Sexually-transmitted Disease Risk in a Micronesian Atoll Population
The potential health threat of AIDS to the native island-based
populations in the Pacific is now widely appreciated by those working in
the public-health sector throughout the region. Although several
countries in the region are yet to identify any cases of AIDS or HIV
seropositivity, there is reason to suspect that heterosexual contact may
emerge as a predominant mode of spread of HIV infection into native
Pacific island populations. Sexual networks and their relationship to
potentially 'risky behaviours' are described for a single native
Micronesian atoll community on the basis of ethnographic observation and
interviewing. This description is combined with the investigation of
historic-demographic dimensions of the epidemiology of
sexually-transmitted diseases in the same population to draw some
conclusions about the opportunities for HIV transmission and acquisition
among the sexually-active portions of this community. Although
sexually-transmitted diseases have not had an appreciable
epidemiological or demographic impact on the population in the past, the
sexual networks within the community and beyond provide ample
opportunity for the introduction and spread of sexually transmitted
diseases, including HIV and its sequel AIDS.
Sexually transmitted diseases (STDs) contributed to reductions in fertility and population size in many Micronesian islands between the late 1800s and early 1900s. This paper explores the potential health threat of AIDS to an indigenous village population of 1250 on the Butaritari Atoll, Kiribati. Study results are based upon observations, surveys, and interviews exclusively with women in the community over 12 months in 1990-91. This population is of Catholic faith and high fertility, with a low biomedical contraceptive acceptance rate and near universal marriage by age 25. Marriage in this culture may be either socially formalized and permanent or consist solely of temporary relations between married men and nonmarried women while men are employed on other islands away from wives. Generally, those who cohabit and have sexual relations are considered married. Little premarital sexual activity takes place in this community; women are expected to be virgins at marriage. Men, however, are encouraged to gain premarital sexual experience. Since young men only infrequently succeed in having sex prior to marriage, most sexual activity occurs within marriage. Women are passive in all aspects of the sexual relationship are dare to discourage their spouses' sexual advances only during menstruation, in advanced pregnancy, after birth, and when they are ill. Female marital infidelity is not tolerated, though married men are known to seek attention from the limited pool of nonmarried women in the population. At most, men may secure the attention of five such women over the course of their lives. Anal sex is not practiced within heterosexual relationships and homosexuality is very rare and not tolerated. Despite these relatively conservative sexual norms, HIV threatens to enter and spread within this community through heterosexual intercourse. Men from Kiribati work off-island on foreign ships for months at a time. While away, they have been known to have sex with foreign prostitutes and may contract STDs. On vacation and when contracts expire, these men return to the island to recommence their usual sexual relations. Both married women and the small percentage of unmarried sexually available women may be infected by these men. HIV may then spread among other married couples and single individuals in the community. The frequent practice by women of inserting vaginal agents and cauterizing their genitals to dry and tighten the vagina also increases the potential for mucosal tearing and subsequent HIV infections. In closing, the reader is cautioned to not infer that observations from this community are universally applicable within Micronesia; Kiribati historically has suffered less than other regional islands from STDs
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