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The Pandemic

Sub-Saharan Africa ranks first in terms of the number of people living with HIV/AIDS. Of the 28.1 million African PLHA, an estimated 2.4 million children under 15 years had contracted the virus largely through MTCT. Since the outbreak of HIV struck a cumulative 19 million
Africans have died of aids – three times more than the number of aids deaths recorded in other parts of the world. By the end of 2001, there were two million more women than men carrying HIV while an estimated 13 million children had lost their mother or both parents to HIV/AIDS pandemic (UNAIDS,
December 2001
, AIDS Epidemic Update).

The rate of HIV prevalence rises as one travels south: from a prevalence rate of 5% amongst some West African Countries to 36 % in Botswana. By the end of 1999, the
adult prevalence rate for Tanzania stood at 8.09 % (1,200,000); that of Uganda has fallen from 14 % to 8 % while that of Kenya remains in the double digits.

The following topics/areas will be discussed: (1) factors driving sexual transmission of
HIV; (2) impact of HIV/AIDS on the various sectors that make society; (3) current methods being utilized to tackle the pandemic; (4) challenges and hurdles encountered in tackling the pandemic; (5) need for new strategies in tackling the problem; (6) hope for the future.

Driving Factors of the HIV Transmission

Sources from all corners of Africa suggest that a complex mosaic of factors play a role in kick-starting a sexual transmission of HIV and/or driving
infectious rates to higher degrees. In Tanzania, these factors are mainly cultural beliefs, psychological, behavioural, social, and biological factors among others.

Talking about sex is taboo in many Tanzanian societies. In such circumstances, it
is difficulty for sexual partners to enquire about the sexual behaviour of one’s partner. To enquire about the sexual life of one’s part is tantamount to calling that person a “prostitute”. Under such circumstances, sexual acts are undertaken in the hope that the partner is HIV negative rather
than basing such acts on scientific facts.

To make matters worse, some people have not come to terms with sex-in-condom. Some believe that sex-in-condom is not enjoyable. Linked to sex taboos are some beliefs, which render the
availability of some contraceptives like condoms irrelevant as an alternative for prevention against HIV in Tanzania. Some people believe that sex-in-condom in not enjoyable. In such a case, distribution of and education on the use of condoms would not be a priority.

Male adolescents tend to associate their identity with their capacity to conquer or to subdue women – a trait learnt from older members of society. In some African cultures, the worth of a man is measured in terms of the number of women one has had sex with.
Psychologically, a young male adolescent may feel inferior if he has no woman under his control. Moreover, some frustrated men or women tend to “cure” their conditions through sexual intercourse: an outlet, which is readily available among sex workers.

On the other hand, a good number of female adolescents tend to view themselves in a relational context. A young female adolescent will tend to cling to a boy for security, and for positive self-regard among other things. In the process, the young adult may easily give in
to a sexual affair in order not to loose the “friend”. In addition, given that talk about sex is taboo; and sex-in-condom is not likely, the chance of HIV infection is greatly raised.

The major behavioural factor catalysing the rapid
increase of HIV infection derives from the fact that human beings, being social animals by nature, tend to have multiple sexual partners. The presence of this impulse in human beings might explain why HIV/AIDS has been diagnosed in individuals from all educational, social, economic, political,
and religious domains. Apart form multiple partners, there is a large percentage of individuals with overlapping partners. If one member in an overlapping domain has the deadly virus, then the possibility of the others getting it is very high.

From an economical point of view, the poor and dependent tend to be at a higher risk level of contracting HIV/AIDS than those who are well off economically. Socio-economic instability leads to commercial sex and increases vulnerability to HIV/AIDS for those involved in sex trade. Gender based
discrimination deprives women the power to be economically independent. Furthermore, a good number of women tend to peg their economic gains on marriage. Under such circumstances, – prostitution, discrimination and marriage – women are robbed off control over the circumstance or safety of sex.

The phenomenon of “age-mixing” seems to be on the increase in current generations. This social phenomenon where older men seek younger girls or older women seek younger boys tends to put the young generation at higher risks. Generally, older members of society tend to
have a psychological control over young members making the latter group an easier prey to manipulation. Moreover, the movements of individuals from one region to another, for reasons such as job commitments, and business endeavours tend to create large area networks of sexual partnerships. This
could be one of the reasons that make HIV/AIDS prevalence among members of the police and the army, long distance truck drivers and traders to be very high.

Lastly, the levels of HIV transmission arising out of sexual intercourse might sore
because of biological factors. A person whose immune system is already weakened by malnutrition, lack of a balanced diet, or the presence of other diseases in the body is at high risks of contracting HIV/AIDS. High levels of sexually transmitted diseases among commercial sex workers contribute
to the skyrocketing of HIV/AIDS cases among the members of this group.

