THE HISTORY OF HIV AND AIDS IN TANZANIA

The first cases of AIDS were reported in the Kagera region in 1983 and by 1987 every region in the country had reported AIDS cases. In 1985, the government set up the NACP (National AIDS Control Programme) to coordinate the response and established AIDS coordinators in each district in the country.In order to confront the growing epidemic, the NACP developed a medium term plan for the period 1987-1991 which was then followed by two more medium term plans covering 1992-1996 and 1998-2002. These plans had three main aims: the decentralisation of the health sector response, reducing HIV transmission and relieving the social consequences of HIV/AIDS through care and assistance.

However, according to Tanzania’s first National Multisectoral Framework (2003-2007) the three medium term plans did not halt the spread of HIV. By the time the third medium term plan came into being HIV prevalence had reached 8 percent.⁶ It is important to bear in mind however that, at this time, Tanzania had no coordinated monitoring and evaluation system, and systems for collecting data on HIV prevalence varied widely from region to region. Therefore, frequent delays in reporting as well as general underreporting suggest that the HIV prevalence could have been much higher.A national policy, which had been under development since 1991, was finalised in 2001, following the declaration of 'war' on HIV/AIDS by former president Mkapa.

The Tanzania Commission for AIDS (TACAIDS) was then established in 2002 to coordinate the multisectoral response, bringing together all stakeholders including government, business and civil society to provide strategic guidance to HIV/AIDS programmes, projects and interventions.⁸ In 2003, TACAIDS launched the first National Multisectoral Framework (NMSF) 2003-2007, which outlined all areas of focus for stakeholders including cross cutting themes like stigma and discrimination, as well as prevention, care and support and dealing with the socio-economic consequences of HIV and AIDS. Under each broad theme, certain strategic areas were identified (such as school based prevention or blood safety) and goals, challenges, targets and indicators of success were specified.Tanzania’s second National Strategic Framework (2008-2012) analyses the achievements and challenges faced in the implementation of the first NMSF, as well as identifying new targets and indicators of success.¹⁰

The current situation in Tanzania

A study published in 2005, using evidence drawn from Kenya and Tanzania exposed some findings which challenged some widely held assumptions about the effects of HIV and AIDS. The study found that generally the highest prevalence of HIV was found amongst the wealthiest households, particularly affecting wealthy women, as opposed to poorer and rural households.Since the study, academics have suggested various reasons for this phenomenon: wealthier people tend to have the resources which lead to greater and more frequent mobility and expose them to wider sexual networks, encouraging multiple and concurrent relationships. They also tend to have greater access to HIV medications that prolong their lives and are more likely to live in urban areas, which have the highest prevalence.

However, the HIV prevalence gap between wealthier urban groups and poorer rural communities is slowly closing.¹³ A 2008 study found that knowledge of sexually transmitted infections was ‘alarmingly low’ in rural Tanzania and associated with low condom use and HIV infection.¹⁴ Reduced prevalence has mainly been noted among the most educated (those who attended secondary school) while among those with no formal education, prevalence has not decreased and the number of new infections has risen.¹⁵ Because access to health care and knowledge of HIV and AIDS is typically lower in rural areas, prevention efforts must be increased if new infections are going to be reduced.