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The clinical association between HIV and other sexually transmitted disease is accepted medical wisdom and it is widely recognised, even among those persons most at risk, that the same behaviours are implicated in the spread of both infections. How is it then that sexually transmitted disease remains a life-threatening problem in so many areas? One answer is that too little attention is paid to social and cultural risk factors embedded in the context of ordinary people's lives; that reduction of health risk is never a matter of 'simple' behaviour change. This article sets out the interaction of risk factors in the context of a low-income Kampala parish. It demonstrates the logic of 'risk' patterns in the management of sexually transmitted disease-not only of delaying or avoiding treatment altogether, but also of the common first recourse to self-prescription and home treatment, and of the preference for traditional over Western options. These choices are made by people who are aware of the risks to health and life associated with venereal infections, and who 'know' that biomedicine administered in the nearby hospital is optimal in their treatment. The anomaly is explained by the fact that sexually transmitted disease and the risk of HIV are never the only things they have to worry about. The specifics of this case show that external efforts to control HIV/AIDS will be improved by sensitivity to other-than-health risks inherent in the context of sexually transmitted disease treatment/non-treatment choices. The observation that health and life may be put at risk for reasons having little to do with poverty and/or ignorance has general application in the prevention of other diseases and the design of more appropriate intervention programmes. [ABSTRACT FROM AUTHOR]

We set out to investigate the extent to which cultural constructs might determine treatment-seeking for diarrhoea in the poorer populations of Lusaka, Zambia. This paper describes these concepts and perceptions and outlines a classification of such illnesses, together with an analysis of its implications for understanding treatment choice. Data were derived from focus group discussions, a household survey, a survey of practitioners of traditional medicine and interviews with local residents attending an urban health centre with persistent diarrhoea. The classification is based on symptoms and perceptions of aetiology. While resulting categories convey imperatives for treatment choice, it is clear that individuals with diarrhoeal illnesses seek treatment from multiple sources. This may be because any single illness may fit more than once category, or because unrelenting ill-health engenders desperate behaviour. The cultural constructs do not fully explain treatment choice and attitudes to prevention, but could be used to improve communication regarding public health and treatment strategies. [ABSTRACT FROM AUTHOR]