SEXUALLY TRANSMITTED DISEASES IN MWANZA, TANZANIA: RISK, BELIEFS, HEALTH CARE SEEKING BEHAVIOUR, AND RESPONSES.

Objective: In Mwanza region, an HIV/STD intervention program has been in progress in the rural population since 1991. The information in this study was gathered to increase understanding about lay concepts of sexually transmitted diseases and to provide information to inform HIV/AIDS/STD interventions. Methods: During a rapid ethnographic survey, 4 investigators conducted more than 100 interviews in 3 rural villages and one roadside settlement with a wide range of key informants including fishers, truck drivers, professional sex workers, STD patients, traditional healers, health care workers, bar attendants, and traders. Results: High-risk transmission sites included bars, guesthouses, periodic markets, and beaches. People at high risk included men with money and/or away from home such as truck drivers, fishers, government officials, and businessmen, and single women who are barmaids, traders, and secondary school students. Despite linguistic differences in typologies, signs and symptoms were similar in many reported STD conditions when compared to the biomedical model. Some common conditions and diseases e.g. schistosomiasis were believed incorrectly to be sexually transmitted. Multiple sources of treatment were sought. Conclusion: The existence of transient social groups with high-risk behaviour is a challenge to the organization and delivery of STD services. Effective interventions will entail cooperation between multiple sectors based on detailed knowledge of local populations and conditions. Interventions should be accompanied by simple research techniques to assist timely assessment