Tropical Diseases in Africa – Malaria

By Shravya Murali – Art in Tanzania internship

As a significant health problem in several tropical regions of the world, malaria costs almost 435,000 lives annually. A substantial fraction of these deaths occurs in Africa. The proportion of cases and deaths In Tanzania alone constitutes 3% of those globally. Over the past few years, the number of malaria cases have been on the rise, with a staggering increase by 3.5 million from 2016 to 2017 as reported by the WHO.

How does malaria spread?

Malaria in humans is caused by four kinds of parasites from the Plasmodium genus – Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae. A fifth species Plasmodium knowlesi, is a zoonotic species infecting animals. Of the five species, Plasmodium falciparum results in the most severe form of malaria and is responsible for the majority of malaria-related deaths, especially among children below the age of five.

Malaria is transmitted to humans through the bite of a female Anopheles mosquito that is infected by one of the malaria-causing parasites. The Anopheles mosquito can also spread the parasite from a human to another human when it feeds on an infected human’s blood meal, and later goes to bite another human.

Human-to-human transmission can also occur through blood transfusion, organ transplant, or sharing needles containing contaminated blood as the malaria parasite can be found on red blood cells. Malaria can also be transmitted from a pregnant mother to her child before or during delivery, which is also known as congenital malaria. However, malaria is not contagious and cannot be transmitted through casual contact (i.e. by sitting next to someone infected) or sexual contact.

What are the effects of the disease?

Those infected with malaria often experience flu like illnesses and fever. Symptoms often include headache, fatigue, chills, muscle soreness, nausea, vomiting, and diarrhea. As malaria can cause a loss of red blood cells it may lead to anemia, and jaundice, which is the yellow coloring of skin and eyes. If left and treated malaria becomes life-threatening as it can cause kidney failure, mental confusion, seizures, coma, and death. Usually these symptoms occur about 10 days after a malaria infection. Malaria caused by P.vivax and P.ovale may occur again and the parasites may reside in the liver for up to around four years after an individual has been bitten by an Anopheles mosquito. These dormant parasites may become active later and invade the individual’s red blood cells, causing another malarial infection.

How is malaria treated?

If a patient is suspected to be infected with malaria, a drop of his/her blood is often observed under a microscope to detect the malaria parasite. Treatments for malaria vary based on the severity of malaria, clinical status of the patient, the Plasmodium species causing the infection, and prior use of anti-malarial drugs.

In Mainland Tanzania, artemether lumefantrine, a drug that can be orally consumed, is used for uncomplicated malaria. In Zanzibar, however, artesunate and amodiaquine are used. For severe malaria, artesunate and quinine are injected in patients in both Mainland and Zanzibar. Quinine is another drug that is only used when other drugs are ineffective, as quinine is known to have more side effects than the others. However, quinine is used to treat malaria in the first trimester of pregnancy as it is not known to have significant effects on the child at therapeutic doses.

What could be done to prevent the disease?

To prevent malaria, one could consume anti-malarial drugs (i.e. atovaquone, chloroquine, doxycycline). While it is possible to provide infants and children some of these drugs, not all drugs are suitable for children and doses are based on the weight of the child.

Apart from anti-malarial drugs, one should also prevent mosquito bites (specifically at night), which could be done by sleeping under insecticide-treated bed nets, wearing fully covered / long-sleeved clothing at night, and carrying an insect repellent.

With the increase in the number of malaria cases over the years, it is crucial that members of the public and healthcare professionals cooperate in fight against the disease. While the research for vaccination against malaria is ongoing, it is also essential for everyone to play a part by taking precautions to avoid malaria.

Tropical Diseases in Africa – Sleeping Sickness

by Shravya Murali – Art in Tanzania internship

Human African Trypanosomiasis, also known as ‘Sleeping Sickness’ is a neglected tropical disease, and a recurrent public health problem in Sub-Saharan Africa. The deadly sleeping sickness has robbed tens of thousands of lives of individuals in Africa annually, and about 65 million people continue to be at risk of falling prey to it. Fortunately, internationally coordinated efforts have led to a drastic drop in death rates after 2000, with the reported cases of infection being 992 in 2019. It is vital to sustain these global efforts to eradicate the disease for the safety of millions residing in Sub-Saharan Africa.

How does sleeping sickness spread?

This life-threatening disease is spread to humans via bites from tsetse flies that carry the parasite (Trypanosoma brucei) causing the disease. Tsetse flies are exclusively found in Africa, specifically in the south of the Sahara. While there are about 30 species or sub-species of the tsetse fly, only six are known to be able to transmit the sleeping sickness parasite to humans.

However, this disease can also spread from an infected individual to another individual via:

  1. Contaminated needles (i.e., sharing of needles with an infected individual)
  2. Sexual contact – reported to have resulted in the spread of the disease between humans in some cases.
  3. Pregnancy – The parasite is able to cross the placenta, thereby spreading from mother to fetus.
  4. Mechanical transmission – The parasite may spread from human-to-human through other insects that feed on blood.

What are the effects of the disease?

The disease can manifest in two forms caused by different subspecies of the Trypanosoma brucei sleeping sickness parasite – T.b.rhodesiense and T.b.gambiense. The former is commonly associated with the presentation of a painful inflammation, known as ‘chancre’, at the site of the bite. The latter rarely results in a chancre although this has been occasionally observed in infected travellers from non-endemic regions. The “Winterbottom’s sign”, or swollen lymph nodes, is more commonly observed in infections caused by T.b.gambiense.

Regardless of the subspecies of the parasite, the disease comprises of two stages at which it can be clinically diagnosed – the early stage, and the late stage. Furthermore, the symptoms are usually common, causing difficulties in identifying the subspecies that resulted in the disease.

In the early stage, the parasite is found in the blood and the lymphatic system. Its symptoms commonly include:

  • Restlessness
  • Fatigue
  • Headache
  • Itchiness
  • Joint pain

Signs such as weight loss, intermittent fevers that occur could for a day up to a week, and swelling of the liver and spleen, are usually indicative of an early-stage infection.

In T.b.gambiense infections, the disease progresses slowly as it proceeds from the early stage to the late stage after about 300 to 500 days. On the other hand, T.b.rhodesiense infections advance quicky from the early to the late stage in only around 21 to 60 days.

The late stage is known to be riskier as the parasite enters the central nervous system and results in inflammation of the brain – a condition known as meningoencephalitis – which causes neuropsychiatric problems and tends to be fatal. Some of the neuropsychiatric issues include reversal of the sleep-wake cycle (hence the name “Sleeping Sickness”), hallucinations, anxiety, aggression, and mania. The patient may also enter coma, and if left untreated, this stage leads to death.

How is sleeping sickness treated?

The sleeping sickness, after infection, is normally treated by administered specific drugs depending on the stage of infection. For early-stage infection, pentamidine or suramin is used. Both drugs produce unwanted side-effects and can only be used for early-stage infections. While suramin can result in allergic reactions, pentamidine, is commonly well-tolerated by patients. In the late stage, melarsoprol, eflornithine, and nifurtimox are usually used. While melarsoprol can be used to treat both gambiense and rhodesiense infections, it is obtained from arsenic, hence resulting in serious side effects such as reactive encephalopathy – altering brain function. Eflornithine and nifurtimox are less toxic, but the former is only effective against gambiense infection, while the latter has not been studied for its effectiveness against rhodesiense infections. Hence, the current treatments against late stage rhodesiense infections are still inadequate, drawing an urgent need for sufficient treatment considering the quick progression of infection caused by this subspecies.

