Social marketing of pre-packaged treatment for men with urethral discharge (Clear Seven) in Uganda.

We implemented social marketing of pre-packaged treatment for men with urethral discharge (Clear Seven) in Uganda, and studied its feasibility, acceptability and effectiveness as a possible means to treat STDs and thereby prevent HIV. Clear Seven was distributed at private health care outlets in three rural districts and two divisions of the capital. Comparisons were made with a pre-intervention period in the same sites plus one additional rural district. There were almost universally positive attitudes to Clear Seven. Cure rate (84% versus 47%), treatment compliance (93% versus 87%), and condom use during treatment (36% versus 18%) were significantly higher among Clear Seven users (n=422) than controls (n=405). Partner referral was similar but fewer Clear Seven partners were symptomatic when seeking treatment. Distribution of socially marketed pre-packaged treatment for male urethritis should be expanded in sub-Saharan Africa. Consideration should be given to developing similar kits for women.

Silence: The Concern of Parents; Teachers and HIV Councillors about Sex Education in an AIDS Impacted Area in SW Uganda

"Objectives: To a) Describe the traditional system of knowledge acquisition i.e. timing; how; by whom b) identify and explain gaps and problems in sex education. c) Outline community identified problems. Traditional mechanisms that provided youth with information regarding sexuality and marital expectations are no longer adhered to as they once were. In the absence of effective alternatives; this can be Lethal. Methods: This research was conducted in a trading and is part of a larger project intended to assess and counter disease impacts. Open ended interviews and focus groups were conducted with parents; teachers and HIV counsellors. Results: Family integrity was maintained if the paternal auntie (ssenga) ensured that a young girls was a virgin on her wedding night. As a safeguard the aunt was to provide information about sexuality; privately; secretly at the onset of sexual maturation. Much less emphasis was placed on the young boys sexuality. Migration due land pressure and urbanization; familial conflict and high death rates attributed to AIDS; contribute to the silence. Many parents and teachers do not feel capable in providing youth with this information. Mothers did and still do feel reticent about addressing such intimate issues. ""I get embarrassed to talk about sexual matters to my daughter ... some sex words in our language are too heavy to utter ... how do I mention a penis or vagina before my son or daughter?"" Parents and teachers assume that the other is delivering sex education. Potential solutions forwarded have included training a specialist within schools and parent teacher meetings aimed at addressing these issues. Conclusions: Both parents and teachers; as care takers; acknowledge that their own silence is highly problematic and that this must change. This change is behavioural in itself. They have offered solutions of their own to counter disease impact in their families and community."

"""We are Dying and Getting Finished; Who Will We Leave These Ones For?"" Women's Concerns about Childbearing in Rural Rakai; SW Uganda."

Objectives: To a) Establish the parameters of reproductive choice amongst women who are at high risk for HIV infection. b) Discuss the impact ofthese parameters on issues concerning perinatal transmission. Methods: Research wasdone in amixed ethinicity trading centre in AIDS affected SW Uganda. This ethnographic study used both in-depth; open ended interviews and focus groups with women who believe they are infected or have been tested HIV positive. Results: Regardless of' marriage form' birth control including condom use is perceived to be non negotiable. 'They only use them with those women from out' 'Men want to be associated with many numbers of children... want to leave someone behind' 'Did you come here just to eat?' Women do exercise reproductive choice; either in refusal or without husbands' knowledge (pills; injections; traditional methods). The consquences of refusal to either have sex or produce children are very restrictive; they lead to separation(leaving women economically vulnerable) or the men will go out and find another woman. Little change occurs in relationships where positive sero-status of one or both partners is a real possibility. Evidence suggests that certainty of sero-status gives the impetus to make hard decisions;reproductively. Uncertainty leads to both confusion and fatalism. REgardless of access to cash; sick babies are neglected(immunization; breast feeding; treatment) by both parents. ''This one is slimming anyway''. Mothers experience both the stigma and associated burdens of caring for the sick child. In addition they often decide not to treat themselves. Birth of healthy babies indicate that parents are negative. Conclusion: The voices of women are a testimony to the constraints they expirience sexually and reproductively. They do have a 'choice'. However ;the repercussions of this choice; particularly in high risk environments become restrictive and burdensome