Towards a Tanzania with no new HIV infections
Tanzania is making good progress in containing its HIV and AIDS epidemic. The national prevalence among the general population (15–49 age group) is estimated to have dropped from 7.1 percent in 2004 to 5.7 percent in 2008. Data from the 2010 Tanzania Demographic Health Survey (TDHS) suggests significant improvement in some key areas, which may reduce adolescent vulnerability to HIV and AIDS.
Over 50 percent of sexually active adolescent girls used a condom during their last sexual encounter – a 32 percent increase since 2004. The data indicates that condom use by sexually active adolescent boys also rose by more than 17 percent during the same period.
The TDHS 2010 data suggests that high-risk sex practices have decreased with the proportion of girls aged 15 to 19 years having sex with more than two partners falling from 5 percent in 2004 to 2 percent in 2010.
Nevertheless, although HIV prevalence has slightly decreased, many challenges still exist in Tanzania’s effort to achieve reduction in new HIV infections. It is estimated that about 100,000 Tanzanians between 15–49 years are newly infected with HIV each year.
On the Tanzania Mainland, approximately 80 percent of HIV infections arise from sexual contact between HIV-infected and uninfected individuals, with mother-to-child transmission accounting for 18 percent and 2 percent through others.
About 1.4 million people are currently living with HIV, and approximately 11 percent of them are children under 15. Among young people aged 15 to 24 years, the average HIV prevalence is 3.6 percent and is significantly higher among females than males. For example, the HIV prevalence among women aged 23 to 24 years is as high as 7 percent compared with 2 percent among males.
While almost all young people aged 15 to 24 years have heard about HIV and AIDS, relatively few know enough to protect themselves against infection.
According to 2010 data, among young people aged 15–24 years only 48 percent of girls and 43 percent of boys have comprehensive knowledge of HIV and AIDS. Comprehensive knowledge increases with education. Almost 60 percent of young people aged 15 to 24 years with secondary or higher education possesses comprehensive knowledge of HIV and AIDS, compared to only 21 percent of youth with no education.
Sexual violence and HIV risks
Childhood sexual violence has been associated with sexual risk taking behaviour in adolescence and adulthood. Sexual violence increases a victim’s risk of contracting sexually transmitted infections, including HIV.
It also undermines self-esteem and feeling of self-worth. According to results from the national survey on Violence Against Children in Tanzania, girls and boys who experienced childhood sexual violence (reported at about 28 percent and 13 percent respectively) are more likely to engage in sexual risk taking behaviour.
This may include engaging in unprotected sex, having multiple sexual partners and sex with casual partners, engaging in transactional sex, and in substance abuse. All of these behaviours are likely to increase the risk of HIV acquisition.
HIV and AIDS in Zanzibar
Prevalence of HIV and AIDS in Zanzibar has stabilised at less than 1 percent since 2002. Zanzibar’s HIV epidemic is concentrated in certain groups, including sex workers (prevalence of 10.1 percent), drug users (particularly injecting drug users at 16.1 percent) and men who have sex with men (12.3 percent).
Reaching these most at risk populations has been a challenge due to stigma and discrimination and social and cultural taboos associated with these groups. Young people are also regarded as being at heightened risk of contracting HIV not only due to risk behaviours related to early sexual debut, unprotected sex with multiple partners and experimentation with drugs but also due to low awareness of the risks of HIV transmission.
Early marriage, sexual abuse and gender inequality undermines negotiation and decision-making powers that increase the vulnerability of girls. Data on the number of children living with HIV and paediatric AIDS in Zanzibar is scarce and not easily available. This complicates the possibility of reaching all children requiring services.