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Browsing Human Capital and Social Services by Author "Zanzibar AIDs Commission"
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Item National AIDS Spending Assessment (NASA)(2019-09-20) Zanzibar AIDs CommissionZanzibar consists of two main islands, Unguja and Pemba and a number of smaller islands. According to 2012 Population and Housing Census projections, by 2018 Zanzibar had a total population of 1,579,849 inhabitants (768,528 males and 811,321 females). It has an annual population growth rate of 2.8% and a population density of 400 people per square kilometre (km2). More than half of the inhabitants (53.7%) live in urban areas and the rest (46.3%) in rural areas. The large part of the population is the youth (0 - 17 years) which forms 47% of the total population.Being one of the countries that form the United Republic of Tanzania (URT), Zanzibar is committed to implement national and international responses to HIV & AIDS. While guided by the 3-ones principles, the response has been led by the Zanzibar AIDS Commission (ZAC). This is a legal entity mandated to provide strategic leadership and coordination of the national response. ZAC has developed and coordinated the implementation of the first, second and now the third National Multi-sectoral Strategic Framework (ZNSPIII) for Zanzibar that inform and guide the implementation of the national response. In addition, the health sector has been mandated to implement and oversee the health sector component of the national response through the Zanzibar Integrated HIV, Hepatitis, Tuberculosis and Leprosy Program (ZIHHTLP) which is a Department under the Ministry of Health (MoH). The national response is informed in-country by the global strategies that are guided by existing and new evidences. The united Republic of Tanzania has joined the world by committing to bold targets in the Sustainable Development Goal (SDG) of ending the AIDS epidemic by 2030. The country has adopted and is monitoring the reduction of new infection as guided by UNAIDS, in its Fast-Track commitments on HIV Combination Prevention strategy. An effective and long-term response to HIV & AIDS in any developing country must have a primary financial commitment from the national resources. As countries prioritize HIV & AIDS through increased budget allocation and development of multi-sectoral plans and work actively to involve government departments outside the health sector in the fight against HIV & AIDS, the role of budgeting and expenditure tracking to the success of these programs is of paramount importance. Thus, monitoring public expenditure for HIV & AIDS in Zanzibar is vital for several reasons: i. More than looking at policy or legislation, a country’s budget is the clearest, most reliable and telling indicator of a country’s prioritization of the epidemic. ii. The national budget is the key to sustainability of any government program and in ensuring reliable availability of human workforce iii. With the current noticeable fluctuation in availability of donor funds to many African countries [such as those from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the Presidential Emergency Plan for AIDS Relief (PEPFAR)], it is important for public and non-public structures to track these funds, as well as advocating for increased in country funds allocation. iv. With the announcement of many African countries to roll-out Anti-retroviral (ARV) programs to all HIV-positive citizens, it is necessary to monitor the funds allocated for care, treatment and support services as part of ensuring continuum of care. v. Sustainable financing of HIV & AIDS programs is a critical element in achieving the UNAIDS' 90-90-90 goals in line with national and regional policies. On understanding this, ZAC in collaboration with UNAIDS launched a study to track expenditures on HIV & AIDS related interventions starting from the source of funds to beneficiaries level with the aim of establishing whether what has been allocated to providers reached the intended beneficiaries through appropriate interventions. The study employed the National AIDS Spending Assessment (NASA) Tools and principles developed and supported by UNAIDS.Item Study of condom access and factors that influence uptake and utilization of male and female condoms in Zanzibar(2018-10) Zanzibar AIDs CommissionCondoms reduce the risk of transmitting Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs). Zanzibar AIDS Commission (ZAC) noted through the condom assessment of 2016 that although condoms acceptance and use increased in the past 10 years, availability was still limited. The strategy Zanzibar condom strategy of 2016 noted that condoms availability and distribution in Zanzibar was influenced by cultural and religious beliefs and laxity in the procurement and supply management system. ZAC therefore undertook a condom study within all the 11 districts October 2018. The overall goal of this study was to determine factors that influence the uptake and usage of male and female condoms in Zanzibar. The study sought information from community members, condom suppliers, connectors1 and influential persons with focus to determine the: extent to which male and female condoms are accessible; barriers to obtaining male or female condoms; reasons that make people use or not use condoms; community attitudes and perceptions towards condoms; and how condom accessibility might be improved. The study found that condoms are moderately accessible for community members in Zanzibar. 