Commentary: Sexually transmitted infection in South Africa: 50 years after Sidney Kark

Abstract

‘The problem of syphilis in South Africa is so closely related to the development of the country that a study of the social factors responsible for its spread is likely to assist in its control’ wrote Sidney Kark in 1949 in the South African Medical Journal.1 We would paraphrase: the biomedical paradigm of sexually transmitted infection (STI) relies on the germ causation theory; whereas health promotion theory looks at the multiple determinants (psychological, social, economic, historical and political) which underlie behaviours that result in the spread of STI, and hamper their control. Venereal syphilis was introduced into the Cape region of South Africa by sailors, army troops and white settlers from the 17th century onwards; but was initially confined to coastal areas.2 Lichtenstein, in 1802 found no evidence of syphilis among the amaXhosa of the Eastern Cape.3 Livingstone, in 1857 could detect little syphilis among the Batswana people;2 but by 1885 Warren noted the ‘natives’ of ‘Bechuanaland to be badly infected’.4

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