STD prevention programs promote practices and messages that are presumed to fit with most conditions of U.S. communities. Yet, the social and cultural contexts for low-income ethnic communities may frame STD prevention differently, so that people calculate their risk and take actions based on what they have learned through their own observations and life experiences. To understand how people at high risk for STDs make decisions and take actions to protect themselves from these diseases, the authors conducted 38 ethnographic interviews with individuals living in a rural community in the South. Practices they reported include selecting “safe” partners on the basis of appearance, familiarity, or church attendance; washing before and after sex to prevent infection; self-treatment with antibiotics obtained without a prescription; and visiting the clinic frequently for checkups for asymptomatic infections. The authors compare and contrast their worldview with the public health concepts of primary and secondary STD prevention.
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References
1.
1. Piot P, Islam MQ: Sexually transmitted diseases in the 1990s: Global epidemiology and challenges for control. Sex Transm Dis21: S7-S13, 1994.
2.
2. Hiltunen-Back E, Rostila T, Kautiainen H, Paavonen J, Reunala T: Rapid decrease on endemic gonorrhea in Finland. Sex Transm Dis25(4): 181-186, 1998.
3.
3. Centers for Disease Control and Prevention: Sexually Transmitted Disease Surveillance, 1996. Atlanta, GA, Division of STD Prevention, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Public Health Service, 1997.
4.
4. Brandt AM: No Magic Bullet. New York, Oxford University Press, 1987.
5.
5. Centers for Disease Control and Prevention: 1998 guidelines for treatment of sexually transmitted diseases. Morb Mort Wkly Rep47(RR-1): 13-13, 1998.
6.
6. Runyan CW: Health assessment and public policy within a public health framework, in Karoly P (ed.): Measurement Strategies in Health Psychology. New York, John Wiley, 1985, pp. 601-627.
7.
7. Division of STD/HIV Prevention: Sexually Transmitted Disease Surveillance, 1993. Atlanta, GA, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Public Health Service, 1994.
8.
8. Noegel R, Kirby J, Schrader M, Wasserheit J: Sexually transmitted disease accelerated prevention campaigns: Opportunities to expand prevention efforts in the United States. Journal of Sexually Transmitted Diseases20: 118-122, 1993.
9.
9. Airhihenbuwa CO, DiClemente RJ, Wingood GM, Lowe A: HIV/AIDS education and prevention among African-Americans: A focus on culture. AIDS Educ Prev4: 135-142, 1992.
10.
10. Liebow E: Tally’s Corner: A Study of Negro Streetcorner Men. Boston: Little, Brown, 1967.
11.
11. Rose D: Black American Street Life. Philadelphia, University of Pennsylvania Press, 1987.
12.
12. Stack CB: All Our Kin: Strategies for Survival in a Black Community. New York, Harper & Row, 1974.
13.
13. Wilson WJ: The Truly Disadvantaged. Chicago, University of Chicago Press, 1987.
14.
14. Lester B: The social context of HIV transmission in the African-American community. Ethn Dis3: 387-394, 1993.
15.
15. Deren S, Tortu S, Davis WR: An AIDS risk reduction project with inner-city women, in Squire C (ed.): Women and AIDS: Psychological Perspectives. London, Sage, 1993, pp. 73-89.
16.
16. Hobfoll S, Jackson A, Lavin J, Britton PJ, Shepherd JB: Safer sex knowledge, behavior, and attitudes of inner-city women. Health Psychol12: 481-488, 1993.
17.
17. Jemmot L, Jemmot J: Increasing condom-use intentions among sexually active Black adolescent women. Nurs Res41: 273-279, 1992.
18.
18. Wallace R, Fullilove MT, Flisher AJ: AIDS, violence and behavioral coding: Information theory, risk behavior and dynamic process on core-group sociogeographic networks. Soc Sci Med43(3): 339-352, 1996.
19.
19. Balshem M, Oxman G, Van Rooyan D, Girod K: Syphilis, sex and crack cocaine: Images of risk and morality. Soc Sci Med35: 147-160, 1992.
20.
20. Kline A, Kline E, Oken E: Minority women and sexual choice in the age of AIDS. Soc Sci Med34: 447-457, 1992.
21.
21. Sibthorpe B: The social construction of sexual relationships as a determinant of HIV risk perception and condom use among injection drug users. Med Anthropol6(3): 255-270, 1992.
22.
22. Scrimshaw SCM, Carballo M, Ramos L, Blair BA: The AIDS rapid anthropological assessment procedures: A tool for health education planning and evaluation. Health Educ18(1): 111-123, 1991.
