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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 III. The Tanzania AIDS Project: An Overview (See Below) V. Supporting Interventions and Creating an Enabling Environment VII. Important Lessons Learned From TAP's Experience VIII. Subproject Highlights A. NGO Cluster Projects III. The Tanzania AIDS Project: An Overview AIDSCAP's strategic approach to HIV/AIDS prevention and control hinges on reducing one or all of three key variables in sexual transmission of HIV and other STIs, including: (1) reducing the rate of exposure to STIs by lowering the rate of partner change; (2) reducing the efficiency of transmission; and (3) shortening the duration of infectivity. 1,2 AIDSCAP, therefore, supports interventions that aim to decrease sexual risk, focusing on sexual partner reduction and increased condom use, or that aim to increase effective treatment of curable STIs. While its ultimate goal is to lower the incidence of HIV in target populations, its more immediate objective is to strengthen the technical and management capacity of local partners to conduct STI/AIDS prevention and control interventions. This emphasis on enhancing local capacity reflects AIDSCAP's commitment to having a lasting impact in host countries. The AIDSCAP/Tanzania AIDS Project is consistent with the strategic logic and capacity building principle outlined above. It builds on the experience of USAID's AIDSTECH and AIDSCAP projects, but reshaped the direction and scope of the activities to better respond to the expanding dimensions of the epidemic in Tanzania. The TAP phase of USAID's AIDS activities in Tanzania constitutes an important programmatic shift in three respects. First, instead of an earlier strategic emphasis on prevention interventions with "high risk" groups, such as sex workers and truck drivers, the TAP project's target populations are more broadly defined and explicitly inclusive of adults and youth generally. Second, in addition to prevention, TAP aims to reduce the growing health and social consequences of AIDS in Tanzania. Persons with HIV or AIDS, their families, and orphans from AIDS-related circumstances are also targeted to receive improved care and support. And third, to accommodate these expanded goals, TAP instituted an implementation structure that is conducive to achieving broad-based community mobilization. While the structure of supporting separate interventions with specific target audiences was phased out, a system of supporting regional NGO coalitions has been phased in. These regional NGO "clusters" were TAP's primary venue for entering and mobilizing Tanzanian communities. Worksite initiatives that were launched prior to TAP continue to receive support, although these are being absorbed into TAP's organizational structure of NGO clusters. TAP's programmatic and structural reformulation represents an attempt to weave STI/AIDS prevention and care interventions into the fabric of Tanzanian social life. Its specific aim is to enable institutions that are firmly grounded in Tanzanian communities to more effectively respond to the AIDS crisis. This implementation approach, as highlighted in the previous section, is in line with the National AIDS Control Programme's Medium Term Plan for 1992-1996, which strongly advocates engaging Tanzanian NGOs in the nation's effort to cope with the epidemic and its social impacts. While TAP's implementation structure is unique, the program is technically consistent with AIDSCAP's core prevention strategies of reducing the rate of sexual partner change, increasing effective treatment of curable STIs, and increasing access to and use of condoms. Also, although TAP's targeting strategy broadens the conventional emphases on "high risk transmitter groups," it is important to stress that, targeting remains an essential aspect of TAP's strategic foundation. Rather than eliminating targeted interventions, the NGO cluster framework provides an opportunity of interfacing with a greater diversity, and larger number of target population segments. In this way, TAP's strategy better reflects the epidemiologic contours of HIV and other STIs in Tanzania, where infection rates are extremely elevated in the general population as well as in "core" risk groups. In order for behavior change interventions to be successful, implementing NGOs must have sufficient technical and management capacity to effectively plan and conduct activities; they must also operate in a favorable environmental context. The key functions of TAP's central office are, accordingly, to strengthen the capacity of TAP partner organizations and to enhance the social and policy environment for implementing STI/AIDS programs. To this end, TAP's support units provide training and technical assistance to NGO partners, produce IEC materials and media programs, train clinicians in STI case management, and implement a national condom social marketing project. Most important, TAP provides continual guidance and assistance to the NGO cluster projects through regular and frequent consultative management visits, which emphasize full participation of cluster partners. The TAP program, in summary, can conceptually be represented as multi-tiered, with the uppermost tier representing TAP's key support functions described above, followed by the organization of nine regional NGO clusters, and then by participating NGOs, who constitute the entry point into Tanzanian communities at the district, ward and village levels. It should be emphasized that the different tiers of the TAP organization represent a hierarchy of project support for community level behavior change interventions. The unique strength of this project lies in its framework that promotes integrated community-based STI/AIDS interventions via coalitions of NGOs. Rather than a mosaic of separate projects implementing different components of a comprehensive intervention strategy, this framework provides a coherent reinforcing environment for TAP's NGO cluster projects. Moreover, by strengthening Tanzanians' ability to cope with the severe impacts of AIDS, the TAP project embraces the important notion that AIDS prevention and care are not distinct spheres, but instead are aspects on a continuum of programmatic opportunities and needs. In this sense, TAP represents a holistic out-look on and response to the AIDS epidemic. The remainder of this document describes the project in detail, beginning with an overview of the project's main components, followed by a summary of results from evaluation and other research, and finally, a review of the important lessons learned from TAP's experience to date. The second half of the paper provides summaries of each TAP-funded project. Endnotes
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