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This report comprehensively summarizes the FHI/AIDSCAP program in Tanzania (1991-1997). The report includes a background and country context for the program, as well as an overview of the Tanzania AIDS Project, and a discussion of work undertaken to mobilize communities and strengthen capacity; support interventions and create an enabling environment; and conduct research and evaluation. Lessons learned from the program are also listed.
Table of Contents II. Background and Country Context (See Below) III. The Tanzania AIDS Project: An Overview V. Supporting Interventions and Creating an Enabling Environment VII. Important Lessons Learned From TAP's Experience VIII. Subproject Highlights A. NGO Cluster Projects II. Background and Country Context A. Epidemiology of HIV/AIDS and Other STIs The AIDS epidemic in Tanzania spread widely and rapidly since the first cases were reported in 1983. By 1995, the National AIDS Control Programme (NACP) of Tanzania estimated that 1.2 million Tanzanians were infected with HIV, and close to 82,000 cases had been reported to the Ministry of Health. Indicative of the severity of the epidemic, in rural and urban sites throughout the country HIV prevalence in women seeking ante-natal care is extremely elevated, frequently over 10 percent and in one rural site, Mwambani in Mbeya Region, 32.5 percent. (Table 1 below summarizes prevalence of HIV and syphilis from samples of women seeking care at ante-natal clinics.) Population-based and blood donor studies confirm this data, and further indicate significant variation in prevalence by region and gender. According to the most recent available data, for instance, overall HIV prevalence in Mara Region is 8.8 percent in urban areas, 6.5 percent peri-urban areas, and 2.6 percent in rural areas. In Arusha, 10.7 percent of poor urban dwellers tested positive for HIV compared to 2.2 percent in semi-urban centers, and 1.6 percent in rural villages. In "high risk transmission areas," such as truck stop towns and other commercial centers along major transportation routes, prevalence rates of HIV and other STIs are substantially higher as the data shown in Table 2 below indicate. Table 1: HIV and syphilis prevalence in women seeking care at ante-natal clinics
Source: Ministry of Health of Tanzania Mainland. 1995. National AIDS Control Programme HIV/AIDS/STD Surveillance. Dar es Salaam, Tanzania: Epidemiology Unit, NACP. Table 2: Selected STI prevalence in women in high risk transmission area clinics
Source: Final report for the AMREF TAP-funded project STD Services for High Frequency Transmitters of HIV, 1996. The devastating impact of the AIDS epidemic on Tanzanian families and communities is difficult to represent in aggregate measures and projections. Its consequences are, nevertheless, strikingly apparent in other statistics, such as AIDS patient rates in urban hospitals (e.g., one-third of hospital beds in Dar es Salaam are estimated to be occupied by AIDS patients), the number of children in Tanzania orphaned from AIDS-related circumstances (estimated to exceed 750,000 by the year 2000), and the epidemic's effect on the nation's official economy (by one World Bank calculation, Tanzania's gross national product could be reduced by as much as 24 percent due to the high prevalence of AIDS in working age adults). While percentages and total numbers such as these inadequately depict the suffering and loss that AIDS engenders for individuals and families, they certainly illustrate the scope of this epidemic for country as a whole. B. Response to AIDS in Tanzania and the Role of AIDSCAP/TAP In response to what was clearly an emerging epidemic and with assistance from the WHO Global Programme on AIDS, the government of Tanzania instituted a short-term plan in 1985-1986 to examine the nature and dimensions of the epidemic in order to chart out a longer course of action. The National AIDS Control Programme of Tanzania was subsequently founded in 1987 and launched intervention and control activities in 1988. The NACP's first medium-term plan (MTP) for 1987 to 1991 included programs to reduce spread of HIV, blood screening, enhanced clinical services for HIV/AIDS patients, epidemiologic surveillance and other research, and eventually STI treatment, initially based on etiologic management. By 1989 regional and district AIDS committees had been formed, educational materials developed and laboratory services established. A review of the national program in preparation for the second medium-term plan for 1992-1996 revealed the need to further decentralize planning, decision making and activities in order to improve responsiveness and regional appropriateness of the program. The MTP II, therefore, strongly advocates a horizontal implementation structure to engage institutions both within and outside the Ministry of Health, including the full involvement of non-governmental organizations (NGOs). In support of the government of Tanzania's efforts to stem the spread of HIV and mitigate the social and health consequences of AIDS, USAID has provided technical and financial assistance for prevention and control projects in Tanzania since 1988, initially via AIDSTECH and AIDSCOM projects and beginning in 1991 through AIDSCAP. In 1993 USAID/Tanzania initiated the Tanzania AIDS Project, which, by emphasizing development and support of NGO activities, responds to the second medium-term plan's accent on decentralization and on horizontal, multisectorial program implementation. While TAP ends in 1998, AIDSCAP ends in 1997. This report covers the period of AIDSCAP activities through July 1997. |
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