When is sex safe? Insiders' views on sexually transmitted disease prevention and treatment

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 differ ently, so that people calculate their risk and take actions based on what t hey have learned through their own observations and life experiences. To un derstand how people at high risk for STDs make decisions and take actions t o protect themselves from these diseases, the authors conducted 38 ethnogra phic interviews with individuals living in a rural community in the South. Practices they reported include selecting "safe" partners on the basis of a ppearance, familiarity, or church attendance; washing before and after sex to prevent infection; self-treatment with antibiotics obtained without a pr escription; and visiting the clinic frequently for checkups for asymptomati c infections. The authors compare and contrast their worldview with the pub lic health concepts of primary and secondary STD prevention.