GHENT UNIVERSITY Karoline FONCK - International Centre for ...

Stigmatization by health staff also may play a role in preventing some patients from seeking
medical care.
In addition, the delay between attending a primary health facility and the STD referral clinic
was considerable, which is quite worrisome. More than half of the patients had sought
treatment elsewhere before attending the STD clinic. Treatment for STDs is not available at
all primary health care clinics in Nairobi. Therefore, patients with STDs often must be
rerouted immediately to the nearest clinic with STD treatment or to the STD referral clinic.
Consequently, the clinics with STD treatment should refer only the patients with STD who do
not respond to the first-line syndromic treatment approach provided.
This system, although still causing some delay in appropriate treatment, seems to function
well. However, more operational research on the efficiency of referral is needed. The delay in
presenting to the STD clinic is considerably shorter for referred patients, indicating that
referral status decreases the stigma attached to attending an STD clinic. Patients who have
been to the STD clinic before find it much easier to come straight to the STD clinic for the
next episode.
With regard to health-seeking behavior, men more often than women report a different
healthcare-seeking attitude when confronted with an STD. The men in this study reported
attending the public health sector significantly less often for an STD than for other health
problems. This implies that adequate STD case management must be offered as widely as
possible to have a significant impact on the STD epidemic.
The women were more likely than the men to have unprotected sex while symptomatic, the
married women more so than the unmarried women. This observation further reinforces the
belief about the imbalance in African families, with the woman possibly unable to refuse sex
or negotiate safe sex with her husband or regular partner. Thus, the women, expected to be
sexually and socially subordinate to men, continue to be infected by their partners (Ickovics
1998). This observation is supported by the fact that two thirds of the men in the current
study admitted their extramarital sex activity, but still blamed their wives for contracting the
STD (Rakwar 1999).
A similar observation was made by Moses et al. in 1994, who found that married women
were more likely than unmarried women to engage in sex while symptomatic, and that a
large proportion of them had sex several times before seeking treatment. Men also reported
more multiple partners than women. Therefore, men are more likely than women to transmit
STDs to their partners. This is consistent with the belief that African women are at increased
HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 44