Country watch: Tanzania.

PIP: The TANESA Project has developed an easily replicable "mapping" intervention to assist communities in identifying and addressing risk situations for HIV/sexually transmitted disease (STD) infection and sexual violence. Some of the identified risk situations include drinking habits and alcoholism, exchanging sex for gift and money, lack of condoms, inadequate community efforts against sexual abuse and violence, and lack of parental guidance or participation of fathers in educating their children. The mapping approach also allows the participants to propose solutions to the problems they have identified and discuss these with community leaders so that the whole community would take action to address HIV/STDs. To ensure effectiveness of the program, a follow-up is undertaken by a multi-sectoral team composed of representatives from the district council, agricultural extension, community development, as well as representatives from the health and planning departments.^ieng

More than a health issue.

PIP: Magu is a rural district of Tanzania in which approximately 5% of adults are infected with HIV. Sexually transmitted diseases are common in this district which borders Lake Victoria and is crossed by a major truck route. In 1995, the Tanzania Netherlands Support Project on AIDS (TANESA) organized a 3-day workshop for members of the district primary health care (PHC) committee to review the district HIV/AIDS program. Committee members included staff from health, community development, education, water and fisheries sectors, and the district planning office. Local nongovernmental organizations (NGOs) and churches were also invited. Workshop participants created a multisectoral "AIDS-Action" team comprised of the district planning officer, district AIDS control coordinator, and representatives of the planning, health, development, culture, and education sectors and NGOs. The team will represent relevant sectors and NGOs, plan and coordinate all AIDS-related activities at the district level, mobilize resources for HIV/AIDS prevention activities at the district level, and meet quarterly and report to the district PHC committee. The team's main contact with the local community is through the social services committee. Efforts to support district councilors and problems encountered by the team are discussed.^ieng

Changes in male sexual behaviour in response to the AIDS epidemic: evidence from a cohort study in urban Tanzania.

OBJECTIVE: To examine changes in sexual behaviour among men in urban Tanzania. DESIGN: An observational cohort study among factory workers during 1991-1994. METHODS: Data from five follow-up visits with structured questionnaire-guided interviews and biomedical data were analysed to examine trends in sexual behaviour and sexually transmitted disease/HIV among 752 men. In-depth interviews were conducted to evaluate the magnitude of reporting bias. RESULTS: During the 2 years of observation, the proportion of men with more than one sexual partner during the month preceding the interview declined from 22.3 to 12.2%. The proportion of men reporting casual sex partners during the last month was almost halved: from 9.8 to 5.2%. The decline in the reporting of extramarital partners was gradual and pronounced. There were only minor changes in reported condom use, notably an increase in use with casual partners, and no changes in coital frequency. Data from in-depth interviews confirmed that reduction in sexual partners was the predominant change. CONCLUSIONS: This study documents that, in response to the AIDS epidemic, changes in male sexual behaviour are taking place in urban areas in Africa. The predominant change among these men, who are predominantly married and aged over 25 years, is a reduction of the number of sexual partners, although condom use remains low.

PIP: During October 1991 to April 1994, health workers in Tanzania interviewed and conducted a physical examination of 752 men who had made at least 4 follow-up visits to the clinic at a large urban textile factory in Mwanza to examine trends in sexual behavior and sexually transmitted disease (STD)/HIV of factory workers and their spouses. Each man was followed for about 2 years. Researchers aimed to determine whether the intervention to reduce HIV transmission at the clinic had an impact on sex behavior. The intervention included free and effective treatment of STDs, a syphilis test at each visit, voluntary HIV counseling services, and health education activities (workshops, peer educators). The proportion of married men increased from 83.4% to 88.4% during the study period. Men were less likely to have more than 1 sexual partner in the previous month after 5 visits than before the first visit (12.2% vs. 22.3%; p 0.01 for trend). They were also less likely to have had casual partners during the previous month (5.2% vs. 9.8%; p 0.001 for trend). Married men were less likely to have extramarital relations (6.5% vs. 20.1% for regular non-cohabiting partner; p 0.01 and 2.7% vs. 8; p 0.001). Condom use in the previous month did not change significantly (2.5% vs. 3.1%; p = 0.377). It did increase significantly with a casual partner, however (7.6% vs. 27.3%; p = 0.002 for trend). Frequency of intercourse did not change. The HIV-incidence rate decreased considerably (1.77 vs. 0.66/100 person-years of observation for a rate ratio of 0.37). Multiple sex partners in the previous month was more common among men 20-29 years old or who consumed moderate or excessive amounts of alcohol than among those over age 40 or who consumed no alcohol. These findings suggest that even though sexual activity did not decline, it became more commonly with 1 partner and within marriage, especially among men 40 and older who did not drink alcohol. Condom use remained low, except with casual partners. ¿

HIV / AIDS and STD health promotion in Tanzanian fishing villages.

PIP: The Tanzania-Netherlands Project to Support AIDS Control (TANESA) conducted rapid appraisals in 14 villages with fishing camps along Lake Victoria to determine needs and resources available for HIV/STD (sexually transmitted disease) prevention. Discussions with village members sparked interest, so TANESA launched a health promotion program. It first set up a pilot project in a village of about 600 persons with an established fishing camp. TANESA trained 6 young women and 8 fishermen during a 4-day workshop as peer educators. The topics included anatomy and biology, STDs, HIV prevention, adult education, counseling, and communication skills. Training techniques used were short lectures, group discussions, role-playing, and exercises from a workbook. The newly trained peer educators helped set up a general education campaign: video shows, exhibition boards, pamphlets, condom distribution, and discussion sessions with peers. Village leaders did not support the idea of official classes, an AIDS information room, or a village health committee. Nevertheless, the peer educators continued their mission. Once a month, the program coordinator visits them and advocates the program to village leaders. TANESA next replicated the program in a larger village (about 6000 population). This time, it first mobilized village leaders to develop the program themselves. The core groups were fishermen, female bar and guesthouse workers, and young unemployed women offering sex for money. Each group chose its own peer educators. Village leaders were responsible for the educational campaign organized by the peer educators. The campaign received a positive response and effected positive attitudes towards condom use. Village leaders organized an AIDS action committee. TANESA now provides technical support, fosters a team spirit among peer educators, and supports monitoring activities. Peer educators express an increase in their self-esteem and self-confidence.^ieng