59% of the community members reported that condoms are easily accessible and available, while 50% reported having used a condom. Condoms were reported as more available in urban areas and easily accessed at health facilities and community outreach projects. The interviewees stated that they found it easier to use male condoms, yet many had never seen the female condoms and only 3% of the respondents reported using them. Condom brands that were reported most available in the communities were Salama, Government supplied condoms and Dume as mentioned by 37%, 35% and 10% of the community members interviewed. The Government condoms are distributed free of charge, Salama is sold at Tanzania Shillings (TZS) 500 and Dume at TZS 1,000. Barriers found to be limiting access to male and female condoms in Zanzibar included: (a) stigma faced at condom distribution outlets, whereby less than a half (47%) found the outlets very convenient; (b) unfriendliness of some service providers who violated privacy, were judgmental, refused to give out condoms, or did not understand the clients’ needs, whereby only 47% found the providers to be very friendly; (c) selling price and cost of obtaining condoms which ranged from free to TZS 6,000 for some people; (d) far distance from condom distribution outlets which led some to spend an average of TZS 500 to TZS 1,600 on transport; (e) ignorance on where to get and how to use condoms as noted by 20% of the interviewees; (f) lack of privacy where condoms are sourced; (g) and restrictive socio-cultural and religious norms as quoted by 49% of the interviewees. The study found a moderate use of condoms at the most recent sexual intercourse whereby 41% reported having used a condom on this occasion. Male and female condoms were used by 92% and 3% of the respondents respectively. The following proportion of those who used condoms at last sex reported various reasons for their usage: 56% to prevent STI; 38% to prevent unplanned pregnancies; 19% to prevent HIV re-infection; 10% to protect partner from infections; 10% to prevent HIV infection; and 6% to protect self from a partner who was not trusted. Likewise, the following proportion of those who did not use condoms at last sex reported the following reasons for non-usage: 46% due to trusting their sex partners; 24% because they or their partners did not like condom; 6% due to not having condoms; 5% for fearing perceived side effects2 of using condoms; 5% for not having tested for disease; and 3% in order to comply with religious restrictions for not using condoms. Other reasons reported by community members for non-use of condoms included: wanting to conceive children; fearing rejection or Gender Based Violence (GBV) from a sex partner who dislikes condoms; not having money for obtaining condoms; and fear of damaging their image or reputation due to the stigma associated with using condoms. 79% felt that it is challenging to use the female condom as compared male condoms. The study found a mix of both positive and supportive attitudes, as well as negative attitudes towards condoms among community members and other stakeholders interviewed. Most of the influential persons within the Government Ministries, Departments and Agencies (MDAs) and Development Partners held the notion that condoms play a critical function to prevent infection with diseases and unplanned pregnancies, therefore condom use should be promoted. The same position was held by health workers, pharmacists and connectors. Community members who also mirrored this notion specified the critical role of condoms to: prevent unplanned pregnancies, STIs, HIV, and HIV re-infection. Some also mentioned maintaining hygiene during sex and enhancing the freedom to enjoy sex without worrying about infections. Some of the religious leaders and a few community members did not embrace the use of condoms. The faith leaders mostly took the position of: promoting abstinence and faithfulness; forbidding condom use; allowing condom use only for HIV discordant couples; accepting condoms for Family Planning (FP) among married couples; and/or leaving condom use as a personal decision for individuals. The community members who did not support the promotion of condom use in Zanzibar stated that condoms: reduce the enjoyment and satisfaction of sex; have various negative side-effects; tend to burst during sex and thereby cause unplanned pregnancies and the spread of disease; promote promiscuity; and deny people the right to have children. Stakeholders who were interviewed made the following recommendations for improving access to and utilization of condoms: establish more condom distribution outlets, especially in the under-served remote and/or rural areas; distribute condoms in more diversified outlets like recreation places, hotels, learning institutions and other places; enhance client privacy and confidentiality at places where condoms are being distributed; undertake Information Education and Communication (IEC) for community members on benefits of, how to use and where to obtain condoms; implement Social and Behavior Change (SBCC) to increase uptake and utilization of condoms by community members; identify and deploy more connectors to distribute condoms and provide information among various community groups; engage all stakeholders in providing information and making decisions related to condom programming; increase friendliness of service providers; provide guidelines for condom programming; reduce price and cost of obtaining condoms; undertake quality assurance to make sure condoms don’t burst or have negative effects; compel written and drawn instructions for usage and disposal on the condom packaging; and control ages of persons whom condoms can be sold to.