Joe Lugalla

Monitoring of HIV-1 infection prevalence and trends in the general population using pregnant women as a sentinel population: 9 years experience from the Kagera region of Tanzania.

Summary: In the Kagera region of Tanzania, a population‐based study was initiated in 1987 followed by the establishment of antenatal‐clinic‐based sentinel surveillance system in the town of Bukoba in 1990. Repeat studies in both populations in Bukoba in 1993 and 1996 made it possible to study the dynamics of HIV infection prevalence and incidence in the area. This study aims at comparing the findings from this sentinel surveillance system with those of cross‐sectional studies in the general population to assess its validity in estimating HIV prevalence and their trends in the general population. A multistage cluster sampling technique was used in the population‐based studies whereas the antenatal‐clinic‐based population was obtained by consecutively recruiting antenatal care attenders coming for the first time during a given pregnancy. Antibodies against HIV infection were tested using two independent enzyme‐linked immunosorbent assay (ELISA) antibody detection tests. Unlinked anonymous testing strategy was adopted for the sentinel population. Age‐adjusted prevalence among antenatal care attenders decreased from 22.4% (95% confidence interval [CI], 20.6‐25.2) in 1990 to 16.1% (95% CI, 15.9‐18.8) in 1993 and further to 13.7% (95% CI, 11.8‐14.3) in 1996. These results closely resemble those of the general population of adult women in the clinics catchment area (the town of Bukoba) where the ageadjusted prevalence of 29.1% (95% CI, 24.4‐34.6) in 1987 showed a decrease in the studies in 1993 18.7% (95% CI, 15.1‐23.0) and in 1996 14.9% (95% CI, 12.0‐17.1). The study indicates that general population trend estimates can be generated using sentinel surveillance data based on pregnant women visiting an antenatal clinic for the first time during a given pregnancy. The benefits of using this group outweigh its limitations that are brought about by possible selection bias. Continued surveillance of the epidemic based on antenatal care patients as a sentinel population is therefore recommended.

The impact of structural adjustment policies on women's and children's health in Tanzania

Since 1981, the government of Tanzania has adopted a variety of policy measures including the National Economic Survival Plan (NESP), Structural Adjustment Program (SAP), Economic Recovery Program (ERP) I, ERP II, Economic and Social Action Plan (ESAP), and Priority Social Action Plan (PSAP) to deal with the countrys present social and economic crisis dating back to the late 1970s. The main objective of the these adjustment measures has been to attain macroeconomic balance by bringing national expenditure into line with national income to reduce inflation and to increase exports. Other objectives have been to maintain egalitarian income distribution and the provision of basic social services to the majority of the population. To realize these objectives, the government has been controlling credit and removed subsidies on certain food items and agricultural inputs, introduced a system of progressive devaluation, liberalized trade, and has been trying to reduce government expenditure by introducing cost sharing measures in the education and health sector. The author concludes that the erosion of real incomes and increased poverty have had a devastating effect upon women and children. Rural women have heavier workloads as males migrate to urban areas in search of work, there is increased maternal mortality, and chronic malnutrition and poverty make it difficult to implement HIV/AIDS intervention strategies.

Sexual behaviour patterns and condom use in Tanzania: results from the 1996 Demographic and Health Survey.

Abstract We conducted this study to determine the factors associated with high-risk sexual behaviour and condom use among men and women who participated in the 1996 Tanzania Demographic and Health Survey (TDHS); and to assess changes in sexual behaviour between 1991/92 and 1996 TDHS. Respondents were regarded to have practised high-risk sexual behaviour if they were married or cohabiting and had other regular or non-regular sexual partners; or if they were unmarried and had non-regular partners or multiple regular partners. About 8% of women and 29% of men practised high-risk sexual behaviour. High-risk sexual behaviour was common among younger men and women, and decreased with increasing level of education in women. Respondents who were unmarried, Muslims and those who perceived themselves at increased risk of HIV/AIDS were more likely to practise high-risk sexual behaviour. About 4% of women and 15% of men reported to have used condoms during their last sexual encounter. Condom users were signijicantly more likely to practise high-risk sexual behaviour. Overall, no major changes in sexual behaviour and condom use were observed during the period between the two surveys. Predictors of high-risk sexual behaviour and condom use identified in this report provide valuable information that can be used to design targeted HIV/AIDS interventiom in Tanzania.

