People at high risk for STDs used a variety of primary and secondary prevention strategies QUESTION: How do people at high risk for sexually transmitted diseases (STDs) understand and practice STD prevention? Design Ethnography. Setting A rural county in North Carolina, USA. Participants 38 low income people ?18 years of age (20 men, 33 African-American) were identified from an STD clinic and a county jail, and by social service professionals. 24 of the participants reported having had &gt;1 STD. Methods Indepth interviews of 1 -- 2 hours were held with each participant. Questions focused on sexual behaviour and condom use, drug use, STD care seeking and self treatment, and sexual risk taking in relation to curable STDs such as gonorrhoea, chlamydia, and syphilis. Interviews were audiotaped and transcribed. Codes, common patterns, and emergent themes were identified. Sections of 4 interviews were excluded because of data contamination by an inexperienced interviewer. Main findings The findings reflect an insider's (emic) view of how to protect oneself from STDs and why. Primary and secondary prevention strategies were identified. The most common primary prevention strategy was partner selection based on familiarity, appearance, and reputation. Familiarity was equated with safety. The extended friendship ...