researchers further reported that men who said they would use condoms with casual partners did not in fact do so, explaining in each case that the circumstances were special because the woman was respectable. The researchers concluded that focusing campaigns on condom use with unknown partners who are assumed to be strangers is useless in a context in which people do not consider any partners to be unknown.

In focus group interviews conducted in Rakai district, Uganda, after several years of vigorous campaigns to promote AIDS awareness and behavior change, people in rural areas did believe that risky sexual activity was on the wane. Optimists might think this finding reflects a new, lower-level, post-AIDS norm. In urban areas, however, people thought their neighbors were just as active as ever but more discreet, a change that might also translate into an increasing tendency to underreport the numbers of partners in surveys (Konde-Lule, 1993). Adolescent groups were especially unlikely to think sexual activity had diminished. Working in the same area, Obbo (1993b) reports an interesting attempt to ''map" sexual networks.19 The work shows that even if people reduce their partner numbers to a small band of people they know well, such as old classmates, they are still at considerable risk of infection. Of 15 people in two interlinked urban networks in 1989, only 2 had survived by 1992.

The failure of awareness programs and interventions to effect more substantial change in condom use should be judged in context. Despite initial willingness among adolescents in Durban, South Africa, to try condoms with their partners, few had positive experiences, challenging widely held notions of male sexual prowess, love, and accepted patterns of interpersonal communication between the sexes (Preston-Whyte, 1994). In a culture where condoms are uncommon and have a rather sordid image, such an outcome is hardly surprising.

Focus groups illuminate the frightening possibility that behavior change may be in the wrong direction. An overwhelming majority of schoolchildren involved in an essay-writing exercise in Uganda thought it likely that those who found out they were seropositive would deliberately go out and spread the disease (Obbo, 1993a). Konde-Lule (1993) reports similar findings, and IRESCO (1995) describes the same dynamic in relation to STDs in Cameroon.

Authors frequently observe that knowing how to reduce risk effectively is not in itself enough to change behavior; people must have the power to make the required changes. Ulin (1992) suggests that the failure of AIDS campaigns to recognize this fact can be fatal to their impact. The WHO/GPA surveys attempted to determine how "empowered" people felt by asking whether they believed AIDS could be avoided by behavior change. Consistently high proportions


 The networks are discovered through what amounts to gossip (albeit from several sources), so it is difficult to judge how accurate the information is.

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement