AIDS. It’s about you. It’s about me. It’s about all of us.
That’s the slogan for Tanzania’s National HIV and AIDS Communication and Advocacy Strategy. Indeed it is about all of us. About 1 in 12 Tanzanians is infected. It affects every family, every village, every company. Lenana.net has compiled some information about AIDS in Tanzania — statistics, strategy, and trends.
Statistics
Prevalence rate: 7 percent.
There are big geographical variations, though. For example:
• Urban/town prevalence (2004): 11 percent
• Rural/village prevalence (2004): 5 percent
• Lowest prevalence: Kagera region, 4.8 percent
• Highest prevalence: Mbeya region, 15.3 percent
• Zanzibar overall prevalence: 1 percent
• Zanzibar prevalence among intravenous drug users: more than 25 percent
Modes of transmission
• 80 percent through sexual activity
• 19 percent via mother-to-child transmission
• 1 percent other means (blood transfusions, unsafe injections)
Gender differences
• Ratio of infected men to infected women: 1:1.22
This means for every 100 infected men in TZ, there are 122 infected women
• Peak age group for women: Age 30-34, 13 percent infected
• Peak age group for men: Age 40-44, 12 percent infected
HIV Testing
• 5 percent of women, and 7 percent of men in TZ have been tested for HIV in the last year.
• 15 percent of Tanzanians have ever been tested.
• 13 percent of pregnant women were tested during antenatal care
HIV/AIDS prevalence rates
Total: 7 percent (Male: 6.3)(Female 7.7)
Rural: 5.3 percent (Male: 4.8)(Female 5.8)
Urban: 10.9 percent (Male: 12)(Female 9.6)
No education: 5.3 percent (Male: 4.2)(Female 5.8)
Finished secondary: 8.2 percent (Male: 7.3)(Female 9.3)
Age 15-19: 2.1 percent (Male: 2.1)(Female 2.1)
Age 20-24: 5.2 percent (Male: 4.2)(Female 6.0)
Age 25-49: 9.5 percent (Male: 8.6)(Female 10.3)
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•Orphanhood (percent of children under 18 whose mother, father, or both have died)
Total: 11 percent (Rural: 10)(Urban: 14)
Knowledge & Beliefs
Source: Tanzania HIV/AIDS indicator survey, 2003-04
• Percent of people age 15-24 who know of at least one formal source of condoms.
Total: 62 percent (Male: 72)(Female 52)
Rural: 56 percent (Male: 67)(Female 44)
Urban: 76 percent (Male: 84)(Female 68)
No education: 46 percent (Male: 61)(Female 32)
Finished secondary: 83 percent (Male: 90)(Female 77)
• Percent of people who correctly report that a healthy-looking person can have AIDS, that AIDS cannot be transmitted by mosquito bites, and that AIDS cannot be transmitted by supernatural means:
Total: 55 percent (Male: 58)(Female 52)
Rural: 50 percent (Male: 54)(Female 46)
Urban: 66 percent (Male: 68)(Female 63)
No education: 32 percent (Male: 32)(Female 31)
Finished secondary: 83 percent (Male: 82)(Female 84)
• Percent who reject the idea that AIDS can be transmitted by supernatural means:
Total: 86 percent (Male: 89)(Female 82)
Rural: 85 percent (Male: 89)(Female 81)
Urban: 87 percent (Male: 90)(Female 85)
No education: 75 percent (Male: 78)(Female 72)
Finished secondary: 95 percent (Male: 95)(Female 94)
• Percent who correctly identify the two major ways of preventing sexual transmission of HIV (using condoms and limiting sex to one faithful, uninfected partner), who reject the two most common local misconceptions about HIV transmission, and who know that a healthy-looking person can have HIV:
Total: 50 percent (Male: 54)(Female 46)
Rural: 47 percent (Male: 51)(Female 42)
Urban: 59 percent (Male: 62)(Female 56)
No education: 30 percent (Male: 32)(Female 27)
Finished secondary: 69 percent (Male: 71)(Female 66)
• Percent who say they would buy fresh vegetables from a vendor known to have HIV:
Total: 57 percent (Male: 62)(Female 52)
Rural: 51 percent (Male: 56)(Female 45)
Urban: 73 percent (Male: 78)(Female 68)
No education: 35 percent (Male: 37)(Female 33)
Finished secondary: 87 percent (Male: 91)(Female 83)
• Percent who say they would not want to keep secret the HIV+ status of a family member:
Total: 66 percent (Male: 70)(Female 62)
Rural: 65 percent (Male: 68)(Female 61)
Urban: 70 percent (Male: 76)(Female 64)
No education: 58 percent (Male: 59)(Female 57)
Finished secondary: 77 percent (Male: 80)(Female 73)
• Adult support of education on condom use for prevention of HIV/AIDS among young people:
Total: 65 percent (Male: 69)(Female 61)
Rural: 64 percent (Male: 69)(Female 58)
Urban: 68 percent (Male: 69)(Female 66)
No education: 60 percent (Male: 66)(Female 53)
Finished secondary: 66 percent (Male: 69)(Female 62)
Sexual practices
Source: Tanzania HIV/AIDS indicator survey, 2003-04
• Percent of sexually active respondents who had casual sex (sex with a non-marital, non-cohabitating partner) in the last 12 months:
Total: 34 percent (Male: 46)(Female 23)
Age 15-19: 75 percent (Male: 96)(Female 53)
Age 20-24: 50 percent (Male: 73)(Female 27)
No education: 31 percent (Male: 45)(Female 17)
Finished secondary: 45 percent (Male: 51)(Female 38)
• Percent of respondents who used a condom the last time they had casual sex:
Total: 44 percent (Male: 50)(Female 38)
Age 15-19: 38 percent (Male: 38)(Female 37)
Age 20-24: 50 percent (Male: 47)(Female 54)
Rural: 36 percent (Male: 43)(Female 28)
Urban: 57 percent (Male: 62)(Female 52)
• Percentage of sexually active respondents who used a condom the last time they had sex with anyone:
Total: 16 percent (Male: 20)(Female: 12)
Rural: 11 percent (Male: 16)(Female 7)
Urban: 26 percent (Male: 29)(Female 22)
• Percent of respondent men who reported sex with a sex worker in the last 12 months:
Total: 2 percent (Rural: 2)(Urban: 2)
• Percentage of men who used a condom the last time they had sex with a sex worker:
Total: 60 percent (Rural: 50)(Urban: 78)
• Median age at first sex among young people:
Total: 18 percent (Male: 18)(Female: 18)
Rural: 11 percent (Male: 16)(Female 7)
Urban: 26 percent (Male: 29)(Female 22)
• Abstinence (percent of never-married people age 15-24 who have never had sex)
Total: 53 percent (Male: 46)(Female: 59)
Rural: 57 percent (Male: 50)(Female 63)
Urban: 46 percent (Male: 39)(Female 53)
• Percent of single sexually active people age 15-24 who used a condom last time they had sex:
Total: 46 percent (Male: 47)(Female: 44)
Rural: 36 percent (Male: 41)(Female 30)
Urban: 60 percent (Male: 59)(Female 60)
• Percent of people age 15-24 who report having forced sex in the last 12 months:
Total: 2 percent (Rural: 2)(Urban: 4)
• Percent of people who have ever taken an HIV test:
Total: 15 percent (Male: 15)(Female 15)
Rural: 11 percent (Male: 13)(Female 9)
Urban: 25 percent (Male: 22)(Female 28)
No education: 8 percent (Male: 8)(Female 7)
Finished secondary: 31 percent (Male: 26)(Female 35)
About AIDS in Tanzania
Poverty allows HIV to thrive in Tanzania. Through anti-retroviral therapy, HIV in the developed world is no longer the death sentence it once was. It has become something of a chronic illness, with which people can live for many years. But in Tanzania, ARVs are still not accessible to the majority of people living with HIV/AIDS. Thus the disease remains a major cause of morbidity and mortality. Here there is often a quick decline to death. There is a long way to go before HIV/AIDS in Tanzania makes the jump from fatal infectious disease to chronic illness.
The health-care system is built on the fundamental of cure-and-release. This fundamental is incompatible with incurable diseases such as HIV/AIDS. Complications arising from HIV/AIDS have overwhelmed the country’s hospitals, which compromises the care of those that come for unrelated illnesses and injuries. More than half of all hospital beds in Tanzania are occupied by people seeking care for HIV/AIDS-related matters.
Home-based care
Home-based care workers and volunteers help bridge the gap in health-care facilities. In many cases, home-based care is preferable over being hospitalized because it allows the sick to be close to his family and in the comfort of home. It’s especially effective when the family and community is educated about AIDS and safe practices for caring for the sick. TACAIDS has outlined strategic objectives for home-based care:
• Encourage the creation of conducive environments for preventive care and support
• To break the barrier of silence within home and community settings
• To actively involve family members in the whole process of care and support within the home environment.
• To advocate for the support of home-based and community care support structures and systems within families and communities.
• To reduce stigma, fear, denial, and discrimination associated with HIV/AIDS through information and education.
Hopeful signs
The prevalence rate in neighboring Uganda, where social and economic conditions are similar to Tanzania, fell from about 15 percent in the mid-1990s to 6 percent by 2003. Asian countries such as Thailand and Cambodia have lowered their HIV rates by aggressively focusing on prevention in the sex industry. HIV rates in the urban areas of Kenya have dropped sharply after specifically targeted programs went to work in those areas.
Coordinated strategy
Tanzania’s commission for the disease, TACAIDS, coordinates a strategy for coping with the disease on a national scale. It has listed nine specific frame strategies designed to help the various groups involved in the fight against AIDS in their planning.
1. STI control and case management
2. Condom promotion and distribution
3. Voluntary counseling and testing
4. Prevention of mother-to-child transmission
5. School-based interventions (primary and secondary)
6. Health promotion for specific populations (women, men, youth)
7. Health promotion for vulnerable groups (sex workers, gay men, prisoners)
8. Workplace intervention
9. Universal precautions in health care and non-health care settings
Efforts were made to meet these strategies. 60 million condoms were passed out during 2004. Guideline for post-exposure prophylaxis among health workers was put in place, though application has been slow. Access to voluntary counseling and testing was expanded, though much of the rural population still does not have access.
Orphans and vulnerable children are especially at risk. They constitute 17 percent of children under 17 in mainland Tanzania. OVC/MVCs are defined as belonging to at least one of these 12 categories: Orphans, abused and neglected children, children in institutions, child mothers, working children (including child domestic servants), children with disabilities, children living on the streets, children in conflict with the law, child sex workers, children displaced due to war/calamities, children caring for terminally ill parents, and children heading households. AIDS-induced orphanhood constitutes almost 60 percent of all orphans in the country. There are about 2.5 million orphans in Tanzania.
Challenges: There are relatively few NGOs working to support vulnerable children. There is no official policy on vulnerable children relating to AIDS. There are few interventions to support the guardians, caregivers, and communities responsible for them. Social workers are spread thin and are unavailable or unable to provide the necessary support to these children. There is a shortage of human and financial resources in the government’s Social Welfare Department.
Cultural practices that hinder the HIV/AIDS fight
• Widow inheritance: When a woman’s husband dies, she is inherited by her late husband’s brother.
• Wife sharing: The Maasai, as well as some other tribes, have sexually open societies that encourage wife sharing, and the marriage of young girls to older men.
• Female genital mutilation: The danger of HIV transmission through female circumcision is high. It is a common practice among many of the tribes of Tanzania.
• Appropriation of estate: In most rural places, it’s common for the widow to be thrown out of her house after her husband dies. This leaves widows and children whose parents have died with AIDS to be landless. AIDS has made this scenario very common.
• Traditional medicine as treatment: Some people choose to seek treatment for HIV/AIDS from traditional healers or witchdoctors. If these traditional healers are ignorant of the causes of HIV transmission, they can spread it among their clients.
• Forced marriage: Girls are sometimes forced to marry men, who can be much older than them. If the man chosen for them is infected, they often have no options to prevent getting infected themselves because of gender inequality and family pressure.
Organizational obstacles
Unaids.org identifies these problems in the fight against HIV in Tanzania:
• Commitment and capacity at the middle levels of government remain weak, though. Lack of personnel and limited technical capacity result in low absorption of funds at the district level.
• Lack of human resources lowers the quality and availability of services. Limited coordination capacity at the lower levels of government result in scattered and ineffective interventions.
• There is an urgent need for research into drivers of the epidemic. This data could provide the foundation for evidence-based HIV interventions to focus specific populations instead of the general approach that has been taken.
• An emerging issue is substance abuse, which is becoming especially evident on the island of Zanzibar. A survey put HIV prevalence above 25 percent among drug users on the islands. Much of Unaids’ focus in Tanzania in 2006 was directed to Zanzibar.
Works cited:
National HIV & AIDS Communication and Advocacy Strategy: Conceptual Summary. United Republic of Tanzania. May 2006
National HIV & AIDS Communication and Advocacy Strategy: Socio-economic Impact of HIV/AIDS on Most Vulnerable Children. Dr Suma Kaare. United Republic of Tanzania. May 2006.
National HIV & AIDS Communication and Advocacy Strategy: Knowledge, Attitudes, and Practices. United Republic of Tanzania. 2003-04 data.
National HIV & AIDS Communication and Advocacy Strategy: Prevention. Dr Annefreida Kisesa. United Republic of Tanzania. May 2006.
National HIV & AIDS Communication and Advocacy Strategy: Cultural Practices That Hinder the Fight Against HIV/AIDS. Mary Rusimbi. United Republic of Tanzania. May 2006.
Joint United Nations Programme on HIV/AIDS: Tanzania Country Situation Analysis. www.unaids.org/en/. July 2007.