23.
23. Catania JA, Kegeles SM, Coates T: Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM). Health Educ Q17: 53-72, 1992.
24.
24. Amaro H: Love, sex, and power: Considering women’s realities in HIV prevention. Am Psychol50(6): 437-447, 1995.
25.
25. Singer N: Understanding sexual risk behavior from drug users’ accounts of their life experiences. Qualitative Health Research5(2): 237-249, 1995.
26.
26. Dorfman LE, Derish PA, Cohen JB: Hey girlfriend: An evaluation of AIDS prevention among women in the sex industry. Health Educ Q19: 25-40, 1992.
27.
27. O’Brien K, Wortman CB, Kessler RC, Joseph JG: Social relationships of men at risk for AIDS. Soc Sci Med36(9): 1161-1167, 1993.
28.
28. North Carolina Rural Economic Development Center: North Carolina Rural Profile: Economic and Social Trends Affecting Rural North Carolina. Raleigh, North Carolina Rural Economic Development Center, 1992.
29.
29. Thomas JC, Kulik AL, Schoenbach VJ: Syphilis in the South: Rural rates surpass urban rates in North Carolina. Am Public Health85(8): 1119-1122, 1995.
30.
30. Thomas J, Schoenbach V, Weiner D, Parker E, Earp J: Rural gonorrhea in the southeastern United States: A neglected epidemic?Am Epidemiol143(3): 269-277, 1996.
31.
31. U.S. Department of Health and Human Services: US Epidemiologic Reference Manual: County Alcohol Problem Indicators (Vol. 3, 3rd ed.). Washington, DC, ADAMHA, 1991.
32.
32. North Carolina State Bureau of Investigation: Counties Ranked by Arrests Per 100,000 of Population Over 4-Year Period. Durham, Alcohol/Drug Council of North Carolina, 1990.
33.
33. Lincoln YS, Guba EG: Naturalistic Inquiry. Beverly Hills, CA, Sage, 1985.
34.
34. Marshall C, Rossman GB: Designing Qualitative Research. Newbury Park, CA, Sage, 1989.
35.
35. Patton MQ: Qualitative Evaluation and Research Methods. Newbury Park, CA, Sage, 1990.
36.
36. Denzin NK, Lincoln YS: Handbook of Qualitative Research. Thousand Oaks, CA, Sage, 1994.
37.
37. Van Maanen J: Tales of the Field: On Writing Ethnography. Chicago, University of Chicago Press, 1988.
38.
38. Spradley JP: Participant Observation. New York, Holt, Rinehart and Winston, 1980.
39.
39. Thomas J: Doing critical ethnography. Qualitative Research Methods26: 1-83, 1993.
40.
40. Agar MH: Speaking of ethnography. Qualitative Research Methods2: 1-79, 1986.
41.
41. Denzin NK: Interpretive Ethnography: Ethnographic Practices for the 21st Century. Thousand Oaks, CA, Sage, 1997.
42.
42. Miles MB, Huberman AM: Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA, Sage, 1994.
43.
43. Strauss A, Corbin J: Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park, CA, Sage, 1990.
44.
44. Rosenstock IM: The health belief model: Explaining health behavior through expectancies, in Glanz K (ed.): Health Behavior and Health Education. San Francisco, Jossey-Bass, 1990, pp. 39-62.
45.
45. Stoeltje B: “Bow-legged bastard”: A manner of speaking. Folklore Annual Center for Intercultural Studies in Folklore and Oral History, University of Texas, Austin4-5: 175-180, 1973.
46.
46. Abrahams RD: Negotiating respect, in Farrer CR (ed.): Women and Folklore: Images and Genres. Prospect Heights, IL, Waveland, 1986, pp. 58-80.
47.
47. Good BJ: Medicine, Rationality, and Experience. New York, Cambridge University Press, 1994.
48.
48. Lindenbaum S, Lock M: Knowledge, Power and Practice. Berkeley, University of California Press, 1993.
49.
49. O’Reilly K: Applied anthropology and public health, in Hill CE (ed.): Training Manual in Applied Medical Anthropology. Washington, DC, American Anthropological Association, 1991, pp. 88-100.
50.
50. Paul B: Health, Culture, and Community. New York, Russell Sage, 1955.
51.
51. Thomas JC, Eng E, Clark M, Robinson J, Blumenthal C: Lay health advisors: Sexually transmitted disease prevention through community involvement. Am J Public Health88(8): 1252-1253, 1998.
