Citizens, dependents, sons of the soil

The impact of biomedicine and biomedical technologies on identity and sociality has long been the focus of medical anthropology. In this article we revisit these debates in a discussion of how unprecedented encounters with biomedicine during the West African Ebola outbreak have featured in Sierra Leoneans’ understandings of citizenship and belonging, using the case study of an Ebola vaccine trial taking place in Kambia District (EBOVAC Salone). Analysing our ethnographic material in conversation with a historical analysis of notions of belonging and citizenship, we show how participation in a vaccine trial in a moment of crisis allowed people to tell stories about themselves as political subjects and to situate themselves in a conversation about the nature of citizenship that both pre-dates and post-dates the epidemic

Local narratives of sexual and other violence against children and young people in Zanzibar.

Understandings of violence, and especially sexual violence against children, must be situated within the local context. The 2009 Violence against Children Survey in Zanzibar indicated that 6% of girls and 9% of boys reported having experienced sexual violence before the age of 18 years. This paper reports on an in-depth qualitative study conducted in Zanzibar to provide further insights to these findings by examining the circumstances for sexual and other violence against children in Zanzibar. Twenty-four in-depth interviews with young people and 18 focus-group discussions with young people and adults were conducted in rural and urban Zanzibar. A further 8 interviews were conducted with parents and key stakeholders in government and NGO offices that provide services for children. The findings revealed that religious and cultural practices, which form the foundation of Swahili culture in Zanzibar, provide a moral frame for childhood development, but structural factors make children vulnerable to sexual violence. Both boys and girls are vulnerable to sexual violence in the home, neighbourhood, at school and, in particular, at madrasa or Qur'anic schools. As religion and culture are strong influences on childhood, preventing sexual violence at madrasa schools would strengthen the positive aspects of religious teachings for ensuring a safe childhood

Women's sexual subjectivity in a Tanzania city in the era of neoliberalism and AIDS

This paper draws on anthropological research exploring women's changing sexuality within an urban context of Tanzania. The women involved were participating in an HIV prevention trial and worked in bars, restaurants, hotels and nightclubs, or sold local beer or food in Mwanza city. In ethnographic fieldwork and interviews and group discussions with women, narratives about sexuality focused on gendered and moral discourses of sexuality, the commodification of sexuality, and emotions and intimacy in relationships. This paper discusses how women's sexual subjectivies are shaped by a city where social, structural and economic changes over an era of neoliberalism and AIDS has created both disciplinary and liberalising spaces in which gendered and moral discourses of sexuality have emerged

Comparative ethnographies of medical research: materiality, social relations, citizenship and hope in Tanzania and Sierra Leone.

In this paper we bring together ethnographic research carried out during two clinical prevention trials to explore identities, relations and political imaginations that were brought to life by these different technologies. We highlight the ways in which critical anthropological engagement in clinical trials can help us radically reconsider the parameters and standards of medical research. In the paper we analyse the very different circumstances that made these two trials possible, highlighting the different temporalities and politics of HIV and Ebola as epidemics. We then describe four themes revealed by ethnographic research with participants and their communities but mediated by the specific sociopolitical contexts in which the trials were taking place. In both countries we found materiality and notions of exchange to be important to participants' understanding of the value of medical research and their role within it. These dynamics were governed through social relations and moral economies that also underpinned challenges to Western notions of research ethics. The clinical trials offered a language to express both disaffection and disillusionment with the political status quo (often through rumours and anxieties) while at the same time setting the foundations for alternative visions of citizenship. Attached to these were expressions of 'uncertainty and hope' steeped in locally distinctive notions of destiny and expectations of the future

Key Considerations: Cross-Border Dynamics Between Uganda and Tanzania in the Context of the Outbreak of Ebola, 2022

This brief summarises key considerations concerning cross-border dynamics between Tanzania and Uganda in the context of the outbreak of Ebola (Sudan Virus Disease, SVD) in Uganda. It is part of a series focusing on at-risk border areas between Uganda and four high priority neighbouring countries: Rwanda; Tanzania; Kenya and South Sudan. The current outbreak is of the Sudan strain of Ebola (SVD). SVD is used in this paper to refer to the current outbreak in East Africa, whereas outbreaks of Zaire Ebolavirus disease or general references to Ebola are referred to as EVD. The current outbreak began in Mubende, Uganda, on 19 September 2022, approximately 240km from the Uganda-Tanzania border. It has since spread to nine Ugandan districts, including two in the Kampala metropolitan area. Kampala is a transport hub, with a population over 3.6 million. While the global risk from SVD remains low according to the World Health Organization, its presence in the Ugandan capital has significantly heightened the risk to regional neighbours. At the time of writing, there had been no cases of Ebola imported from Uganda into Tanzania. This brief provides details about cross-border relations, the political and economic dynamics likely to influence these, and specific areas and actors most at risk. It is based on a rapid review of existing published and grey literature, previous ethnographic research in Tanzania, and informal discussions with colleagues from the Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Tanzania National Institute for Medical Research (NIMR), Uganda Red Cross Society, Tanzania Red Cross Society (TRCS), International Organization for Migration (IOM), IFRC, US CDC and CDC Tanzania. The brief was developed by Shelley Lees and Mark Marchant (London School of Hygiene & Tropical Medicine) with support from Olivia Tulloch (Anthrologica) and Hugh Lamarque (University of Edinburgh). Additional review and inputs were provided by The Tanzania Red Cross and UNICEF. The brief is the responsibility of the Social Science in Humanitarian Action Platform (SSHAP).Wellcome TrustForeign, Commonwealth & Development Office (FCDO

Key social science priorities for long-term COVID-19 response

Non peer reviewe

'It is just the way it was in the past before I went to test': a qualitative study to explore responses to HIV prevention counselling in rural Tanzania.