What could be done to prevent the disease?

Due to the lack of drugs or vaccines to allow for immunity against sleeping sickness, the only way to prevent the disease currently is to avoid contact with tsetse flies. In countries where tsetse flies are found, the following precautions can be taken:

  • Checking vehicles before travelling in them, as tsetse flies are drawn to motion and dust from vehicles in motion.
  • Wearing fully covered clothing, such as pants and shirts with long sleeves.
  • Ensure that clothes worn are of neutral colours or blend with the environment, as tsetse flies are attracted to colours that stand out in the environment.
  • Avoiding bushes, where the tsetse flies often reside.
  • Using insect repellent to prevent bites from other blood-sucking insects other than tsetse flies that can spread the disease – as tsetse flies are not significantly affected by insect repellents.

The World Health Organisation (WHO) aims to completely eradicate the African Trypanosomiasis by 2030, with international research organisations coordinating to study potential treatments that are more effective, and drugs that may help prevent the disease. At the same time, it is also important that individuals play their part in avoiding transmission of the disease by taking the necessary precautions for the safety of all.

Government Expenditure to Combat Pandemic Situation

JAMES MATHEW MGAYA – Art in Tanzania internship

Other Africa countries have prioritized the pandemic and the accompanying lockdowns measures that have worsened the severe food insecurity problem, increasing the population of people living in extreme poverty. While Tanzania has opted for a different approach. Though Tanzania’s unconventional approach to COVID-19 may be slow in response ad seem to lack in direction, its uniqueness illustrates the need for government to form context-specific smart containment strategies and recovery plans. The Tanzania government’s expenditure was to maintain multiple competing priorities, so far the government did not ignore the pandemic by increase public health funding. Tanzania’s interest was to contain the transmission of the virus along all its borders and coordinate closely with its partners, maintain diplomatic relationships, ensure trade is not severely disrupted, and invest in formal small-holder farmers to produce for domestic economy.

How did it work?

Tanzania used its government expenditure to refocus on financial services which makes them among 14 African countries that did not introduce any social safety measures, such as cash transfers. Instead, the government focused on responding with some economic measures through the Bank of Tanzania with various policies to ease liquidity and safeguard the stability of the financial sector. The bank reduced the discount rate, lowered the minimum reserve requirements ratio, incentivised the restructuring of loans for severally affected borrowers, and relaxed limits on mobile money use.

Tanzanian government expenditure focused on increasing its capacity to maintain and manage the virus, while pursuing sustainable economic development. In other words, Tanzania can learn to adapt and live with the virus in a way that is not detrimental to the economy, but not overwhelming the health system. They fund health centres and witness the Covid-19 emergence facilities and also Government built special covid-19 health centres to combat it and increase public health funding to local health centres to implement mass testing, enforce social distancing, and sanitation measures.

Tanzanian government expenditure uses the Strategic Cities Project for Tanzania development objectives to facilitate the Additional Financing (AF) which enhances the development impact and sustainability of the investments financed by the original project by investing in equipment and operation, and maintenance capacity for existing infrastructure, and deepening local government capacity for urban management. These initiatives enable the government to maintain multiple competing priorities, managing the transmission rate, while ensuring food security creating and protecting jobs. 

Conclusion

The COVID-19 pandemic will have short-, medium-. and long-term effects on territorial development and sub-national government functioning and finance. One risk is that many governments respond to focus only on the short term. But the Tanzanian government use it’s expenditure to longer-term priorities must be included in the immediate response measures in order to boost the resilience of regional socio-economic systems. Much effort of Tanzanian government redirected to growth of economy during pandemic so as government expenditure was driven by strong public investment and export earnings. The government’s firm focus and commitment during this pandemic have been to avoid a complete halt of economic activities. 

Resources

The International Growth Centre – COVID-19 in Tanzania: Is business as usual response enough?

COVID-19 AND ECONOMY IN TANZANIA

JAMES MGAYA – Art in Tanzania internship

The pandemic has forced to switch the plans globally. All fashion, sport, and technology events have been cancelled or have changed to be online. Possible instability generated by an outbreak and associated behavioural changes could result in temporary food shortages, price spikes, and disruption to markets.

Such price rises would be felt most by vulnerable populations who depend on markets for their food as well as those already depending on humanitarian assistance to maintain their livelihoods and food access. In Tanzania it was the season of cashew nut during Asian outspread of Covid 19 pandemic as we all know that Asians their the consumers of cashew nuts for years now the Vietnam, India; Malaysia and so on.

During the period the shipment stops due to curfews and lockdowns. Mtwara’s economy went down with it although it was the year before but now it was devastated situation and desperate moment for farmers who were hungry for money due to last year recovery.

  We witness Global stock markets crashed in March 2020, but in tourism industry unemployment was inevitable , tourism enterprise experience bankruptcies, The pandemic has had a significant impact on the aviation industry due to the resulting travel restrictions as well as a slump in demand among travellers air Tanzania incurs tremendous loss which is facing accumulated losses of TZS150 billion Tanzanian shillings (USD64.6 million).

Thank to God Tanzania’s macroeconomic performance has been strong for the last decade, but the current crisis is an unprecedented shock that requires strong, well-targeted and sustained policy response.

The gravity of the situation was easy to Tanzanians, the impacts of COVID-19 are being felt in different ways and the measures taken by the respective governments have also differed on the areas of focus and comprehensiveness.

When our late President John Magufuli let people to continue working this bring relief to low-income earners who eat according to the day and work, they do. If measures of lockdown implemented like other nation people of Tanzania Most in big cities would starve for food more than pandemic. Thanks to him we Tanzanians at least overcome fear of unknown although many international organisations went on lockdown.   

The pandemic has been affecting the entire food market system due to border closures, trade restrictions and confinement measures have been preventing farmers from accessing markets, including for buying inputs and selling their produce, and agricultural middle men from harvesting crops, thus disrupting domestic and international food supply chains and reducing access to healthy, safe and diverse diets. 

We experience panic buying which lead to genuine shortages of spices, citric fruits and vegetables regards of fear of the unknown, which is caused by emotional pressure and uncertainty to food security. This increases the amount of entrepreneurs who seize opportunities to produce different products, and the spread of lies rumours of preventive measure and commodities to social medias so as people can earn income.

During the earlier stage of the pandemic, supply shortages were expected to affect a number of sectors due to panic buying, increased usage of goods to fight the pandemic, and disruption to factories and logistics. There have been widespread reports of shortages of pharmaceuticals product with many areas seeing panic buying and consequent shortages of food and other essential grocery items.

The verdict

Tanzanian economy, including lower export demand, supply chain disruptions for domestic producers and suppressed private consumption. International travel bans and caution against contracting the virus have severely hurt the tourism sector, which had been one of the fastest-growing sectors in the economy.

The pandemic is impacting lives and livelihoods particularly those in urban settings relying on self-employment and informal/micro enterprises. However, government has already taken, and this forecast assumes the authorities will take additional health and economic policy measures to mitigate negative impacts. 

