In this book, I describe the findings from an anthropological study of the links between inner-city women's condom use rates and their experiences and understandings of heterosexual relationships. I also discuss findings from a smaller project on seropositivity self-disclosure among HIV-positive individuals.
The condom use research took place in Cleveland, Ohio, over a twoyear period between 1991 and 1993. I began the study at the request of Dr. Philip Toltzis, who oversees health education for women seeking pregnancy-related care at the five urban health care centers associated with Cleveland's Maternity and Infant Health Care Program (M&I). Alarmed by the rising rates of HIV infections and AIDS among the poor, urban, mostly Black women who use the M&I clinics, Toltzis directed staff members to include AIDS and safer sex information in their educational efforts. But according to clinic records and staff reports clients did not comply with the pro-condom advice they were given.
Toltzis assumed that the clients were not stupid and that their non-use of condoms was not a result of ignorance of the facts about HIV transmission. The clients were well-informed of these facts by clinic staff members. But, as Toltzis also knew, sometimes health education messages do not make an impact because of communication problems -- sometimes "doctor's orders" simply do not make sense to the people being asked to comply with them. Toltzis guessed that cultural barriers were probably blocking full communication between his AIDS educators and their clients, and he saw that an anthropological approach to AIDS education could help. So, from his office in the Pediatrics and Infectious Disease division at Rainbow Babies' and Children's Hospital, Toltzis rang up Dr. Jill Korbin, an anthropologist at Case Western Reserve University who shared his interest in urban pediatric health. Toltzis hoped that Korbin could help him out.
About that time, I arrived at Case Western Reserve's anthropology department, where I would be working as a postdoctoral research fellow. I