Foundations for effective strategies to control sexually transmitted infections: voices from rural Kenya

Achieving maximal benefit from clinic-based, sexually transmitted infection (STI) control strategies requires that persons seek treatment at public cl inics. Community-based, ethnographic research methods were used to examine patterns of health-seeking behavior for sexually transmitted infections ill western Kenya. Illness narratives of sexually transmitted infections provi ded the basis for an analysis of sequential steps in health-seeking behavio r, namely recognition, classification, overcoming stigma, identification of treatment options and selection of a course of therapy. A variety of terms were used to identify STI, including multiple terms referring to "women's disease". The stigma associated with STI, reflected in the terminology, was based on a set of beliefs on the causes, contagiousness and sequelae of ST I, and resulted in delays in seeking treatment. Five commonly used treatmen t options were identified, with multiple sources of care often used concurr ently. The desire for privacy, cost and belief in the efficacy of tradition al medicines strongly influenced health-seeking behaviour. A belief that se xually transmitted infections must be transmitted in order to achieve cure was professed by several respondents and promoted by a traditional healer. Implications for STI control strategies are derived, including the developm ent of educational messages and the design of clinics.