Typical Skin diseases Tanzania

By Gwamaka Mwakyusa – Art in Tanzania internship

Skin diseases such as acne, psoriasis, and eczema are associated with a significant impairment in the quality of the patient’s daily life. Several instruments assess quality-of-life (QoL) in adults and children with skin disease and help us understand its impact. Three groups of investigators have recently examined the psychosocial effects of skin disorders.

Smidt and colleagues developed and tested a new instrument specifically designed to assess these issues in adolescents, who are particularly vulnerable to issues of self-esteem. Skindex-Teen addresses such age-specific matters as sports participation, peer relationships, and clothing choices. In the 200 patients studied, acne was the most common skin condition. The reliability of the 21-item scale was greater than 0.4, and test-retest reliability was supported by acceptable intraclass correlation coefficients for the total score, physical symptoms scale score, and psychosocial functioning scale score.

Numerous observations and limited studies have suggested that psoriasis increases stress and depression. Kurd and colleagues mined the British General Practice Research Database to assess the association of psoriasis with depression, anxiety, and suicidality in a large population. Compared with 766,950 patients without psoriasis, 149,998 psoriasis patients had significantly more clinically diagnosed psychiatric diseases. Additionally, among the psoriasis patients, those with most severe cutaneous disease was more likely to have depression, anxiety, and suicidality diagnoses.

Evers and colleagues analyzed the effects of psychological stressors on skin disease in patients with psoriasis. This report follows their earlier finding of clinical exacerbation of psoriasis in the month following stressful life events. The present longitudinal, prospective study assessed how stressors affect serum levels of cortisol, a key component of the hypothalamic-pituitary-adrenal (HPA) axis, in psoriasis patients. They found that peak levels of daily stressors were significantly associated with lower cortisol levels and that patients with persistent high stress had lower mean cortisol levels than patients with lower stress. The stress response involves activation of both the HPA axis and the autonomic nervous system, both of which interact with the immune system. Therefore, stressful events could exacerbate and prolong chronic inflammatory diseases such as psoriasis. Other investigators have reported a blunting of the HPA axis in some subjects with psoriasis, which could account for inadequate secretion of cortisol and a resulting exacerbation of clinical disease.

The common issues for clean drinking water availability in the Eastern Africa

By Ekaterina Kilima – Art in Tanzania internship

The shortage of freshwater resources is considered a global problem which affects many parts of the world, including the Eastern African countries. It is often wrongly believed that, because the majority of the Earth’s surface is covered with water, the availability of clean drinking water for humans is abundant. In reality, only 3% of the global water is considered freshwater suitable for drinking (WWF). Therefore, there is a high need for a well-balanced management of the available water resources.

One of the main issues for high water demand in the Eastern Africa is the ongoing population growth and urbanization, which in fact increases the standards of living and requires more water per capita. For example, urban population in Tanzania has increased by 7.2 million people between 2005 and 2015 but the water sector bodies fail to respond adequately to these changes (GIZ 2018). It may sound like a paradox that, while the Eastern African states hold the largest amount of on ground water reservoirs on the continent, with Lake Victoria being the second largest freshwater lake in the world, at least half of the population is vulnerable to the water scarcity problem. Nonetheless, there are several socio-economic and socio-political causes which enhance the problem of drinking water availability.

Lake Victoria

One of these causes is an increasing water demand in agriculture which receives water for irrigation from the nearby freshwater resources such as rivers and lakes. Some amount of freshwater from the wetlands is being lost in the process because of inefficient irrigation methods. Due to the increasing population, the conflict between the water needs of citizens and the water needs of farming is going to become more explicit. Moreover, surface water reserves often get polluted because of the closely located industrial activities, for example oil extraction or transportation. Water contamination can also happen due to nutrient and wastewater transportation from urban and rural areas which is closely connected to poor sanitation practices. After getting polluted, this water cannot be used in households unless using multi-stage water filters.

Perhaps, one of the most complex causes for freshwater scarcity for the Eastern Africa is the trans-boundary ownership of the water sources as well as their weak management. Most countries in the Eastern Africa must share water resources with each other which often leads to uneven distribution of the fresh water (IJWRD 2016). Therefore, the problem is not in the lack of water reservoirs but in the unfair distribution and poor management. The inaccuracy of the water management involves inadequate implementation of the environmental law, corruption of interests among authorities but also lack of problem-specific knowledge and funds.

There is no universal list of solutions that would help all the countries in the Eastern Africa. The perfect mix of solutions for each country would depend on the criteria such as population, climate, level of corruption, economic and political stability, and others. However, there are some suggestions that are critical for each country. One, it is important to support local farmers in their transition to more efficient irrigation practices which would allow more water to be available for drinking and household needs. Second, governments should increase the global awareness on the positive changes in the region to attract more foreign investments. Governments should work closely with international organizations and NGOs to develop more sustainable projects to provide equitable access to clean drinking water. Third, it is critical to legally protect African wetlands from human-led contamination and avoid any disturbance of the ecosystem.

Clean drinking water condition in Addis Ababa (Ethiopia). General Overview

By Ekaterina Kilima – Art in Tanzania internship

According to the World Bank (2019), Ethiopia is one of the priority African countries for the Global Water Security & Sanitation Partnership (GWSP) programs. In other words, a lot of money is being invested in Ethiopia to improve its water and sanitation systems. Currently, Addis Ababa is considered a region with very safe drinking water (85 % of water is low risk) compared to other regions of Ethiopia (only 7% of water is low risk in particular places) (CSAE 2017). Access to clean drinking water is a big inequality issue as the region’s poorest people barely have access to high quality water unlike the richest group.

A recent epidemiological study conducted by Wolde et al. (2020) suggested that the clean water in Addis Ababa might be exposed to bacteria and parasites more during the wet season (January-October) due to high rainfall. The results of the study have shown that, although mostly insignificant, slight contamination was found in the water samples from public taps and reservoirs (around 6% each). Traces of fecal coliforms and total coliforms were found in those samples. The highest contamination results were observed in the water samples from springs and wells (76% and 79% contamination respectively). The number of fecal coliforms was decreasing with every week of the season while the number of total coliforms was increasing. Moreover, some samples were collected from Akaki, Gefersa, and Lege Dadi water plants but the parasitological results for them were negative. Wolde et al (2020) also note that the quality of the water might depend on the condition of the water supply reservoirs. For example, most reservoirs in Addis Ababa are well maintained. However, most springs are often exposed to heavy rain, flood, and microorganism contamination. It is important to check the serviceability of the public and private taps in a timely manner and to prevent them from being tied with cloths, ropes, and plastic tubes as it can enhance the contamination. This statement can also be proved by another study conducted by the Central Statistical Agency of Ethiopia in 2017. It was found that nearly 95% of households that receive low-risk water, get it from improved high-quality sources. The most common source of clean drinking water was the piped water on premises while the most dangerous was unprotected springs and surface water (CSAE 2017).

Some key lessons to remember are that the highest quality water is usually consumed in urban areas rather than rural and this water comes from secured and improved sources such as public pipes or kiosks. Bottled water is also a good source of high-quality water but is not consumed by many people. It is important to maintain the quality of the water reservoirs and make necessary repairments to ensure that people get good quality water. One of the biggest social issues regarding water supply is inequality because Addis Ababa poorest areas still do not have access to clean water.