BACKGROUND: Voluntary counselling and testing (VCT) for HIV first evolved in Western settings, with one aim being to promote behaviours which lower the risk of onward transmission or acquisition of HIV. However, although quantitative studies have shown that the impact of VCT on sexual behaviour change has been limited in African settings, there is a lack of qualitative research exploring perceptions of HIV prevention counselling messages, particularly among clients testing HIV-negative. We conducted a qualitative study to explore healthcare worker, community and both HIV-negative and HIV-positive clients' perceptions of HIV prevention counselling messages in rural Tanzania. METHODS: This study was carried out within the context of an ongoing community HIV cohort study in Kisesa, northwest Tanzania. Nine group sessions incorporating participatory learning and action (PLA) activities were conducted in order to gain general community perspectives of HIV testing and counselling (HTC) services. Thirty in-depth interviews (IDIs) with HIV-negative and HIV-positive service users explored individual perceptions of HIV prevention counselling messages, while five IDIs were carried out with nurses or counsellors offering HTC in order to explore provider perspectives. RESULTS: Two key themes revolving around socio-cultural and contextual factors emerged in understanding responses to HIV prevention counselling messages. The first included constraints to client-counsellor interactions, which were impeded as a result of difficulties discussing private sexual behaviours during counselling sessions, a hierarchical relationship between healthcare providers and clients, insufficient levels of training and support for counsellors, and client concerns about confidentiality. The second theme related to imbalanced gender-power dynamics, which constrained the extent to which women felt able to control their HIV-related risk. CONCLUSION: Within the broader social context of a rural African setting, HIV prevention counselling based on a Western model of individual-level agency seems unlikely to make a significant contribution to sexual behaviour change until there is greater recognition by counsellors of the ways in which power dynamics within many relationships influence behaviour change. More culturally relevant counselling strategies and messages and infrastructural improvements such as additional training for counsellors and counselling rooms which ensure privacy and confidentiality, may lead to better outcomes in terms of sexual risk reduction

The impact of a human papillomavirus (HPV) vaccination campaign on routine primary health service provision and health workers in Tanzania: a controlled before and after study.

BACKGROUND: The burden of cervical cancer and shortage of screening services in Tanzania confers an urgent need for human papillomavirus (HPV) vaccination. However, the sustainability and impact of another new vaccine campaign in an under-resourced health system requires consideration. We aimed to determine the impact of the government's school-based HPV vaccine campaign in Kilimanjaro region on the provision of routine primary health services and staff workload. METHODS: Data on daily numbers of consultations were collected from health facility register books in 63 dispensaries and health centres in North-West Tanzania for 20 weeks in 2014. Changes in outpatient, antenatal care (ANC), family planning (FP) and immunisation service activity levels before, during and after the two HPV vaccination campaigns in 2014 in 30 facilities within Kilimanjaro region ('intervention facilities') were compared with changes in activity levels in 33 facilities in Arusha region ('controls'). Qualitative interviews were conducted with health workers in Kilimanjaro region who delivered HPV vaccination and those who remained at the facility during in-school HPV vaccine delivery to explore perceptions of workload and capacity. RESULTS: Health facility activity levels were low and very variable in both regions. Controlling for district, facility type, catchment population, clinical staff per 1000 catchment population and the timing of other campaigns, no evidence of a decrease in consultations at the health facility during HPV vaccination week was found across outpatient, ANC, routine immunisation and FP services. However, compared to the average week before and after the campaign, health workers reported longer working hours and patient waiting times, feeling over-stretched and performing duties outside their normal roles whilst colleagues were absent from the facility conducting the HPV vaccine campaign. CONCLUSION: Qualitative interviews with health workers revealed that staff absence from the health facility is common for a number of reasons, including vaccination campaigns. Health workers perceived that the absence of their colleagues increased the workload at the health facility. The numbers of consultations for each service on 'normal days' were low and highly variable and there was no clear detrimental effect of the HPV vaccination campaign on routine health service activity

Intimate Partner Relationships and Gender Norms in Mali: The Scope of Cash Transfers Targeted to Men to Reduce Intimate Partner Violence.

Mali has implemented the Filets Sociaux (Jigisémèjiri) program that aims to reduce poverty through cash transfers (CTs) to predominantly male heads of household with accompanying measures. This paper reports on a qualitative study of the effects of the program on intimate partner relationships. In-depth interviews were conducted with men and women in monogamous and polygamous households. Findings revealed that the positive aspects of intimate partner relationships were communication and shared values. However, discussions around decision-making revealed male authority with limited influence by women. Physical violence was reported to be caused by tensions and disputes. Whereas sexual violence was contested, some women described sexual force as violence but men and women asserted that compliance in sexual matters by women was expected. Men also asserted control through preventing women from working outside the home. The CTs were managed by the husband, with some involvement of wives in decision-making about the use of CTs. CTs were reported to reduce household poverty and improve wellbeing, especially for men. There were reports of the effects of the program on IPV, especially in the reduction of physical violence, its effects on sexual violence and controlling behaviour were reported to be limited. Since women are not the primary recipients of the CT, there limited effect on women's agency to challenge male authority and control around sexual and financial matters. CTs may be more effective if targeted to women, alongside skill and knowledge strengthening to utilize cash transfers to assert their rights to equality and prevent violence