'I trap her with a CD, then tomorrow find her with a big old man who bought her a smart phone'. Constructions of masculinities and transactional sex: a qualitative study from North-Western Tanzania.

Men's role in transactional sex is relatively unexplored, limiting initiatives to prevent exploitative transactional sex and its negative health implications for girls and women. We addressed this literature gap by conducting eight focus group discussions and twenty in-depth-interviews with boys and men aged 14?-?49?years in 2015 in Tanzania. We employed a novel combination of theoretical perspectives - gender and masculinities, and social norms - to understand how transactional sex participation contributes to perpetuating gendered hierarchies, and how reference groups influence men's behaviour. Findings signal two gender norms that men display within transactional sex: the expectation of men's provision in sexual relationships, and the expectation that men should exhibit heightened sexuality and sexual prowess. Adherence to these expectations in transactional sex relationships varied between older and younger men and created hierarchies among men and between men and women and girls. We found that approval of transactional sex was contested. Although young men were likely to object to transactional sex, they occupied a structurally weaker position than older men. Findings suggest that interventions should employ gender synchronised and gender transformative approaches and should prioritise the promotion of alternative positive norms over preventing the exchange of gifts or money in relationships

Facilitators and Barriers to Linkage to HIV Care and Treatment among Female Sex Workers in a Community-based HIV Prevention Intervention in Tanzania: a qualitative study

Abstract Background HIV-infected female sex workers (FSWs) have poor linkage to HIV care in sub-Sahara Africa. Methods We conducted 21 focus group discussions (FGDs) to explore factors influencing linkage to HIV care among FSWs tested for HIV through a comprehensive community-based HIV prevention project in Tanzania. Results Influences on linkage to care were present at the system, societal and individual levels. System-level factors included unfriendly service delivery environment, including lengthy pre-enrolment sessions, concerns about confidentiality, stigmatising attitudes of health providers. Societal-level factors included myths and misconceptions about ART and stigma. On the individual level, most notable was fear of not being able to continue to have a livelihood if one’s status were to be known. Facilitators were noted, including the availability of transport to services, friendly health care providers and peer-support referral and networks. Conclusion Findings of this study underscore the importance of peer-supported linkages to HIV care and the need for respectful, high-quality care

Prevalence and correlates of depression and anxiety symptoms among out-of-school adolescent girls and young women in Tanzania: A cross-sectional study

BackgroundIn sub-Saharan Africa, adolescent girls and young women (AGYW) who are out of school are at higher risk of depressive and anxiety disorders compared to their school attending peers. However, little is known about the prevalence and risk factors for these conditions among out-of-school AGYW. This study examines the prevalence of depression and anxiety and associated factors in a community sample of out-of-school AGYW in Tanzania.MethodsA cross-sectional analysis of baseline data from an on-going cluster randomized controlled trial in North-West Tanzania was conducted. A total of 3013 out-of-school AGYW aged 15 to 23 years from 30 clusters were included. Anxiety and depression were assessed using the Patient Health Questionnaire (PHQ-4), a tool comprising of PHQ-2 and Generalized Anxiety Disorders (GAD-2) screeners. Data were collected using Audio Computer-Assisted Self-Interview (ACASI). A random-effects logistic regression was fitted for binary outcomes and an ordinal logistic regression model with robust variance was used to adjust for clustering at the village level. Logistic regression and ordinal logistic regression were used to explore the associations between mental disorders symptoms and other factors.ResultsThe prevalence of depressive (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) symptoms among out-of-school AGYW were 36% (95% CI 33.8%-37.3%) and 31% (95% CI 29.0%-32.3%) respectively. Further, using the PHQ-4 tool, 33% (95% CI 30.8%-34.2%) had mild, 20% (95% CI 18.3%-21.1%) moderate and 6% (95% CI 5.5%-7.2%) had severe symptoms of anxiety and depression. After adjusting for other covariates, two factors most strongly associated with having anxiety symptoms were violence experience from sexual partners (AOR = 1.63, 95% CI: 1.36-1.96) and HIV positive status (AOR = 1.54, 95% CI: 1.03-2.31). Likewise, living alone, with younger siblings or others (AOR = 2.51, 95% CI: 1.47-4.29) and violence experience from sexual partners (AOR = 1.90, 95% CI: 1.59-2.27) were strongly associated with depression symptoms. Having savings (AOR = 0.81, 95% CI: 0.70-0.95) and emotional support (AOR = 0.82, 95% CI: 0.67-0.99) were protective against depression and anxiety, respectively.ConclusionDepressive and anxiety symptoms are prevalent among out-of-school AGYW in Tanzania. The findings emphasize the need to strengthen preventive interventions and scale-up mental health disorder screening, referral for diagnosis and management

Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

Quality appraisal tool. (DOCX 20 kb

Understanding the relationship between couple dynamics and engagement with HIV care services: insights from a qualitative study in Eastern and Southern Africa

The Bottlenecks Study was funded by the Bill and Melinda Gates Foundation (OPP1082114). This paper was also made possible with the support of The Wellcome Trust (085477/Z/08/Z). Research (undertaken in Kisesa and) reported in this publication was supported by the National Institute Of Allergy and Infectious Diseases (NIAID), Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute on Drug Abuse (NIDA), National Cancer Institute (NCI) and the National Institute of Mental Health (NIMH), in accordance with the regulatory requirements of the National Institutes of Health under Award Number U01AI069911East Africa IeDEA Consortium. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. AW is funded by a Population Health Scientist award, jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the European Union

"Eat and you will be eaten": a qualitative study exploring costs and benefits of age-disparate sexual relationships in Tanzania and Uganda: implications for girls' sexual and reproductive health interventions