Sources:

https://www.researchgate.net/publication/339804186_Quality_and_safety_of_municipal_drinking_water_in_Addis_Ababa_City_Ethiopia

https://washdata.org/report/drinking-water-quality-ethiopia-ess-2016

AGING GLOBALLY

Art in Tanzania

INTRODUCTION

The subject of old age and aging has been of great concern to the international community particularly in view of economic, political and social dimensions.

The United Nations Organization reports (1999) show that there has been an increase in the number of older people in the World. This increase has been demonstrated more in developing nations where the rates do not match with the available resources to cater for older people’s health, nutrition and other basic services essential for human life.  According to these reports, in 1950 the United Nations estimated an existence of 200 million people aged 60 years and above. In 1975 that number increased to 350 million people and is expected to reach 625 million people by 2005.  It is also expected that by the year 2050, the number of older people for the first time in human history, will have increased and surpassed the number of children under 14 years of age. In the African continent alone, that number is expected to increase from the present 38 million to 212 million.

The increase in the number and percentage of this population is a success in that it demonstrates an improved standard of living those results from better services such as health and education. This increase, however, is a challenge because the government is called upon to put in place the vital infrastructure for providing services to older people.

The majority of older people live in poverty and uncertainty. Furthermore, the fact that a large number of older people (about 75 percent) live in rural areas and that the number of older women is bigger than that of older men presents yet an additional challenge. In view of this there is a need for the government, its institutions and voluntary agencies to create an environment that recognizes older people and gives them an opportunity to participate fully in the daily life of the society.

The government realizes that older people are a resource in the development of our nation. The existence of Tanzania as a nation is an evidence of older peoples’ contribution in political, economic, cultural, and social arena.

CHAPTER ONE

1.1 CONCEPT AND MEANING OF OLD AGE

Old age and aging is a concept that defines the final stage of human growth from childhood, youth to old age. In Tanzania an individual is recognized as an older person based on age, responsibilities and his or her status, for example, a leader at his or her workplace or in a clan. The older people we have were either salaried or self-employed or those living in rural areas whose advanced age limits them from active work.

In developed countries such as Britain and United States of America (USA) old age is associated with retirement at 60 years. In other countries retiring age differs according to gender. In Latvia for example men retire at the age of 55 whereas women retire at the age of 60.

Despite the fact that government employees retire at the age of 60 and that older people in rural areas and those who are self-employed stop working only due to limited energy, it remains that at the age of 60 years.  There are clear indications of decrease in their working ability. Both the National Health Policy and the Public Service Act recognize 60 years as retirement age. For the purpose of this policy, an older person is an individual who is 60 years and above.

1.2 THE SITUATION OF OLDER PEOPLE IN THE COUNTRY

The twentieth century has witnessed an increase in the number of older people. According to available statistics, Tanzania with an estimated total population of 33,500,000, has about 1.4 million older people (4 per cent of the total population) aged 60 years and above. This figure will increase to 8.3 million (10 per cent of the total population) by the year 2050.

In everyday social life, older people are an acknowledged source of information, knowledge and experience. In traditional life both older and young people shared responsibilities. Whereas older people were custodians of customs and traditions, advisers/mediators and childcare, the young people had the responsibility of providing basic needs including food, shelter, clothing and protection. Older people in Tanzania are of various groups that include retirees, peasants, herdsmen and fishermen.

Generally, the situation of older people in Tanzania is characterized by the following:

1.2.1 Weakening of traditional life:

Globalization, growth of towns and the movement of people from rural to urban areas in search of jobs have changed the formal relationship in the family and society in general. As a result of weakened traditional life, older people are no longer playing a vital role in the life of the community. Consequently, the young people do not show respect to older people and often times despise them.

1.2.2 Inadequate care:

The movement of young people from rural to urban centers have left the majority of older people lonely and unprotected. Moreover HIV/AIDS pandemic has taken away lives of the majority of young people. On the other hand, older people are increasingly called upon to care for themselves and their orphaned grandchildren.

1.2.3 Poverty:

Economically, older people are among the poorest in the society. Various groups of older people such as peasants, herdsmen and fishermen do not belong to any formal social security system. Retired older people who are members of the Social Security Schemes face problems resulting from inadequate benefits and bureaucratic bottlenecks.

Furthermore, the existing poverty reduction strategies do not include older people.

1.2.4 Diseases:

The majority of people become old with poor health due to poor lifestyles and poor nutrition during their childhood, women with heavy workload and frequent pregnancies. Prolonged diseases are a common feature among many older people. Additionally, health services are not easily accessible to the majority of older people besides they are expensive. Health care professionals on the other hand lack motivation and are not adequately trained to handle older peoples’ illness.

1.2.5 Older Women and incompatible traditions.

Older women are more affected by old age problems. Women live longer than men, that is why there are more older women than men. Older women struggle against problems related to their gender, furthermore they are denied the right to inherit and own property including land. In some areas women have been raped and killed due to superstitious beliefs.

1.2.6 Older women with disabilities:

Due to our culture and environment, women, people with disabilities, and older people have had an unequal opportunity to participate in decision making on issues related to their development and welfare.

Where women have been discriminated due to their sex, people with disabilities do not have access to equal opportunities to participate in securing their own development. Additionally, older people have not received the recognition they deserve, a situation which denies their right to own and inherit property.

1.2.7 Laws that do not protect older people:

The current social and legal systems do not provide adequate protection and security to older people as a special group. Consequently, they do not receive deserving care and older women are denied their right to own and inherit property.

1.3 Rationale for the Policy:

The life situation and circumstances of older people demand for a National Policy to guide the provision of services and their participation in the life of the community. The National Ageing Policy addresses the following:

  • To recognize older people as an important resource in national development.
  • To allocate enough resources with a goal of improving service delivery to older people.
  • To involve older people in decision making in matters that concern them and the nation at large.

CHAPTER TWO

2.0 POLICY DIRECTION.

2.1 Direction:

This policy concerns older people living in rural and urban areas as well as other special groups of older people such as retirees, peasants, herdsmen, and fishermen. It also concerns young people who need to prepare themselves for responsible old age.

2.2 General Objective:

The general objective of the policy is to ensure that older people are recognized, provided with basic services, and are accorded with the opportunity to fully participate in the daily life of the community.

2.3 Specific Objectives:

  • To recognize older people as a resource.
  • To create a conducive environment for the provision of basic services to older people.
  • To allocate resources for older people’s income generation activities and their welfare.
  • To empower families for sustained support to older people.
  • To initiate and sustain programs that provide older people with the opportunity to participate in economic development initiatives.
  • To prepare strategies and programs geared towards elimination of negative attitudes and age discrimination.
  • To enact laws that promote and protect the welfare of older people.

CHAPTER THREE

3.0 POLICY STATEMENTS.

The government realizes that older people are a resource in the development of our nation. The existence of Tanzania as a nation is an evidence of older people’s contribution in political, economic, cultural and social arena. Besides protection and care, services emphasis will be put on involving older people in national development and incorporating them in the national development plans.

The National Ageing Policy recognizes human rights as stipulated in the Tanzanian constitution of 1977 as amended in 1984 and 1995 respectively. Moreover, the policy has taken into consideration the United Nations Organization declaration No. 46 of 1991 on the following older people’s rights.

  • Independence
  • Participation
  • Care
  • Self – fulfillment
  • Dignity

The following Policy statements aim at providing an implementation framework which will facilitate improvement of older people’s life and set the aging agenda within the national development paradigm.