Effects of the Pandemic

The HIV/AIDS pandemic has a profound socio-economic impact. Economic gains
made after many years of hard work and sacrifice are slowly reversed. Governments are forced to allocate more resources to health care. UNAIDS estimates that the strength of marginalized economies, including the Tanzanian economy, will be reduced by 20 % in the next decade. In the process,
investments are shut down thereby slowing down the government’s plan to revitalize the economy.

aids compromises savings, as medical expenditure increases. It is estimated that 40 % of all patients in urban hospitals are HIV positive (Daily
News, 2nd April 2001).
Governments have to buy blood-screening equipments in its struggle to combat aids while individuals spend considerable amount of resources in caring for themselves, or for other affected individuals. In the process, more and more Tanzanians are sucked into
the dark vicious circle of poverty.

The bulk of those who have died from aids come from Sub-Saharan Africa: of the 21 million deaths caused by AIDS world wide, 17 million cases have been reported in Africa. Given the number of HIV positive cases
reported, the situation will persist for a near future but on a vaster scale. It is estimated that a quarter of the citizens of acutely affected countries will perish from HIV/AIDS. In such circumstances, the workforce of nations such as Tanzania is slowly but effectively dismantled.

The impact of HIV/AIDS on the education sector is horrifying. According to a study done in Tanzania in 1996 by the World Bank, the number of available teachers will continue to fall drastically as more and more fall to aids. The “considerable investment already made in
the education of those who die from aids will be lost, lowering the returns to education realized, on average, by graduates, their families, employers and communities” (World Bank: Country Study of Tanzania 1996). The percentage of children attending school has been on a gradual decline.
According to a study done by Rugalema, school attendance has dropped from 100 % to 30 % in parts of North West Tanzania (Rugalema: 2001).

face=”Lithograph”>HIV/AIDS pandemic has dealt a deadly blow to family life in Tanzania. At the beginning of 2000
Tanzania had an estimated 700 000 orphans whose parents had died of aids (UNAIDS: Tanzania 2000). Most of these children have no one to cater for their needs and are thus forced into child labour or early responsibilities beyond their handling capacity – children as young as 7 years are
forced to look after their younger brothers and/ or sisters. As parents succumb to aids-related illnesses, the social structures and division of labour in families, workplaces and in the community are greatly inhibited. Surviving children are robbed of time to be with parents as life expectancy
rate drops to the 40s.

A major aspect of HIV/AIDS is stigma.

“HIV/AIDS-related stigma is a real or perceived negative response to a person or persons by individuals, communities or society. It is characterized by rejection, denial, discrediting, disregarding, underrating and social distance. It
frequently leads to discrimination and violation of human rights”
(Regional Consultation Report Stigma and HIV/AIDS in Africa).

The underlying factors of stigma are fear, suffering, ignorance, and misconception about modes of transmission. The conduits of stigma are moral values, and prejudices. The manifestations of stigma include denial and discrimination against and
disregarding others, abuse of human rights, social rejection and depression on the part of the victim. Stigma threatens to dismantle the strong communitarian mode of life that has characterized Tanzania for a long period. Other key constraints to HIV/AIDS control in Tanzania include: lack of
political support within the government and from high-ranking officials, shortages of trained health workers as well as financial resources in the biomedical sector.

Currently Utilized Strategies

Currently there are two independent National aids Control Programmes (NACPs), one on the mainland and one in Zanzibar. Part of NACPS’s policy is to increase awareness of HIV/AIDS; provide people living with HIV/AIDS (PLHA) and their caregivers with social, medical,
physical, and spiritual support; and safeguard and protect the human rights of all PLHA. In 1996, the government finalized and launched a National Strategic Plan for HIV/AIDS for the period 1998 to 2002. It outlines 11 priority areas with an aim of bringing into control the spread of HIV/AIDS
and other STDs; protection of PLHA; lowering the impact of HIV/AIDS on the socio-economic sector; strengthening private organizations (PVOs) and NGOs, communities and individuals affected by the pandemic.

Several private organizations (PVOs) and
NGOs are involved with helping alleviate the impact of HIV/AIDS. Examples include the World Bank, UNAIDS, GTZ, several religious organizations based in or from Tanzania, Muhimbili Voluntary Counselling and Testing Clinic in Dar-es-salaam and Rainbow center in Moshi. International and local PVOs
and NGOS offer a variety of services: taking care of orphans; providing financial support; offering technical services; offering pre-test and post-test counselling services while others accompany the afflicted. Most organizations devote a large proportion of their resources to those already
affected by the pandemic while few devote their time in raising awareness of the dangers of the HIV/AIDS. Most of those involved in the latter activity are weak financially and therefore not quite widespread in ministries such as attending to those highly at risk (the youth and women, for
example), family life education, HIV/AIDS education in schools, and behaviour change education that complements all effective, culturally appropriate, information, education and communication (IEC) activities.

Other current HIV/AIDS remedial
strategies include: searching for financial resources; establishing political leadership; providing access to antiretroviral therapy for Africans living with HIV/AIDS; conducting effective, culturally appropriate, information, education and communication (IEC) campaigns to prevent new
infections; and revamping healthcare and other basic infrastructure.

These strategies require the implementation of other positively correlated projects such as poverty reduction projects since endemic levels of poverty in Africa contribute not
only to the spread of the disease but also militate against remedial efforts.