BACKGROUND: Age-disparate sex is associated with increased HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, little has been done to understand the dynamics of such relationships from the perspectives of either AGYW or older men, and the communities in which these relationships are embedded. This article explores the motivations and perceived benefits of such relationships for AGYW and older men, plus the social and sexual and reproductive health (SRH) consequences. METHODS: This study held 37 participatory focus group discussions and 87 in-depth interviews with young people aged 14-24 and adult community members aged 25-49 in rural and urban Tanzania and Uganda. Participants were sampled using purposive and snowball techniques. Thematic analysis was conducted with the aid of NVIVO 10 software. RESULTS: Motivations, perceived benefits and costs for AGYW centred around four main themes: financial motivations, emotional support, meeting social expectations and reflections on sexual health. Specifically, AGYW noted that older partners gave gifts/money of higher value compared with younger men. Men's perceived benefits and costs revolved around the need to satisfy their sexual desire, the perception that AGYW were capable of engaging in new and creative sexual styles and their desire for prestige among male peers. Both AGYW and men recognised the social and SRH consequences as: risk of violence, social stigma, risk of unplanned pregnancy and risk of sexually transmitted infections including HIV. CONCLUSION: Interventions need to acknowledge the perceived benefits of age-disparate sexual relationships for AGYW and older men and engage them in critical reflection on the medium- to longer-term consequences versus the shorter-term satisfaction of needs, desires and aspirations, as a way to navigate the constrained opportunities they face given existing structural limitations. Interventions should also tackle the structural constraints AGYW face by helping them access resources, become empowered and challenge the expectation of having to depend financially on men. Interventions with men should unpack the assumption that men are naturally hypersexual. The role of peers for both girls and men should be acknowledged, and a shift from individual targeted interventions to changing norms at the community level should be considered

Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania: a narrative review

This review was supported by grants from the Netherlands Organization for International Co-operation in Higher Education and the Ifakara Health Institute, Tanzania

Community response to artemisinin-based combination therapy for childhood malaria: a case study from Dar es Salaam, Tanzania

Background. New malaria treatment guidelines in Tanzania have led to the large-scale deployment of artemether-lumefantrine (Coartem®), popularly known as ALu or dawa mseto. Very little is known about how people in malaria endemic areas interpret policy makers' decision to replace existing anti-malarials, such as sulphadoxine-pyrimethamine (SP) with "new" treatment regimens, such as ALu or other formulations of ACT. This study was conducted to examine community level understandings and interpretations of ALu's efficacy and side-effects. The paper specifically examines the perceived efficacy of ALu as articulated by the mothers of young children diagnosed with malaria and prescribed ALu. Methods Participant observation, six focus group discussions in two large villages, followed by interviews with a random sample of 110 mothers of children less than five years of age, who were diagnosed with malaria and prescribed ALu. Additionally, observations were conducted in two village dispensaries involving interactions between mothers/caretakers and health care providers. Results While more than two-thirds of the mothers had an overall negative disposition toward SP, 97.5% of them spoke favourably about ALu, emphasizing it's ability to help their children to rapidly recover from malaria, without undesirable side-effects. 62.5% of the mothers reported that they were spending less money dealing with malaria than previously when their child was treated with SP. 88% of the mothers had waited for 48 hours or more after the onset of fever before taking their child to the dispensary. Mothers' knowledge and reporting of ALu's dosage was, in many cases, inconsistent with the recommended dosage schedule for children. Conclusion Deployment of ALu has significantly changed community level perceptions of anti-malarial treatment. However, mothers continue to delay seeking care before accessing ALu, limiting the impact of highly subsidized rollout of the drug. Implementation of ACT-based treatment guidelines must be complemented with educational campaigns to insure that mothers seek prompt help for their children within 24 hours of the onset of fever. Improved communication between health care providers and mothers of sick children can facilitate better adherence to ALu's recommended dosage. Community level interpretations of anti-malarials are multifaceted; integrating knowledge of local beliefs and practices surrounding consumption of anti-malarials into programmatic goals can help to significantly improve malaria control interventions.Anthropology, Department ofArts, Faculty ofReviewedFacult

Soft targets or partners in health? Retail pharmacies and their role in Tanzania's malaria control program

The retail sector has been at the center of recent policy debates concerning its role in malaria control programs in Africa. This article closely examines the perspectives of owners and managers of retail pharmacies and drug shops in Dar es Salaam, toward the dominant public health discourse and practices surrounding the deployment of artemisinin-based combination therapy (ACT) as a way forward in malaria control. Drawing on fieldwork conducted between May-August 2007, and July-August 2009, involving in-depth interviews and participant observation in pharmacies and drug shops in Dar es Salaam, the article describes the social realities facing people who manage retail pharmacies, the nature of their interactions with customers, the kinds of antimalarials they sell, and their perspective on how the new malaria treatment guidelines have affected their business. Findings suggest that for most pharmacy owners and managers, it is 'business as usual' concerning the sale of conventional antimalarials, with a majority reporting that the introduction of ACT in public health facilities had not negatively affected their business. Implications of the research findings are examined in the context of proposed interventions to make pharmacy owners and managers more socially responsible and adhere to government health regulations. The article makes a case for actively involving pharmacy owners and managers in decision making processes surrounding the implementation of new treatment guidelines, and training programs that have an impact on their business, social responsibility, and community health. In considering regulatory interventions, health planners must explicitly address the concern that retail pharmacies fill an important role in the country's health care system, and that the complex nexus that drives the global pharmaceutical market often governs their operations at the local level.Tanzania Malaria New antimalarials Retail pharmacies