3.1 Health Services:

Frequent and prolonged diseases is a common feature among many older people. This condition calls for a professional care. Despite this, health services are not easily accessible for the majority of older people and in most cases are expensive. The existing procedure of providing free health services to older people has some shortcomings.

The majority of older people particularly in the rural areas are left out as a result of their inability to prove that they are 60 years and above and that they cannot afford to share the cost. In order to improve the health status of older people, the government, in collaboration with various stakeholders, will ensure that:

(i) The cost sharing policy shall be revised to adjust the criteria for determining 60 years as a standard age.

(ii) Health personnel receive special training to handle older people.

(iii) There is an established mechanism for making follow up on older people’s health.

(iv) There is an established mechanism for awareness creation for older people in HIV/AIDS pandemic and care of its victims.

(v) Older people and the public in general are sensitized/mobilized on old age health related problems.

3.2 Care of older people:

The ability of the oldest to manage themselves is either minimal or not existing. Due to this fact the society has the responsibility of providing them with care and support. However, the family will remain the basic institution of care and support for older people. Institutional care of older people will be the last resort.  Furthermore, the government does not expect to establish older people’s long term care institutions. In order to provide care for older people.

(i) Families and the society in general will be mobilized/sensitized to care and support older people.

(ii) Older people will be cared for in their respective community.

(iii) The government through Local Government and Voluntary Agencies, will continue to provide institutional care to older people and others who have no one to care for.

3.3. Participation of Older People:

Every citizen has an equal right to participate fully in issues that concern him/her and the society as a whole. The government realizes that older people are an important resource that needs to be taped for the development of the nation. In order to do so:

(i) A Mechanism will be put in place to ensure that older people participate in the planning and implementation of development programs at various levels.

(ii) Organizations and groups responsible for older people’s welfare will be dully recognized. The government shall also encourage the formation of such new organizations and groups.

3.4 Older People’s Fund:

The government recognizes older people’s potentiality in poverty reduction initiatives. However, the same has not been translated into reality. In order to develop its utilization, the government in collaboration with various stakeholders will establish a Revolving Loan Fund.

3.5 Income Generation:

Older people are among the poorest in the society. Besides being skilled, knowledgeable and experienced as farmers, fishermen and retired public servants, the majority of older people go into retirement ill-prepared. In order to rectify this situation:

(i) Older people, individually or in groups, will be sensitized and mobilized in establishing income generating activities.

(ii) Local Government Authorities and Voluntary Agencies will incorporate older people’s groups in income generating activities.

3.6 Social Security:

Older people face a number of problems that include lack of savings. The existing Social Security Scheme is designed to accommodate older people who were employed in the formal sector. However, the benefits they receive do not correspond to increasing living costs. Older people in the informal sector such as peasants, fishermen and herdsmen particularly in rural areas face a high degree of vulnerability. In order to rectify this situation:

(i). A mechanism will be established to ensure that social security institutions direct their services to the informal sector.

(ii). Local Government Authorities and Voluntary Agencies will sensitize older people in the informal sector to save through Ward Banks, Primary Cooperative Societies and Savings and Credit Cooperative Societies.

(iii). Families will be mobilized in order to participate in income raising activities.

MAASAI TRADITIONAL HERBAL MEDICINE

By Godwin Agustino Piniel -Art in Tanzania internship

Abstract

The content of this article works to further describe the Maasai ethnic group, their culture, customs, and traditions, specifically describing the traditional medicinal practices which the tribe usually use and apply to cure a number of diseases.

INTRODUCTION

Who are the Maasai’s? A common question coming from anyone who come across this paper. Well, Maasai is one of the famous known tribe which originated from South Sudan and spread into different parts of East Africa, tracing back from about 300 years ago in the region. It should be noted that Maasai falls under the group of the early tribes in Africa and worldwide in general since Africa is the cradle of human civilisation

The major activities the Maasai perform in their daily lifestyle is Pastoralism. Although it was highly disrupted by the German and British colonialism when they came to the region, they soon discovered the advantages of its nature and started to create Reserves, however that could never stop the Maasai to continue with pastoralism.

Since Cattle herding is still the main activity of the Maasai people and is central to their lifestyle, traditionally, the Maasai diet consists mainly of raw meat, raw blood, and milk. The leather is used to fashion Maasai shields. Wealth in the Maasai community is measured by the number of children and cattle you have. A man with many children and cattle is considered very rich compared to the others with money and other assets.

Till to date, a large percentage of the Maasai people have resisted government pressure to settle in permanent homes, distancing themselves from urban areas and continuing to practice a lifestyle that has remained unchanged for centuries.

Maasai Culture

The Maasai culture is predominantly patriarchal, with a council of elders overseeing the daily running of the village and administering matters on the basis of an oral body of law, Men owes general responsibility towards the village and family protection

Besides their colourful costumes, proud warrior society, and fascinating customs, the Maasai are also known for their jumping form of dance, which is traditionally carried out by warriors.

This dance is known as adumu or aigus. The Maasai warriors form a semicircle and take turns jumping at the centre, as high as possible, without letting their heels touch the ground. As each man jumps, the others sing a high-pitched song whose tone depends on the height of the jump.

Image showing Maasai young men attire, after circumcision.

Maasai Dressing Style

The colour of Maasai attire varies according to age and gender. After their circumcision, young men will wear black for several months while waiting for the permanent recovery, older men usually wear red wraparounds, whereas women usually opt for checked, striped, or patterned pieces of cloth.

The Maasai also stretch their earlobes using stone, wood, and bones. They usually wear beaded earrings on the stretched earlobe and smaller piercings on the top of the ear. Traditionally, both men and women stretched their earlobes, because long, stretched lobes were seen as a symbol of wisdom and respect. But now this custom is disappearing,

Maasai Women stretched their earlobe

Image showing Maasai bead works

The Maasai beadwork is especially famous for its intricacy, and it is through beadwork that Maasai women express their position in the society. Natural materials such as clay, shells, and ivory were used before trading with the Europeans began in the 19th century. They were then replaced by colourful glass beads, which allow for more detailed beadwork and colour patterns. Each of the colours used have a meaning: White symbolizes peace, blue is the colour of water, and red is the symbol of warriors and bravery.

Image showing Maasai bead works

A group of people partaking in Maasai traditional medicine in Loliondo

BACKGROUND OF THE MEDICINAL PRACTICES

After a long period of time Masai societies all over East Africa have been famous for their use of traditional medicine to cure various infections and diseases of different kinds including malaria, eye infections, Sore throat, Urinary Tract infections, kidney problems, backaches, and headaches. They cured these kinds of diseases by the aid of specified plants, using their roots, leaves or barks.

A few years back one of the Maasai elder (Ambilikile Mwasapile) in Tanzania around the Arusha Region in Loliondo division had captured the attention of many people after using traditional medicine which cured concrete diseases such as HIV/AIDS, Cancer, Blood pressure. The discovery of this drew in many people in different parts of the world who came to partake in this practice and received their healing.

Through this practice many people started to have trust in traditional medicine from the Maasai Ethnic group, thus helping to gain popularity all over the world below is an image Illustration showing the plant that this Maasai elder used as a medicine which cures several diseases. The purpose of this paper is to describe major traditional plants used by Maasai ethnic group in curing various diseases, also their scientific validity.

From the left is the Tanzanian Minister who visited Loliondo to partake Maasai medicine, and to the right is Maasai elder who gives out the description about the medical plant observed.

