AIDS Alert International

Region shows how an effective program works

Mbeya region has declining trend of HIV

While Tanzania as a nation has had no evidence of a decline in HIV prevalence, the Mbeya region has seen the prevalence among 15- to 24-year-old women decline from 20.5% in 1994-1995 to 14.6% in 2000.1

UNAIDS officials cite the Mbeya region as a good example of what can be accomplished if the right combination of funding, infrastructure-building, and effective prevention interventions are initiated.

Sustained effort shows success

Although Tanzania is a relatively poor country, a sustained, intensive effort at changing behavior — with a focus on young women — has been under way for 13 years and has resulted in a decline of 25% among 15- to 24-year-old women in that region, says Desmond Johns, MD, director of the UNAIDS New York office in New York City.

"This is where prevention messages are working and new infections are decreasing," he says.

"In a neighboring area in the same country, where there’s not the same focus on prevention, the prevalence in this age group went up, so it’s proof that prevention works, and it has to be done with intensity and at a scale where it makes a difference," Johns notes.

The Mbeya region’s 14.6% HIV prevalence may be high by the standards of industrialized nations, but the Mbeya statistics show what could happen among young women with intense prevention efforts in place.

For instance, a neighboring region called Rukwa had only sporadic prevention interventions over the years; and in this region, the HIV prevalence among women, ages 15-24, rose from 22.5% in 1994 to 30.2% in 1999.1

Tanzania’s AIDS epidemic dates back to 1983, and it spread continuously throughout the region, making it one of the earliest epidemics. The Mbeya region was one of the hardest hit areas; and since 1999, AIDS was the main cause of death among Tanzanian adults, ages 15 to 59 years.2

Germany to the rescue

But what has helped the Mbeya region is that the German government, in September 1988, helped the Ministry of Health implement a Regional AIDS Control Programme in Mbeya.

The collaboration focused on establishing a reliable HIV reference laboratory, ensuring the safety of transfused blood, establishing a surveillance system, and initiating prevention educational activities.2

As the HIV prevention work in the Mbeya region matured, the collaboration also initiated efforts to reduce the stigma and discrimination attached to HIV/AIDS, provided advocacy for HIV prevention and care policies among political leaders, and coordinated with other private and public organizations.2

The program’s main interventions include a behavioral change program that uses peer education in primary schools and work places. Peer education also is used with sex workers and their clients, and there is a theater for performances that provide HIV prevention education.3

The Regional AIDS Control Programme also promotes condom use and has used social marketing of condoms in urban and rural areas.

Health care workers in all health facilities are trained in HIV prevention and offer case management for sexually transmitted diseases, including providing routine screening and treatment of pregnant women and their partners for syphilis.3

A legal-assistance element

Another program that appears to work very well in Tanzania is providing legal assistance to women and widows, as well as to orphans, says Peter Piot, MD, executive director of UNAIDS of Geneva. Piot spoke in preparation of World AIDS Day on Dec. 1, 2004, addressing the current state of the world’s AIDS epidemic.

"We’re talking about $50 to $100 a year, very small amounts of money, but these amounts of money make it possible for women to have some food, shelter, and make sure that they can feed their kids and send them to school," he points out.

"And that provides them an environment where ABC prevention [Abstinence, Be Faithful, Use Condoms] can work, where treatment programs can have a chance to have some impact because there is no way you can introduce antiretrovirals in environments and communities where everybody is hungry and where we have this devastation that we’re seeing," Piot adds.

References

1. UNAIDS/World Health Organization. AIDS Epidemic Update: December 2004. Annual report released Dec. 1, 2004; 1-30.

2. Deutsche Gesellschaft Fur Technische Zusanmenarbeit (GTZ) GmbH. Reason for Hope: AIDS Control and Prevention in Mbeya, Tanzania. 2002; 1-12.

3. Jordan-Harder B, Maboko L, Mmbando D, et al. Thirteen years HIV-1 sentinel surveillance and indicators for behavioural change suggest impact of programme activities in southwest Tanzania. AIDS 2004; 18,287-18,294.