least one factor shown in the HIV-seropositivity study to be an HIV/AIDS risk still thought themselves to be in no danger of contracting the disease. Astonishingly, the WHO/GPA surveys showed that proportions feeling themselves vulnerable to the disease were generally much lower in the higher-prevalence areas of East and central Southern Africa than in lower-prevalence West Africa.
Perhaps the explanation for the weak links between behavior and risk perception can be found in Hogsborg and Aaby (1992). Respondents reporting feelings of vulnerability in that study were also liable to report that ''it depends on God." This fatalism was taken one step further by focus group participants who were aware of modes of transmission and risk reduction. Kisekka (no date) and Obbo (1993a) report that the sentiment "after all, you have to die of something" has become a common justification for continued high-risk behavior. 14
In heavily affected Rakai district, Uganda, Konde-Lule (1993) found that AIDS patients were little stigmatized except by adolescents, who thought that since the means of transmission were known, people had only themselves to blame if they fell ill. This feeling was among the most sympathetic attitudes expressed elsewhere, however. Factory workers in Kinshasa, Zaire, stated that anyone known to be HIV-positive would be shunned by his or her neighbors (Irwin et al., 1991), while many respondents in the WHO/GPA survey in the Central African Republic thought AIDS patients deserved no care, and nearly one in five stated flatly that they should be killed. Anarfi (1993) found similar sentiments in Ghana: "The general opinion is that sufferers of the disease must be killed or at best confined" (Anarfi, 1993:65).
The extent of variation even within countries is illustrated in two reports on AIDS from different regions of Tanzania. Kaijage (1994a:15) states that in Kagera, AIDS stigmatization is declining:
Although the problems raised above are still fairly widespread, denial and stigma are less prevalent now than they used to be in the earlier days of the epidemic. … [A]lmost every family, especially in Bukoba, Muleba, and to some extend Karagwe, has been affected by AIDS. People are therefore generally more sympathetic to persons with AIDS (PWAs) than used to be the case. And, for a PWA in Kagera, having AIDS is no longer such a peculiar experience. AIDS is less a disease of shame than it used to be. It is now euphemistically referred to as "this disease," which suggests familiarity with it.
See also Chapter 5 for further discussion of the underreaction to the AIDS epidemic.