One of the major kinds of plants which have been used for curing various diseases is Africana Mill (Oleaceae). A O-europaea sub species, Africana plant leaves are used in folk medicine as a remedy for eye infections, relieving pain such as headaches and backaches, treat sore throat, urinary tract infections, and heal kidney problems. It is also used as a hypotensive, emollient, febrifuge, and styptic The leaves of the tree were reported to be potent for the treatment of malaria in 1854. Different kinds of scientific research have been done concerning the plant whereby the ground leaves were extracted using solvents of varying polarity (hexane, chloroform, dichloromethane (DCM), ethyl acetate, acetone, ethanol, methanol, butanol, and water).

Thin layer of chromatography (TLC) was used to analyse the chemical constituents of the extracts. The TLC plates were developed in three different solvent systems, namely, benzene/ethanol/ammonium solution (BEA), chloroform/ethyl acetate/formic acid (CEF) and ethyl acetate/methanol/water (EMW). The micro-dilution assay and bio autography method were used to evaluate the antibacterial activity of the extracts against Escherichia coliPseudomonas aeruginosaEnterococcus faecalis and Staphylococcus aureus and the antifungal activity against Candida albicans and Cryptococcus neoformans.

The outcome of the Research was, Methanol was the best extractant, yielding a larger amount of plant material whereas hexane yielded the least amount. In phytochemical analyses, more compounds were observed in BEA, followed by EMW and CEF. Qualitative 2, 2- diphenylpacryl-1-hydrazyl (DPPH) assay displayed that all the extracts had antioxidant activity. Antioxidant compounds could not be separated using BEA solvent system while with CEF and EMW enabled antioxidant compounds separation. The minimum inhibitory concentrations (MIC) values against test bacteria ranged between 0.16 and 2.50 mg/mL whereas against fungi, MIC ranged from 0.16 to 0.63 mg/ml. Bioautography results demonstrated that more than one compound was responsible for antimicrobial activity.

Conclusions

The results indicate that leaf extracts of Oleaafricana contain compounds with antioxidant, antibacterial and antifungal activities. Therefore, further studies are required to isolate the active compounds and perform other tests such as cytotoxicity. Oleaafricana may be a potential source of antimicrobial compounds.

HIV AND AIDS IN TANZANIA

By Gwamaka Mwakyusa – Art in Tanzania internship

2018, 1.6 million people were living with HIV in Tanzania. This equates to an estimated HIV prevalence among adults of 4.6%. In the same year, 72,000 people were newly infected with HIV, and 24,000 people died from an AIDS-related illness.

Despite the numbers, Tanzania has done well to control the HIV epidemic over the last decade. Scaling up access to antiretroviral treatment (ART) has meant that between 2010 and 2018, the number of new infections declined by 13% and the number of people dying from an AIDS-related illness has halved.

Key affected populations in Tanzania

Tanzania’s HIV epidemic is generalized, meaning it affects all sections of society, but there are also concentrated epidemics among certain population groups, such as people who inject drugs, men who have sex with men, mobile populations, and sex workers. Heterosexual sex accounts for the vast majority (80%) of HIV infections in the country and women are particularly affected.

The severity of the epidemic varies geographically. Some regions of Tanzania report no HIV prevalence (Kusini Unguja and Kaskazini Pemba) while other regions have prevalence as high as 11.4% (Njombe). Overall, the epidemic has remained steady due to ongoing new infections, population growth and increased access to treatment.

Bar graph showing HIV prevalence by age and sex in Tanzania

Women

Women are disproportionately affected by HIV in Tanzania. In 2018, 880,000 women aged 15 and over were living with HIV, compared to 580,000 adult men. In the same year, more than 36,000 women acquired HIV, compared to around 27,000 men.

The nationally representative 2016-2017 Tanzania Impact Survey (THIS) found that women aged 15-39 are more than twice as likely to be living with HIV as their male counterparts. HIV prevalence is highest among women aged 45-49, at 12% (compared with 8.4% among men of this age

Gender inequality is widespread among women of all ages in Tanzania. In 2016, around 30% of women aged 15-49 who had ever been married or in a long-term relationship were estimated to have experienced physical or sexual violence from a male intimate partner in the past 12 months.9 This increases many women’s vulnerability to HIV, either directly, through sexual violence, or indirectly, through an inability to negotiate condoms or prevent their partner from having other sexual relationships.

In addition, women tend to become infected earlier because they have older partners and get married earlier.

Young people

It is estimated that more than half the population in Tanzania are aged 19 and under.11

THIS reported HIV prevalence among young people (ages 15-24) at 1%, with young women around four times more likely than young men to be living with HIV (2% prevalence among young women, compared to 0.6% prevalence among young men). Prevalence among children (ages 0-14) is 0.3%.

In 2018, just under 24,000 young people in Tanzania became HIV-positive; roughly two-thirds of whom were young women (16,000 new infections among young women, compared to 7,600 among young men).13 In 2016/17, 3.4% of women aged 20-24 were living with HIV, compared to 0.9% of their male counterparts.

The disparity between the sexes is linked to age-related vulnerabilities experienced by young women that intersect with widespread gender inequality. For instance, Tanzania’s ‘sugar daddy’ culture, in which young women embark on sexual relationships with older men in exchange for material goods or social advancement, is a key driver of HIV among young women.

Even though their partners come from age groups with higher HIV prevalence than younger men, and may also engage in other sexual relationships, young women are often unable to negotiate condom use due to the unequal power balance in these relationships. This is demonstrated by a study involving 18 to 24 year-old women in Dar es Salaam, which found that in couples of the

Same age decisions about condom use were together (48%) or by young women alone (34%). Decision-making during sex with older men was predominantly made by the male partner (79%).

Many young people are also unaware about how to prevent transmission. In 2016/17, just 37% of young people demonstrated adequate knowledge on how to prevent HIV and could correctly reject common misconceptions about how the virus is transmitted.17 Young people, particularly young men, are also less likely than older age groups to test for HIV. As a result, in 2016/17 it was estimated that only half of young people living with HIV were aware of their status.

People who inject drugs (PWID)

Tanzania is home to a significant population of people who inject drugs (sometimes referred to as PWID). In 2014, Tanzania National AIDS Control Program (NACP) estimated there were 30,000 people who inject drugs in the country, 35% of whom were living with HIV.

HIV prevalence among women who inject drugs is thought to be twice that of their male peers. The reasons for this are not fully known although possible factors include women who inject drugs being involved in sex work or being last in line when syringes are shared.

Data on people who inject drugs varies widely between studies, due to the hidden nature of this population. Existing evidence suggests heroin use is on the rise and this population group is growing.

Most studies involving people who inject drugs in Tanzania have been conducted in Dar es Salaam and Zanzibar. Zanzibar is a gateway to the African continent and is also situated along a major corridor for drug trafficking. Around one in six people who live in Zanzibar and inject drugs is living with HIV, according to 2010 estimates, although some believe this figure be higher

A 2015 study of 480 people who use drugs in the northwestern city of Mwanza found that 13.5% of respondents injected drugs, 67% of whom shared needles. This study suggests that injecting drug use, particularly heroin, is now a significant issue in a major city outside Dar es Salaam and Zanzibar.

