he best prevention is do not go off with any man on your own unless you really know him very well, do not get into cars with only men, and most important when you go out drinking, make a pact with your friends that you all stick together. Pubs and clubs, the adventure scene, boda bodas and taxis at night, staying late in the office, and being lured into a teachers or uncles room alone are all notorious and avoidable situations where you have to be especially wary.

But if you are unlucky, what to do next? Uganda is generally safe, safer then many European cities or other African countries. Murder of visitors or young girls is very rare. However the concept of consent is different in different countries: in America just to have sex with a drunken woman is technically rape as she did not give valid consent. Here if you go off with a man, or even just smile, he may consider that consent. Add these facts together and it means it is safe to fight! Play fighting is common and can be a turn on, so futile beating with fists is not going to help. If you mean “no” do not try and reason or persuade, make it very very obvious indeed. If “get out now and go” doesn’t work, then you have the right to defend yourself. First of all scream! Do not be scared of men saying “if you tell someone I will kill you”, it is not true unless he has a gun or a knife. The average school teacher, pastor or uncle does not kill anyone, nor do taxi drivers, boda boda drivers, office colleagues

or the sad old letches who hang around bars picking up half drunk visitors with a clever line of bullshit. Keep calm. If a right good scream does not make him back off, then a straight-arm heel of the hand to the nose is very easy and very effective. 2 fingers in the eye are also difficult to ignore, and a knee or good kick in the testicles will make most men give up! There are good martial arts schools in Kampala and as a right wing old dinosaur I think all city girls should consider a basic self defence course!
If you are raped go to a doctor immediately. If you go to a doctor first, it means they can call the police, and you can be interviewed in a safe and familiar place with a sympathetic medical worker holding your hand throughout. I encourage all rape victims to go to the police. First of all it is a crime. Being careless, stupid, in the wrong place, or foolishly trusting is not a crime, and every woman has the right to say “no” at any time in any place, in any situation. It may not do any good, but might prevent another rape by the man if he gets scared, and at the very least improves the real statistics of a crime that is extremely underreported.
All clinics should have a protocol for all rape victims plus any person man or woman who wakes up in the morning realizing they have been stupid. I will get on to that later.
The problem I want to address this week is that there is no reason to believe that a rapist is any more likely to give a girl a STD then a boyfriend. Rape victims run to a doctor for help. The same girl with the same man as a boyfriend may not show any concern until the relationship ends, when reality sets in.
So what is the risk of sex in Uganda?

HIV prevalence may be only 7 or 9%, but this is an average. The great majority of Ugandan men do not have HIV because they are not at risk. They are either monogamous (or in a stable polygamous relationship) or celibate and get tested before a new relationship. They are sensible and responsible and not interested in short term relationships with travellers and visitors. The prevalence of HIV, and by extension other STD’s in these men is very low. However there are a small number of young, educated, non monogamous, non celibate men who are high risk and interested in you. Their risk may be 3 or 4 times the national average. These YENMNCM’s are well known to the Ugandan girls. They know full well these men cannot be trusted, want sex without being tested, and try not to use condoms. They know they are full of bullshit, are unemployed but pretending to be students working during their holidays, pretend to be 5 years younger then they really are, and hang around night clubs trying to pick up school girls. No. Ugandan women are far too smart and are not interested! In summary catch 22: if he’s safe he’s not interested, if he’s interested he’s not safe. So what is the poor yenmncm to do? Not a problem. He has found a never ending supply of gullible young women who are trying to prove they are friendly: expat volunteers! Knowledge is power, so read on and make up your own mind before making a possibly fatal decision.

HIV is the most researched STD, though not necessarily the most dangerous, nor the most common, and the publicity surrounding it can make some people think that it is the only disease that matters. In fact cancer of the cervix kills more women in Europe than HIV and may be the second most common cancer causing death in women. It is now known to be due to Human Papilloma Virus, a sexually transmitted disease. There are about 40 different strains of HPV, but 6 cause most of the cancer. Other strains are more likely to cause warts. It is undetectable and probably more common than HIV. Herpes is common and painful, but difficult to test for except by visual inspection during an episode. Antibody tests are available, but not necessarily useful. Hep B is potentially fatal, and a recent study showed that close to 50% of students had evidence they contracted Hep. B while in university, almost all by sexual contact. Chlamydia is the commonest STD in UK but I know of no statistics in Uganda. Testing for it is pretty easy. Gonorrhea and syphilis are easily identified and treated so seem to be less common then they used to be, though in the 80’s one study showed 30% of married women in one district were infected with gonorrhea. Another study in the 90’s showed 50% of women in one district had an STD of some sort. So “I am careful, we tested for HIV” is not an answer, there are a full dozen diseases out there that are fatal, painful, or cause infertility. No-ones votes to get them, most of the victims were either careless or deceived.
As usual all the bad news is for women. Most of these diseases are visible and easily detected in men. With chlamydia so few women have any symptoms that it is called the “silent epidemic”. 70% of women with gonorrhoea have no symptoms, and if syphilis, chancroid or herpes is on the cervix, you may be completely unaware of it. We see far more women with visible diseases then we do the invisible, e.g. herpes on the labia is painful and visible but on the cervix it is not noticed. HPV causing visible warts on the labia sends a girl off to see the doctor; another strain of HPV causing the potentially fatal cervical cancer is invisible. So we know that for every woman we see with an STD there are far more who are blissfully unaware. Women do not come out to Africa to pick up diseases, but that is what many are doing without even realizing.
Next month I will look at post exposure prophylaxis for rape and waking up in the morning realizing you have been stupid, but this is already be on the websight of The Surgery and The Eye for those needing more information now.
Summary
Rape may be emotionally and psychologically horrific but the wrong boy friend can be equally dangerous medically. If you are raped or wake up in the morning realizing you have been stupid, see a doctor immediatel