Six Strategies

à There is first a need for high-level political support and enforcement of a
National aids Policy and National Strategic Plan, as well as for legislation and enforcement to protect the human rights of PLHA. Further funding sources for NGOs and community-based initiatives must be expanded, and HIV/AIDS /STIs programs integrated with reproductive health services. The focus
should be on youth efforts and activities, including family life education, value education, and HIV/AIDS education programs in schools. In addition, behaviour change programs are needed to complement all IEC activities. Although basic knowledge of HIV/AIDS is high among Tanzanians, knowledge of
self-protection measures and behaviour change is much lower. Thus, there is a need to give preference to those who are vulnerable and to empower women for they compose one of the most vulnerable groups.

à A second step involves a shift in
paradigm. There is a need to shift away from what I call away-from-home institutions. Currently, the popularity and number of away-from-home institutions caring for orphans is on the increase. However, implementations of such calls will only aggravate the living standards of
taxpayers in the country. Moreover, these children zoos hardly prepare them for normal life in society. Therefore, the priority lies in establishing community-based care systems rather than advocating an increase in away-from-home institutions. In December 2001, the WHO’s
Commission on Macroeconomics and Health noted that community-based care systems are vital in reviving ailing health conditions of the people.

Community-based care systems do exist in several parts of Tanzania. Unfortunately, these systems are
weak financially, technically, and in terms of organization. What is needed is to revamp them such that they are well-organized, equipped, informed and involving majority of the people living in a given area where the system is based. In addition, there is a need to shift from providing health
services in static clinics to mobile clinics. Mobile clinics demand that the local populace be energized and charged with information pertaining to first aid care and probably more than first aid instructions. In the process of creating community care systems and mobile clinics; the government
will have tapped an immense source of resources. Moreover, community based care and mobile clinics will be a launching pad for IEC and BCC.

à A third strategy comprises activating and channeling locally available resources in the fight against
HIV/AIDS. Every financial, political, cultural, human skill, and social resource within the indigenous realm needs to be called upon. Tanzanians ought to realize that no donor or well-wisher will do what a Tanzanian can do for other Tanzanians. Tanzanians must accept the responsibility placed
upon them by the pandemic by placing themselves in front line defences against the pandemic. Whatever amount the World Bank, IMF, and collateral donors may provide in aid, it cannot substitute the work of an energized and charged local populace heated with awareness and acting against an
impending threat to her survival. Donors and well-wishers can only complement what Tanzanians have undertaken.

à Fourth is a call to speed up the process of creating and empowering regional forces with neighbours in order to create a force to be
reckoned with at international forums. Regional bodies such as IGAD, EAC, and SADC not only create economies of scale but also add value to their voice at international meetings. For instance, regional groupings would have a stronger say in demanding the right to cheap accessibility of generic
antiretroviral drugs for local Tanzanian if the concern were to be voiced by a regional group rather than by the sole and lonely voice of Tanzania.

à A fifth strategy is a call to the government to formulate long-term structures to combat
HIV/AIDS in the country. Rather than the donors design the structures to control the pandemic from outside the country, they may help the country through these structures. The culture of running to western nations for solutions to problems proper to indigenous African nations is unforgivable for
it denies the local people the right to exercise their thoughts and abilities. If the same western nations were to face a crisis of comparable proportions, their probability of seeking remedial strategies from African nations would be negligible. This calls Tanzania to create a think tank to act
as reservoir for African thought, one that will contain raw data that could quickly be formulated into possible remedies for emerging crisis. The involvement of indigenous professionals working abroad would be of great boost to such a reservoir.

Strategy six demands the tight scrutiny of hidden conditionalities in donor packages that tend to worsen living standards. Donors such as IMF and World Bank have forced Tanzania to adopt SAPs that have had their negative toll on the majority of the people. SAPs have widened the gap between the
rich and the poor. As already mentioned, poverty drives some people to commercial sex, majority of whom constitute golden conduits of HIV doses. With SAPs comes a high cost education that is beyond the reach of ordinary people. When children go out of school, they forfeit their awareness of the
dangers of HIV/AIDS. It is the high time that the government began to say no to donor aid that comes with strings attached.

Hope for the Future

The key to hope for the
future depends on various factors such as an increasing level of awareness of HIV/AIDS among risky groups like youth and women; the germination of feasible local communitarian care systems; the empowering local communities to face the pandemic; an awakening, though slow, of the devastating
impact of HIV/AIDS; and an initial implementation of the National Strategic Plan. The challenge ahead is to make use of the favourable environment and act expeditiously, so as not to lose the high momentum of political support and leadership.

HIV/AIDS pandemic is a threat to human existence on earth and especially those living South of the Sahara – Tanzanians among them. If not controlled, it will drown any hope for an African renaissance. It has been argued that new ways must be implemented to complement current strategies in order
to cub the pandemic. Considering the situation of HIV/AIDS in Tanzanian, the Tanzanian government must put her people in the first line of defence in the war against HIV/AIDS.


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