmission

Most studies concur that among those aware of AIDS, the overwhelming majority are aware of actual modes of transmission and genuine risk behaviors (Irwin et al., 1991; Lindan et al., 1991; Hogsborg and Aaby, 1992; Messersmith et al., 1994). In most sub-Saharan Africa WHO/GPA surveys, sex with prostitutes was recognized as risky by over 90 percent of those respondents who were aware of AIDS, although in Guinea-Bissau, nearly 3 in 10 respondents did not think of the practice as dangerous (Ingham, 1995). However, in a Nigerian study reporting very high awareness of sexual transmission, just 29 percent of women and 17 percent of men mentioned the route of sex with prostitutes spontaneously (Messersmith et al., 1994). The suggestion here of deliberate denial—especially in this case by men who were broadly more educated and aware than women—was reinforced in the same study by the sex differentials in answers to questions about prevention. Of those who knew of AIDS, women were nearly twice as likely as men to mention condom use and avoidance of sex workers, and were also slightly more likely to mention partner reduction. Men who had a history of contact with sex workers were less likely than those who did not to regard sex workers as a source of danger, and the proportion of men saying fewer partners could reduce the risk of HIV infection fell as their number of partners over the

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