The community-health services interface: the critical issue for AIDS prevention*

Drawing on results from a number of studies exploring the community and healthservices response to the AIDS epidemic in Eastern Africa , this chapter discusses the role of different providers of health care: traditional healers and private and public professionals. More than half of all visits to health care providers (pharmacies excluded) for STD seem to occur outside the public services. The studies cited indicate that different approaches may be appropriate to enable different groups of providers of care to promote sexual health through behavioural change. What actually makes community members, individually or as groups, take actions and adopt safer sexual practices to prevent sexually transmitted diseases including AIDS? This chapter discusses the role of different health service providers. Examples are drawn from a research project, supported by the Swedish Government through SIDA/SAREC and conducted as a collaborative effort between Zambian, Kenyan and Swedish institutions, as indicated in the papers cited below. Our work deals with research for community capacity building and the focus has been on the interaction between the community and health service providers. It focuses on behavioural change and prevention of HIV transmission by improved control of conventional STDs. It is well recognized that safe sexual behaviour is probably the best available method for individuals to protect themselves against contracting STDs, AIDS included. The effect of activities to promote ‘safer sex’ is hard to assess, but certainly such activities have so far saved more lives than medically-oriented preventive or curative interventions. An increased knowledge about people’s perceptions of sex, and dialogue within the society on matters of sexuality, facilitate openness and understanding of how people could protect themselves. The studies cited here have mainly been addressed from the perspective of prevention of ‘conventional’ STDs, known to facilitate the transmission of HIV (Cohen 1998), including strategies to improve the quality of STD care. As stated by D’Cruz-Grote (1996), STD programs will have little chance of success in prevention of HIV/AIDS unless ‘...service provision is reoriented to meet the long-term sexual needs of men and women’. This is particularly true in the case of young people (Hitchcock and Fransen 1999). This chapter presents selected observations on perceptions by the community, particularly clients and providers of care, regarding prevention of STDs, including HIV. It * This chapter is based on collaborative research involving researchers (see reference list) from Institute of Economic and Social Research (former IAS), University of Zambia; Department of Community Health, University of Nairobi; Kenya Medical Research Institute, Nairobi; Department of Anthropology and Sociology, University of Hull; and IHCAR, Karolinska Institutet, Stockholm.