Mobile populations

Migration is common in Tanzania. In particular, the expansion of the mining sector has led to greater urbanization and mobility between rural and urban areas. This means that young and sexually active men come into close contact with ‘high risk sexual networks’ made up of sex workers, women at truck stops and miners: all of whom have high levels of HIV prevalence.

Long-distance truck drivers, agricultural plantation workers and fishermen working along coastal trading towns are also at an increased risk of HIV. For example, a 2015 study by the International Organization for Migration on truck drivers in Dar es Salaam found all those surveyed had established sexual relationships with partners at truck stops whom they considered permanent or second wives (described as ‘Mapoza’). A 2018 study involving around 400 people from fishing communities in Tanzania found an overall HIV prevalence of 14%, although this varied widely depending on location, from 7.2% to 23.8%. Around 38% of study participants living with HIV who had been diagnosed had not started treatment.

It is not only mobile men who are at increased risk of HIV infection. Women who travel away from home five or more times in a year have been found to be twice as likely to be infected with HIV than women who do not travel.

Sex workers

Tanzania criminalizes sex work, and it is punishable by law. Despite this, it is estimated that around 150,000 people, mainly women, sell sex, especially in Dar-es-Salaam.

In 2018, HIV prevalence among female sex workers was estimated at 15.4%. However, as with many other key population groups, data is limited and previous estimates suggest HIV prevalence among this group is much higher, at around 31%. Around 70% of sex workers are estimated to use condoms. This is despite sex workers having poor access to HIV prevention

programs, which are thought to reach around one in five.

The gender inequalities that result in women being disproportionately affected by HIV in Tanzania are acutely felt by female sex workers. The fact that sex work is also illegal means sex workers are subject to abuse and human rights violations from clients and from those in authority, including police officers and healthcare workers.

This means many sex workers are reluctant to access HIV prevention, testing and treatment services while also being exposed to high levels of sexual violence, multiple partners and condom less sex.

Men who have sex with men (MSM)

Same-sex sexual relations are illegal in Tanzania. As a result, data on this population group is extremely limited, a situation made worse by a government-sanctioned crackdown on LGBT people that began in 2015.

In 2018, 8.4% of men who have sex with men (sometimes referred to as MSM) in Tanzania were estimated to be living with HIV.36 However previous estimates released in 2014 put prevalence much higher, at 25%. This data suggested there were 49,700 men who have sex with men in the country.

In 2014, only around 14% of men who have sex with men reported using condoms consistently. However, data from 2013 put condom use levels at 63%, highlighting how patchy the evidence currently is.

HIV testing and counselling (HTC) in Tanzania

Results from THIS suggests around 65% of adults in Tanzania have taken an HIV test at least once (59% of men and 71% of women) but only a third regularly test for HIV (every 12 months). Around 16% of adults who tested positive during THIS had never been tested for HIV before (20% of men and 14% of women).

Adolescents (ages 15-19) have particularly low testing levels, despite high levels of sexual activity. THIS found that around 79% of adolescent men and 61% of adolescent women had never tested for HIV before.

Over the last decade, Tanzania has increased its efforts to get more people testing for HIV. The number of voluntary counselling and testing (VCT) sites in the country has rapidly expanded (around 2,100 as of  2013).

In the same year Tanzania introduced new HIV testing approaches such as home-based testing, community testing and provider-initiated testing.

Since other testing approaches, such as index testing, have also been introduced. As a result of these accelerated efforts, in 2018 the number of people living with HIV who were aware of their status was 78%, compared with 64% in 2015.

In 2018 the Tanzanian government began to fully scale-up self-testing for HIV and is focusing on providing self-testing kits for hard-to-reach groups. For example, using antennal clinics to provide pregnant women with self-testing kits to pass onto their husbands or boyfriends. Pilot programs are also being carried out to learn how best to provide self-testing kits to the partners of sex workers and other key and vulnerable populations.

The Tanzanian government has also begun a campaign called Furaha Yangu! (My Happiness!) to increase the number of young men and adolescent boys testing for HIV.

HIV prevention programs in Tanzania

In 2018, 72,000 people became HIV-positive in Tanzania. Although new infections have declined by 13% since 2010, more needs to be done to reduce HIV transmission.

Tanzania is currently implementing its fourth Health Sector HIV and AIDS Strategic Plan (HSHSP IV), which runs between 2017 and 2022. The strategy aims to increase access to combination prevention services for the general population in order to reduce new HIV infections. The guidelines also commit to implementing comprehensive prevention services for a number of key populations, including adolescent girls and young women, female sex workers, men who have sex with men, people who inject drugs, prisoners and migrant populations.

Significant progress that has been made in the prevention of mother-to-child transmission (PMTCT) in the past few years in Tanzania. In 2018, 93% of pregnant women living with HIV were receiving effective ART, compared to 75% in 2010. It is estimated that ART coverage among pregnant women living with HIV has averted around 14,000 new infections among newborns. However, 8,600 children still acquired HIV in 2018.

One of the reasons for HIV transmission still occurring vertically (from parent to child) is that  not all pregnant women are tested for HIV. In 2018, 91% of pregnant women attending antenatal services received HIV testing. In addition, only half (47%) of infants exposed to HIV during pregnancy were tested for HIV within eight weeks of birth (known as ‘early infant diagnosis’).

To reach as many women as possible, the vast majority of PMTCT services are now integrated with reproductive and child health services.

Inefficient antiretroviral drug regimens for pregnant women and new mothers, drug stock-outs and poor adherence to treatment also contribute to the continuing transmission of HIV via this route.

Condom promotion

The Tanzanian government recognizes condom promotion as an integral part of its fight against the epidemic. The goal of its 2017-2022 HIV prevention strategy is to ensure 85% of people engaged in multiple sexual partnerships use condoms correctly and consistently.

To achieve this, around 260 million free condoms must be made available annually. However, weak supply lines and a lack of funding means this may not be achievable. In 2018, it was reported that the Global Fund to Fight AIDS, Tuberculosis and Malaria would finance 120 million public sector condoms, PSI would contribute around 18 million and an additional 20 million would be provided by other sources. This leaves an impending shortfall of around 100 million condoms.

In addition, more effective promotion is needed to encourage people to use condoms. In 2017, it was reported that just 30% of women and 46% of men used a condom the last time they had a sex with a non-marital, non-cohabiting partner. These levels are lower than previously reported, suggesting more people are engaging in risky sexual behavior that leaves them vulnerable to HIV infection

Low condom use is also occurring among high-risk groups. For instance, a study involving 18 to 24 year-old women in Dar-es-salaam found that only 32% used a condom during sex with regular boyfriends. Condom use declined even further if the women were involved in transactional sexual relationships with older men, with only 2% saying they always used a condom during these types of sexual encounters.

HIV awareness and sex education

While Tanzania has a broad sex education curriculum, only a third of schoolteachers have been trained on how to deliver these lessons, meaning access is patchy. In addition, certain subjects, such as the examination of minority sexualities, are not covered. Condom demonstration and condom distribution is also not allowed during sex education lessons. On top of this, the number of people attending school beyond primary level is low, with only around 19% of people having some form of secondary education. This limits the opportunities to reach older adolescents with sexual health education.

To fill these gaps, a number of civil society organizations provide additional sexual and reproductive health and HIV education, in and out of school settings.

