Health and Social Welfare

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    Assessment on Knowledge, Attitude and Practice (KAP) on Adolescents (10 -15 YEARS) in Zanzibar
    (2017) Zanzibar AIDS Commission
    This assessment of the knowledge, attitude and practice related to HIV/SRH among adolescents aged 10 to 15 in Zanzibar has been carried out in May, 2016 with the aim of determining baseline information that will enable monitoring and evaluation of progress regarding behavior change among these adolescents. Specifically, the survey sought to assess awareness, understanding, and misconceptions about HIV/AIDS and SRH; along with the understanding of prevention of new HIV infections and risk behaviors. The assessment was conducted both in Unguja and Pemba in five districts which covered 31 Shehias and 26 schools. The exercise involved 477 respondents of which 235 (49.3%) females and 242 (50.7%) males, and accounts for about 95.4% coverage out of the target sample size of 500 respondents. The adolescents assessed included in and out of school. Regarding the adolescents’ attendance to school and those who are out of schools, the assessment findings showed that 93% of all 477 assessed youngsters are attending school and only 7.1% were found to be out of school. Youth who attend both schools and Madrassas were found that 81% of them are attending madrassa with females being more likely to attend compared to their male counterparts. Females attending Madrassas are leading by 86.4% against males who account for 77%. A special focus was given to whether the assessed youngsters are living with their born parents or guardians. With regard to this interest, the assessment revealed that 58.7% are living with their biological parents (fathers and mothers) and over one third (36.1%) are living with single parent (mother). Youth living with people other than their biological parents accounts for only 5%. Marital status for this age group was initially seemed to be not applicable but later it was not overlooked. Findings from the assessment showed the presence of about 12% of the assessed adolescents in marital bond, portraying evidence of early marriage practices. Distressingly, five youths (4 females and 1 male) which accounts for 1% reported to live together with sexual partners outside marital bond. Findings from this assessment indicate that there is high awareness related to HIV/AIDS with low awareness of Sexual Reproductive Health (SRH) in the assessed areas. The reason for this big difference in awareness between HIV/AIDS and SRH was not explored in this assessment was because it was beyond the understanding of the target group and was not known before. The main source of information for those who have heard HIV/AIDS was TV and radio which together accounts for 76.7%, while all other sources (schools/Madrassas, magazine, books and journals) accounting for only 32.3%. Another focus of this assessment was to measure what adolescents 10-15 know about HIV/AIDS and SRH while most of attitudes and practices appeared to be crosscutting between the two areas. Other findings which are rather astonishing, is the presence of early sexual practices among this group of adolescents from the lowest age of 10 years accounting for 12% of respondents of this age. Apart from those of age 10, all other ages from 11-15 years are practicing sex, which negates the inherent culture of Zanzibar, where youth start engaging in sex 11 only during marriages. These sexual practices reported to be done with limited of use condoms indicating that they are done unprotected, exposing this naïve group to the risk of HIV and other sexually transmitted infections and early pregnancies. Findings further disclosed the prevalence of early marriages among the adolescents who are in and out of schools and the underlying reasons for this include, among others, limited role on the part of imparting knowledge on HIV/ AIDS and SRH to this age group. This responsibility which was supposed to be done by parents/guardians was found to be not adequately done, despite the fact that majority of adolescents are living with their biological parents. Civil Society Organizations (CSOs) found to have inadequately played their part in educating adolescents on HIV/ AIDS and SRH. This calls for HIV/ AIDS and SRH actors/players to strengthen the existing initiatives and synergy to address this target group. A need to devise alternative approaches that will focus this age group and streamline the support for prevention against the spread and subsequent response to HIV/AIDS among adolescents deem necessary. About knowledge on how HIV is transmitted, the results of this assessment further indicate that 56.6% of the adolescents interviewed are aware of the ways in which HIV virus is transmitted. For instance, 56.6% of the respondents agreed that HIV is infected through sexual intercourse; blood contacts were 55.4%; mother to child transmission 59.7% and risk behaviors 60%. The level of knowledge, attitudes and practices explored within this age group, are among the valuable inputs to guide the government in undertaking necessary interventions focusing this target group. Either, findings from this assessment will be appropriate to support government efforts to respond to HIV/AIDS and SRH for this adolescent group in the society. In addition, the findings indicate positive and negative responses with regards to issues of HIV/AIDS and SRH. Despite the fact that a good number of respondents found to be aware and have right information regarding the two assessed areas, there are considerable responses which express either ignorance or uncertainty. The situation explained in this report warrants for creating special awareness programs that target the adolescents of this age group. Based on these assessment results, the assessment team therefore recommend to HIV/AIDS and SHR players to develop appropriate awareness and training programs; incorporate HIV/ AIDS and SRH in school curriculum; improve role of parents and NGOs in educating and disseminating HIV/AIDS and SRH information to adolescents and develop a monitoring and evaluation mechanism for its sustainability
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    National AIDS Spending Assessment (NASA)
    (2019-09-20) Zanzibar AIDS Commission
    Zanzibar 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.
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    National HIV and AIDS Policy
    (2012-08) First Vice President’s Office
    The Revolutionary Government of Zanzibar with support from HIV response partners has collectively initiated and implemented interventions towards averting the impact of the HIV and AIDS scourge which has remained a social, economic, and political concern nationally. This has been made possible by the guidance from the broad framework as laid out by the 2004 National HIV and AIDS policy. It has been possible to stabilize the HIV prevalence in the general population to below 1 percent through these efforts. However, new evidence has uncovered the high HIV prevalence rates amongst the key populations that are way above that of the general population. This is the highest risk that Zanzibar is facing as there is a higher chance that due to the high-risk behavior of the key populations, the transmission of HIV will affect the general population. These calls for new and concerted efforts in the national HIV response necessitate a new policy framework vide the 2012 National HIV and AIDS Policy. Globally it has been observed that investments towards HIV and AIDS have reduced significantly. In this response, countries have been called upon to adopt a strategic approach to investments. This calls for enhanced political leadership to leverage economic development while at the same time marshal internal resources to prioritize and implement the most effective HIV and AIDS programmatic interventions. This policy takes cognizance of these observations and reiterates the government’s commitment to the fight against HIV and AIDS in Zanzibar. The process of formulating this policy was a culmination of profound efforts invested through the leadership of the Zanzibar AIDS Commission (ZAC) with meaningful participation of Development Partners, HIV response implementing partners and the Zanzibari community. The stakeholders who participated in this process came from all sectors and representing a wide range of organisations. It is my conviction that with the level of participation exemplified in this process, all stakeholders shall individually and collectively assume their roles in ensuring the successful implementation of this policy to make Zanzibar free from new HIV infections, free from discrimination and free from AIDS related death.
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    Study of condom access and factors that influence uptake and utilization of male and female condoms in Zanzibar
    (2018-10) Zanzibar AIDs Commission
    Condoms 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.