HIV-1 infection prevalence and incidence trends in areas of contrasting levels of infection in the Kagera region, Tanzania, 1987-2000.

This study aimed at assessing the extent to which decline in HIV infection prevalence reflects decline in incidence in 3 areas with contrasting initial exposure to the HIV epidemic in the Kagera region of Tanzania. A population sample was recruited for the baseline study in 1987 through a multistage cluster sampling technique to determine HIV prevalence. Seronegative individuals identified in the baseline and subsequent studies were followed up for 3 years to yield trends in incidence that were compared for the 3 areas. The overall age-adjusted HIV-1 prevalence in the high-prevalence area of Bukoba urban declined significantly from 24.2% in 1987 to 18.2% in 1993 and later to 13.3% in 1996 (P = 0.0001). In the medium-prevalence area of Muleba, overall age-adjusted prevalence declined significantly from 10.0% in 1987 to 6.8% in 1996 and later to 4.3% in 1999 (P = 0.0003), whereas in the low-prevalence area of Karagwe the prevalence declined from 4.5% in 1987 to 2.6% in 1999 (P = 0.01). In all 3 areas, the most significant decline was consistently observed among women in the age group 15-24 years. No age group exhibited a significant upward prevalence trend. The HIV-1 incidence for Bukoba urban declined from 47.5 to 9.1 per 1000 person-years of observation in 1989 and 1996, respectively, whereas in Muleba it decreased from 8.2 to 3.9 in 1989 and 2000, respectively. Sex-specific estimates indicated a significant decline among women in the high-prevalence area of Bukoba urban from 51.5 to 9.2 per 1000 person-years at risk (P = 0.001). It is concluded that the HIV-1 epidemic in Kagera is on the decrease as reflected by the decline in HIV-1 incidence and prevalence trends particularly among the 15-24 year olds. The decline in the 3 areas of differing magnitude implies that the HIV/AIDS epidemic may be arrested early without necessarily peaking to saturation levels.

Acceptability of voluntary HIV testing with counselling in a rural village in Kagera, Tanzania

A pilot study on acceptability of voluntary HIV testing with counselling was performed in a rural village in Kagera, Tanzania as a potential intervention against HIV transmission. Village residents were prepared by their leaders and subsequently invited to health education group meetings to volunteer for the test. Consenting individuals were interviewed to determine awareness and acceptance of the offer followed by pre-test counselling and taking of a blood sample for subsequent HIV testing. Two months later, the results of the test were returned with post-test counselling coupled with a short interview of a random sample of adults in the village. Of the 245 adults responding to the call, 137 (55.9%) subsequently volunteered. The main reason for volunteering was to know the HIV status (96%). Among those who were aware of the offer, the main reason for not volunteering was that they felt unlikely to catch AIDS, implying that they had a false perception of being at low risk. In this study a significant proportion were willing to volunteer for the HIV test and to receive the results, indicating a moderate level of acceptability. The results also indicate the need for developing innovative ways of enhancing acceptability of voluntary HIV testing with counselling. However, the relationship between knowledge of HIV status and behavioural change is complex and therefore several potential mechanisms may exist by which HIV testing in combination with counselling can influence behaviour. For this reason, people should be given the choice of knowing their HIV status since it may constitute a potential mechanism for influencing behaviour towards reduction of HIV transmission.

The social and cultural contexts of HIV/AIDS transmission in the Kagera region, Tanzania

