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A questionnaire administered to subjects seen during a serological survey in The Gambia revealed that knowledge of AIDS and HIV infection was limited. Males, those with a secondary education and people who lived in urban areas had a better understanding but only 17% of women seen in rural areas had any knowledge of the condition. Only 8% of the subjects seen had used condoms in the preceding 12 months; during this time half of them had done so on less than five occasions. Subjects with a secondary education were more likely to have used condoms. A counsellor met 31 asymptomatic seropositive subjects identified during this survey on two occasions. In the majority, the information given caused anxiety rather than modification of behaviour and, at the time of the second interview, only one subject had discussed the situation with the partner and begun using condoms. Some of the cultural factors which may affect the outcome of counselling in an African society are discussed in the light of these findings.Questionnaires given to people from rural and urban populations seen during a serological survey in The Gambia revealed knowledge about AIDS and HIV infection to be limited. Data was received on 1,898 subjects aged at least 15 years. While only 17% of women in rural areas were aware of the existence of AIDS, males, those with secondary education, and those in urban areas demonstrated better understanding of the disease. 8%, however had used condoms over the past 12 months, with 1/2 doing so on less than 5 occasions. Secondary education generally signaled greater likelihood of condom use among respondents. A counsellor met with 31 asymptomatic, HIV-positive subjects in their homes on 2 occasions during the survey. Failing to generate behavior modifications, information provided by the counsellor largely produced anxiety. By the 2nd interview, only 1 subject had discussed AIDS and HIV infection with the partner and began using condoms. Health education programs targeted to underserved rural areas, women, and those without secondary education are severely needed. Radio, used as the key mode of message dissemination, is challenged on the basis of its audience being potentially limited due to gender and/or socioeconomic factors. Limited education, limited knowledge of AIDS in the community as a whole, sociocultural and attitudinal factors fostering social rejection of the seropositive individual, and gaining acceptability for the condom are potential obstacles to effective counselling for improved education and behavioral change. Joint sessions with partners, group sessions, and repeated exposure to a counsellor are suggested approaches. Research is suggested for alternative approaches.