Voluntary medical male circumcision (VMMC)

Circumcision is an effective HIV prevention strategy, reducing a man’s risk of acquiring HIV by approximately 60%. When used in combination with other prevention measures, circumcision is an important addition to HIV-prevention options for men.

In 2010 the government prioritized 11 regions for scaling VMMC and set a target of 2.8 million circumcisions by 2016.60 Around 2.6 million men were circumcised between 2015 and 2018, equating to around 80% of 15 to 49-year-old men.

CASE STUDY: Creating demand for VMMC

When a VMMC project was first established in the Kaliua District, Tabora, many men were put off by rumors that the removed foreskins would be used for conducting rituals. To dispel these rumors and create demand for the service, peer educators from the project hold meeting with community leaders to answer specific questions and address any concerns about the safety of VMMC and the disposal of foreskins.

Targeting influential people within the community paid off. The number of people presenting for voluntary circumcision, which had previously been visited predominantly by boys from a nearby primary school, subsequently increased to an average of between 20-28 adult men each day.

The local outreach site and dispensary conducted more than 1,000 VMMCs in 2015.

Cash transfer programs

Cash transfer programs form part of a new arm of HIV prevention that focuses on integrated programs for social protection schemes and sexual health. Across sub-Saharan Africa these types of programs have been shown to have a positive effect on preventing HIV and other sexually transmitted infections (STIs).

In one Tanzanian pilot, cash incentives of US$10 or US$20 were given to young adults aged between 18 and 30, as long as they were free from STIs. One year into the study, there was a 25% risk reduction in STIs. These programs show that economic benefit can positively influence people to use condoms more frequently.

In 2017 the Tanzanian government, in collaboration with UNICEF, began a cash transfer scheme called Cash Plus as part of a program to empower and strengthen the resilience and wellbeing of adolescents from the country’s poorest households. Cash Plus participants receive tailored, life skills training on various subjects, including sexual and reproductive health, as well as being linked to sexual and reproductive health and HIV services. They also receive financial support to either stay in school or start a small business and are supported by mentors and peer educators throughout.

Harm reduction

In 2011, with assistance from PEPFAR, Tanzania became the first country in sub-Saharan Africa to implement a harm reduction program for people who inject drugs. A methadone treatment clinic opened up in Tanzania’s largest health facility, based in Dar es Salaam, then extended to a second hospital in the city.  Although there has since been an increase in opioid substitution therapy (OST) interventions outside Dar es Salaam, access remains limited, with just 20% of people who inject drugs able to access OST in 2018.

This is also the case with needle and syringe exchanges. In 2017, just 15 needles and syringes were distributed per person per year. As a result, it is estimated that around 14% of Tanzanian-based people who inject drugs are sharing needles when injecting.

Harm Reduction International also reports that the Tanzanian government has taken “regressive steps” in its harm reduction-related policy in recent years, with policy-makers continuing to favor abstinence-based approaches above harm reduction.

Pre exposure prophylaxis (PrEP)

In 2018 Tanzania began to scale up pre-exposure prophylaxis (PrEP), a daily course of antiretroviral drugs taken by HIV-negative people to protect themselves from infection, for key populations. The following year, the government announced plans to extend this nationwide, including expanding eligibility criteria to include adolescent girls and young women.

As of 2019, it was estimated that between 3,200 and 3,700 people were using PrEP in Tanzania. Most of these people are adolescent girls and young women, although female sex workers and their partners and the HIV-negative partners of people living with HIV are also being targeted by implementation or demonstration projects.

Antiretroviral treatment (ART) in Tanzania

Tanzania has significantly scaled up its antiretroviral (ART) programs in recent years, and the number of people on ART has been steadily increasing since 2010.

In 2017, Tanzania introduced the World Health Organization (WHO) recommended ‘test and treat’ guidelines, which makes anyone testing positive for HIV eligible for immediate treatment regardless of the level of HIV in their body. This has seen ART coverage expand significantly: in 2018, 71% of people living with HIV in Tanzania were receiving ART, equivalent to 1.1 million people.

This is around a 20% increase from 2015, when 52% of HIV-positive people were on ART. As of 2018, around 90% of people diagnosed with HIV began ART in less than seven days.

HIV-positive women are far more likely to be on treatment than HIV-positive men. In 2018, 82% of women and 57% of men living with HIV were receiving ART.

Children (ages 0-14) are less able to access treatment than adults, with 65% of HIV-positive children on ART in 2018. However, this is an improvement on 2015 levels when just 53% of HIV- positive children were on treatment.

More than 95% of people on treatment are still in care after 12 months, according to 2018 data. This is closely linked to good levels of viral suppression. In 2018, 87% of people diagnosed and on treatment were virally suppressed, with men and women enjoying similar levels of viral suppression (86% and 89% respectively). However, due to gaps in testing and linkage to care, overall, only 62% of people living with HIV are virally suppressed.

Studies conducted in various regions of Tanzania have reported low linkage to care for people who test HIV-positive. For example, a study following around 1,000 people newly diagnosed with HIV in Mbeya, a rural area, found just 28% were successfully linked to care. Under-resourced, poorly coordinated health services, as well as high levels of HIV-related stigma were the main reasons these people did not begin treatment.

The Tanzanian government has begun to simplify drug regimens and move to fixed-dose combinations while phasing out toxic drugs such as Stavudine. Evidence is currently mixed as to whether levels of pre-treatment and acquired drug-resistant HIV are high enough to be considered a public health issue in Tanzania.

Civil society’s role

Poverty, poor institutional and infrastructural support, and social and cultural neglect are impeding an effective and progressive HIV response in Tanzania. In 2017, Civicus, the global alliance of civil society organizations and activists dedicated to strengthening citizen action and civil society, placed the country on a watch list due to growing threats to civic space. In February of the same year, the government closed 40 healthcare facilities providing HIV services under the premise that they were promoting homosexuality. In June 2017, President Magufuli severely criticized NGOs working for the rights of LGBTI people.

In 2018, Tanzania’s sustained anti-gay crackdown was part of a broader trend of suppression and a disappearing civil society voice. The repercussions have been felt through all key population groups, affecting access to HIV and sexual health services, and increasing stigma and discrimination.86 It has also resulted in hundreds of LGBT activists going into hiding in order to avoid punishment.

They are raiding houses. It is a horrible thing. It is just going to get worse. So many people are leaving the city, running away. They are targeting the activists, saying we are promoting homosexuality.

The WHO classifies Tanzania within the top 20 high burden countries for tuberculosis (TB) and for TB/HIV.

In 2017, just under 70,000 cases of TB were presented and 98% had a known HIV status. Of this group, 31% were co-infected with HIV, of whom 95% were on antiretroviral treatment. In the same year, 22,000 people living with HIV died due to TB. The death rate has halved since 2010 when there were 44,000 TB-related deaths among HIV-positive people in Tanzania.

The government has prioritized the integration of TB services with HIV services to minimize the burden of these two co-morbidities. Ensuring that people living with HIV are on antiretroviral treatment means that they are in a better place to fight off TB infection. Integrating these two services will also ensure greater access to TB treatment.

The Tanzanian government has done well to keep the country on track to reaching all of the TB targets set within the Millennium Development Goal (MDG) frameworks.

The number of people living with HIV who presented with TB and received treatment for HIV and TB increased from 16% in 2012 to 42% in 2017.92 However, this still leaves a large portion of people with HIV/TB co-infected without comprehensive treatment.