Like poverty the HIV/AIDS epidemic is affecting the sub-continent of Saharan Africa more severely than any other parts of the world with 63% of global AIDS cases occurring in this region. Tanzania is one of the severely affected countries within sub-Saharan Africa. It is evident that AIDS in this continent is transmitted mainly through heterosexual contact. Since a cure is yet to be found a change in sexual behavior seems to be the only reliable method of controlling the further spread of HIV. Sexual behavior is shaped by a variety of social and cultural factors inherent in the society. Therefore understanding the social-cultural context within which AIDS is spreading is important for successful intervention. In order to achieve this the Kagera AIDS Research Project initiated a study aimed at understanding the social cultural processes that shape the dynamics of HIV transmission in the Kagera region of Tanzania. The findings suggest that there are a variety of factors responsible for the rapid transmission of HIV/AIDS in this region which include political factors such as organized violence (war); economic factors particularly poverty; and cultural factors or traditions especially in terms of the way they shape gender inequality romantic attachments and sex meanings and beliefs. The study proposes that intervention strategies must be multi-dimensional and must reflect the local cultural conditions as well as involve the local people. (authors)

Social context of disclosing HIV test results in Tanzania

This study sought to understand how individuals reveal their HIV test results to others and the ways in which social relations affect the disclosure process. The data were collected through open-ended interviews administered in Swahili to informants who had just been tested for HIV and to those who were living with HIV in Dar es Salaam and Iringa regions. Analysis shows that social relations influence the decisions individuals make about disclosure. Most people preferred to reveal their HIV status to close family members. Most also mentioned the fear of being rejected and discriminated against as major reasons for not disclosing their test results to others.

The effectiveness of educational support to orphans and vulnerable children in Tanzania and Uganda

Little evidence is available to assist policy makers and donors in deciding what kinds of programs in developing countries are more likely to be effective in supporting the entry and continuation of OVC in secondary schools. This is particularly important for females whose education has direct bearing on child mortality in the next generation. This study gathered four kinds of educational outcome measures in two East African countries ravaged by the AIDS/HIV pandemic. The goal was to determine whether direct scholarship aid to individual students versus various forms of block grants would be more effective in promoting lower rates of absenteeism, lower dropout rates, higher national examination scores, and higher pass rates for OVC of both genders. Insufficient evidence was available for recipients of scholarships, but OVC with block grant support performed as well or better than their non-OVC counterparts, and significantly better than OVC without support. Contrary to popular belief, girls had lower rates of absenteeism. There were no gender differences in dropout. However, boys consistently outperformed girls on academic tests. Insufficient data systems continue to impede more detailed analysis.

Aids, orphans, and development in Sub-Saharan Africa: A review of the dilemma of public health and development

HIV/AIDS is having devastating consequences on families, young children, and other vulnerable social groups. In this paper, I review the impact of HIV/AIDS on families and development in sub-Saharan Africa. I begin by showing the magnitude of the problem and the factors that have led to rapid spread of HIV/AIDS in this sub-continent. I discuss gender inequality, poverty, social inequality, and globalization, and show how these facilitate the rapid spread of the epidemic. I show how AIDS is creating a mass of orphans on the one hand, and how it is impacting development and creating new public health contradictions on the other. By orphans I mean all those children who have lost either a mother or father or both parents due to AIDS. I argue that AIDS is destroying families and communities and is also manufacturing a great number of orphaned children who are powerless and vulnerable. In order to solve this problem, I suggest the adoption of appropriate, pragmatic, and realistic short-and long-term strategies of dealing with the problem. I conclude by suggesting that the long-term strategy aimed at reducing the number of orphaned children will involve the adoption of appropriate strategies that seek to control HIV/AIDS once and for all.

Conflicts and politics in urban planning in Tanzania

This paper tries to discuss two important issues. First, it examines the conflict between ideology and actual urban planning in Tanzania. It is argued that. via the Arusha-Declaration, Tanzania showed the intention of building an egalitarian society based on the principles of Ujamaa (socialism). Hence one expected that an attempt to transform some colonial structures in order to suit the socialist aspiring nation could be in the agenda. In Tanzania this has never been the case at the level of urban planning. The paper argues that the gap between theory and practice exists because Tanzanias socialist theory itself is weak. and does not emanate from a concrete class analysis of the society itself. Secondly, the paper examines the fragmentation of urban planning in Tanzania. Some legal provisions are contradicting as to who should be responsible for what in urban planning. This contradiction has created problems and conflicts between various organs responsible in urban planning. In all cases it is the majority urban poor who are suffering. The paper suggests that the urban planning in socialist aspiring countries must be unified. coordinated and part and parcel of the overall national development plan. Such move must be implemented in Tanzania.